Vascular Access Decision Tree

How you can help:

  1. Forward vascular access decision trees used at your hospital
  2. Review the prototype decision tree here and provide feedback

After sufficient feedback we will trial our vascular access decision tree.

Our aim is to create a vascular access decision tree that will be used at all hospitals.

The ultrasound image of the patient’s right internal jugular indicates significant stenosis of the vessel so you proceed to successfully insert the Vas Cath on the patient’s left side.  The patient complains of feeling unwell as you wheel them to recovery.  Your suspicions of cardiac tamponade turn out to be true and despite appropriate resuscitative attempts the patient dies….

Interventional Radiologists performing left sided Vas Caths have expressed their concerns as they view the Vas Cath hitting the wall of the superior vena cava as it exits the innominate vein.
It would be prudent that left sided Vas Caths be inserted under fluoroscopic guidance.  How do we introduce this nuance into a simple vascular access decision tree.

 

Several decision trees exist indicating which vascular access device should be requested for a particular situation. Many appear to underestimate the morbidity and mortality attributed to central lines, as a result patients may die from central line complications when a central line is not required. Existing decision trees overlook ‘stepping down’ with the invasiveness of requested line – e.g. if a PICC line cannot be inserted serial peripheral cannulation may be more appropriate than a central line.

One centralised decision tree should be used that staff are familiar with across many hospitals. It should be adaptable for use at particular institutions depending on the skills and facilities present.

We welcome any input into this project.

The decision tree needs to be simple and readily accessible across all healthcare facilities.

Please find examples of vascular access decision trees from different institutions.

The NSW Guideline for the Peripheral Intravenous Cannula (PIVC) Insertion and Post Insertion Care in Adult Patients states:

A PIVC may be retained beyond 72 hours, if there are no signs of inflammation and:

  • Replacement is likely to be difficult and the risk is judged to be greater than retention.
  • The PIVC is likely to be needed for only another 24 hours or less.