PC168. Implementation of a Centralized Vascular Access Service Team for Tunneled Catheter Placement in a Large Academic Medical Center

Abstract

Tunneled catheters (TCs) with and without subcutaneous ports are needed in patients who require prolonged vascular access. Delays in the placement of TCs can lead to increased lengths of stay, which result in higher hospital costs. To increase placement of appropriate catheter type and to decrease wait times, a centralized Vascular Access Service Team (VAST) was implemented at a large academic medical center. The objective of this review was to examine the efficiency of VAST. VAST is composed of physicians from multiple departments in the hospital (vascular surgery, interventional radiology, critical care, nephrology, interventional cardiology, and surgical oncology), nurses with advanced knowledge of intravenous access techniques, and coordinators from the operating room. A centralized consultation service was created whereby each patient undergoes a uniform evaluation for appropriate vascular access. A retrospective review of prospectively collected data was performed for all patients undergoing TC placement from January 2018 to December 2018. Overall, 413 TCs were placed by VAST in 413 patients: 59 subcutaneous ports, 140 Hickman catheters, and 214 TCs for hemodialysis. Indications for TC placement included chemotherapy, hemodialysis, parenteral nutrition, and long-term intravenous antibiotics. Of the 413 patients, 397 (96%) underwent a TC placement within 2 business days of the initial consultation, and 262 (63.4%) patients underwent a TC placement within 1 business day. Median wait time for placement was 31.0 hours, and the mean wait time was 36.7 hours. Of the remaining 16 patients, reasons for delayed placement included refusal of initial procedure (n = 1), preplanning for a different date of procedure (n = 6), patient not medically optimized (n = 4), and patient eating before the procedure (n = 5). In two instances, a consultation for a TC for hemodialysis was re-evaluated for implantation of a subcutaneous port. A centralized VAST is effective in expediting TC placements, evaluating patients for the appropriate catheter type, and improving hospital throughput.