Consider vein preservation when planning intravenous therapy

What is “vein preservation”? Most Google searches for “vein preservation” will return results that include patients with chronic kidney disease (CKD) and the position of vascular access devices. However, because the population ages and the variety of younger, sicker patients within the hospital increases, the term “vein preservation” ought to be encompassing and applied to all acutely unwell patients. Simply put, vein preservation is a conscious effort to preserve (or not use) vessels for potential future use. For example, patients with advanced CKD or end-stage renal disease (ESRD) who’re currently receiving hemodialysis or could also be receiving dialysis in the long run shouldn’t have peripherally inserted central catheters (PICCs) placed of their upper arms (unless the patient’s nephrologist approves) with the intention to preserve the vessels of their arms for future arteriovenous (AV) fistulas or graft sites. Another population group that usually has advanced vascular access planning is cancer patients who will likely be receiving intravenous chemotherapy. Once a treatment regimen has been established, chosen cancer patients are referred to a general surgeon for placement of a subcutaneous port.

Include vein protection in your care plan

How can we incorporate vein preservation into the care plan for the remaining of our patients? We should start by each patient individually and considering among the following conditions and comorbidities within the patient’s medical and surgical history that will impact decisions about vascular access:

• Cancer
• Deep vein thrombosis (DVT), pulmonary embolism (PE), coagulopathies
• chronic kidney disease, end-stage renal failure
• Intravenous drug abuse
• Cuts
• Scar tissue
• Equipment after injury or fracture
• Hemiparesis
• Contractures
• Infections of the upper limbs or chest wall (cellulitis, joint infections)
• Theft Syndrome or Superior Vena Cava Syndrome
• History of failed PICC or central line insertions

Next, we should always determine appropriate access to the prescribed therapy. Interdisciplinary communication is crucial to developing a care plan for the patient’s IV therapy. For example, should we consider something greater than a peripheral IV line if the patient has poor peripheral access and the plan is to start out long-term IV antibiotics or chemotherapy; or does the patient only have one or two days of IV therapy to finish treatment and a brief peripheral line is most appropriate?

Communication is essential

Communication is essential to preserving our patients’ blood vessels in order that we are able to proceed to supply care throughout their lives. Just as algorithms are created for antibiotic stewardship, algorithms also needs to be considered for access management.