Highlights Our project implementing a VAST produced these improved outcomes. There were 31% fewer IV devices. There were 22% fewer needle sticks. There were 49% reduction in delays. Abstract Background: Vascular access is essential in the care of hospitalized pediatric patients. Planning and device selection are important for optimal patient outcomes. Vessel preservation is critical for pediatric patients. Purpose: To determine and evaluate the impact of a vascular access team on pediatric patient care. Methods: A vascular access specialist team (VAST) was implemented on one medical unit at a tertiary children’s hospital, 16 hours a day for 4 weeks. Data Analysis: Descriptive statistics were used, including (a) first-stick success rates, (b) number of needle sticks and vascular access devices per hospital stay, (c) delays in therapy, and (d) frequency of topical analgesic use. Preintervention data were compared with postintervention data. Qualitatively, nursing and medical staff were surveyed to evaluate their perception of project experiences. Results: Compared with preintervention data, 56% fewer peripheral intravenous lines were initiated, and 31% fewer total vascular access devices were used during the hospital stay. There were 22% fewer needle sticks per peripheral intravenous line attempt. The first-stick success rate of the VAST was 71% compared with the bedside nurse rate of 52%. There was a 78% reduction in time between devices/1000 patient-days/week, representing reduced interruptions in therapy. The use of topical anesthetics for intravenous device placement increased 333%. Conclusion: This project provided clarity regarding the value of the VAST for pediatric hospitalized patients. The VAST model is evidence based, follows best-practice guidelines, is fiscally sound, and optimizes nursing practice and quality patient care.

Abstract Aim: This study aimed to investigate the impact of Gebauer’s Pain Ease® (Gebauer Company, Cleveland, OH) topical refrigerant spray on the disinfection of skin sites, focusing on the volar wrist and lower back. The primary objective was to determine whether the application of Pain Ease would compromise the disinfection of these sites, potentially making it a suitable alternative to injectable lidocaine for invasive medical procedures. Methods: This prospective, blinded, controlled study was conducted at Henry Ford Hospital in Detroit, MI. Healthy adult hospital employees were recruited, and written consent was obtained. Swabs were taken from the volar wrist and lower back sites before and after treatment with ChloraPrep™ (BD, Franklin Lakes, NJ) and Pain Ease. Microbial cultures were performed, and microbial growth levels were assessed and categorized. Data analysis included comparisons of microbial growth between untreated samples, ChloraPrep-treated samples, and ChloraPrep + Pain Ease-treated samples. Results: Data were collected from 72 participants, with 6 samples per participant (2 locations, 3 treatments each). For wrist samples, there were no statistically significant differences in microbial growth between ChloraPrep and ChloraPrep + Pain Ease. Similarly, for lower-back samples, microbial growth did not significantly differ between these 2 treatment groups. Conclusions: This study demonstrates that the application of Gebauer’s Pain Ease to ChloraPrep disinfected skin areas does not negatively affect the reduction of the bacterial load, supporting its potential as an alternative to injectable lidocaine and other superficial anesthetics for vascular access or invasive medical procedures. However, further research is warranted to explore the application of Pain Ease in various clinical scenarios and optimize patient comfort during longer and more invasive procedures.

Highlights Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change. Abstract Background: Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (i.e., peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically. Design and Methods: The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24,134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change. Aims and Objectives: The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2. Results: From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions. Conclusions: While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures.

Highlights The rate of IDU among those who received a VAD placement was 3%. The VAD + IDU patients had 1.8 times longer mean LOS than VAD-only cohorts. The VAD + IDU cohort had 1.9 times higher mean inpatient cost than VAD-only cohorts. PPCRI increased in VAD + IDU cohort during pandemic.

Highlights Abstract Aim: Central line-associated bloodstream infections (CLABSIs) result in significant morbidity but are largely preventable. Methods to reduce hospital-acquired CLABSIs are well described, but few recommendations exist for how these practices might translate to patients with central lines in the ambulatory setting. This team sought to reduce the mean monthly community-acquired CLABSI rate by 25% from 11.7 to 8.8 per 1000 community line-days in children with intestinal failure who require home parenteral nutrition within 12 months. Methods: First, an interprofessional quality improvement team was formed. After baseline data collection, plan-do-study-act cycles began. Tests of change consisted of a central venous catheter (CVC) maintenance bundle. This bundle included a CVC care tote with additional supplies, improved educational materials, and ethanol lock prophylaxis. A control chart was used to display the monthly community-acquired CLABSI rate and observe for special cause variation. Results: At baseline, the average monthly community-acquired CLABSI rate was 11.7 per 1000 community catheter-days. The home CVC maintenance bundle was implemented, after which there were 5 consecutive months with no infections. After enhancements to the care bundle and tote, special cause variation was noted, and the average monthly community-acquired CLABSI rate declined by 66% to 4 per 1000 community catheter-days. Special cause variation was noted at 2 other time points without an identifiable cause. Conclusion: A lower community-acquired CLABSI rate has been sustained for 24 months and reflects approximately 12 fewer infections per year in this at-risk population.

Highlights Abstract Aim: Acceptability, usability, and overall ease of use of a safety engineered peripherally inserted intravenous catheter with blood control septum (PIVCBC) were evaluated among clinicians who frequently use peripherally inserted intravenous catheters (PIVCs). This study was conducted in healthy subjects at a Phase 1 facility. Methods: Participating clinicians were ≥18 years of age, employed in a clinical setting, and performed ≥3 PIVC insertions per week. Each clinician completed 6 PIVCBC procedures on 2 to 4 healthy human subjects. Multiple trained observers documented how many attempts it took for the clinician to get a successful stick and what vein was selected for the procedure. Clinicians responded to yes/no questions and to Likert scale statements, describing their experiences with the PIVCBC after the procedures. Video recordings were used to observe procedures. Questionnaire data was summarized by frequency and percent of responses; analyses were conducted using binomial statistics. Results: Clinician agreement ranged from 83% to 97% for: able to observe primary and secondary flashbacks, able to use their regular PIVC insertion technique, found the catheter easy to insert, able to easily remove the needle from the catheter hub, believed the catheter would protect them from blood exposure during insertion, and able to flush the catheter. Overall, 96.7% of the clinicians found the PIVCBC to be acceptable. Conclusions: Overall, the PIVCBC was acceptable, easy to use, and allowed clinicians to maintain their usual PIVC insertion technique while they felt protected from blood exposure during insertion of the catheter.