Vascular Access by Specialists - Pediatrics
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Vascular Access by Specialists
Tricia M. Kleidon, RN, MNursPrac,a,b Darcy Doellman, MSN, RN, CRNI, VA-BCTM,c Stephanie Pitts, MSN, RN, CPN, VA-BCTM,d,e
Marc Stranz, PharmDf,g
Achieving reliable vascular access (VA) facilities attempt to achieve this by radiologist) if a more permanent device
for children devoid of pain, anxiety, and publishing local VA decision trees. is required. In the United States,
complication is the goal of pediatric VA Unfortunately, these are often generic, pediatric vascular access teams have
specialists. VA prevails across various lack an evidence base, and do not evolved in many tertiary hospitals, to
settings, both inpatient and outpatient. provide direction for nonstandard include VAD insertion, complication
In addition, VA spans acute and chronic VA needs. management, data collection, and
medical requirements, ranging from the education.2 The use of technology
seemingly simple, one-time infusion to (ultrasound and tip location) has been
WHY MINIMAGIC MATTERS FOR VA a driving force in improving device
the complex, prolonged treatments SPECIALISTS
requiring multiple, frequent infusions outcomes and the patient and family
Globally, the realization of VA as experience. Ambiguity still exists
and sometimes a lifelong dependency.
a specialty is variable. Even within the surrounding the selection of the most
Regardless of the motive, selection of
same country, the scope and appropriate device.
a vascular access device (VAD) should
recognition of VA specialists differ.1 In
be driven by the individual’s treatment In part, the lack of consistent device
Australia, pediatric VA as a specialty is
(medication properties and treatment terminology may be responsible for this
in its infancy with few, poorly
duration and frequency) and uncertainty.3
resourced VA teams. This health service
pathophysiology (age, acute model relies heavily on medical
and/or chronic disease, existing vessel practitioners to choose the most KEY RECOMMENDATIONS
health, diagnosis, and individual risk appropriate device, undertake the
factors) with the primary aim of insertion if it is a “simple” peripheral Incompatible Infusates
avoiding patient harm. At the heart of intravenous catheter insertion, or refer Choice of a central or peripheral
achieving this is choosing the right VAD to the appropriate medical practitioner catheter is more complex than length of
from the beginning. Most health care (anesthetist, surgeon, or interventional treatment, although this is how VAD
a
Queensland Children’s Hospital, South Brisbane, Australia; bAlliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, Australia;
c
Cincinnati Children’s Hospital Medical Hospital, Cincinnati, Ohio; dB. Braun Medical, Bethlehem, Pennsylvania; eBayCare, St Joseph’s Hospital, Tampa, Florida; fStranz Crossley Inc, Cincinnati,
Ohio; and gBioMatrix Specialty Pharmacy, Columbia, Maryland
Ms Kleidon, Ms Doellman, Ms Pitts, and Mr Stranz conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript;
and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
DOI: https://doi.org/10.1542/peds.2019-3474J
Address correspondence to Tricia M. Kleidon, RN, MNursPrac, Department of Anaesthesia and Pain Management, Queensland Children’s Hospital, Children’s Health
Queensland, 501 Stanley Street, South Brisbane, QLD 4101, Australia. E-mail: tricia.kleidon@health.qld.gov.au
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2020 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: Ms Kleidon reports grants from the National Health and Medical Research Council, employment by Griffith University, grants from the
Children’s Hospital Foundation and Emergency Medicine Foundation, and investigator-initiated research grants and speaker fees provided to Griffith University from
3M Medical, AngioDynamics, Becton Dickinson, and Medical Specialties Australasia (unrelated to the current project). Ms Doellman is on the speaker’s bureau of
Genentech and Lineus Medical and is a consultant for Teleflex Medical; the other authors have indicated they have no financial relationships relevant to this article to
disclose.
FUNDING: Supported by grants from the Association for Vascular Access Foundation, Griffith University, and the University of Michigan.
POTENTIAL CONFLICTS OF INTEREST: Ms Kleidon reports investigator-initiated research grants and speaker fees provided to Griffith University from 3M Medical,
AngioDynamics, Baxter International, Becton Dickinson Bard, Centurion, Cook Medical, Medical Specialties Australasia, and Vygon (unrelated to the current project).
Ms Pitts reports employment by B. Braun Medical and St Joseph’s Children’s Hospital in Tampa, previous employment and stockholder status with AngioDynamics,
and board membership at Navi Medical Technologies; the other authors have indicated they have no potential conflicts of interest to disclose.
Downloaded from www.aappublications.org/news by guest on November 2, 2021
PEDIATRICS Volume 145, number s3, June 2020:e20193474J SUPPLEMENT ARTICLEchoices are often made. Additionally, TABLE 1 Key Points for VA Specialists
the use of multilumen catheters to Key Points
avoid drug-drug incompatibilities is Interdisciplinary collaboration is imperative to ensure due consideration of thorough patient
often the default rather than assessment, insertion factors, and future VA needs.
consultation with interdisciplinary The combination of the miniMAGIC device selection and knowledge of nonperipherally compatible
health care professionals who can infusates can prevent drug-induced phlebitis.
provide knowledge surrounding the Opportunities to advance pediatric VA are evident in the areas of uncertainty or disagreement and
represent variance in practice and gaps in the literature.
judicious use of multilumen catheters. Integration of miniMAGIC into the electronic ordering system may support guidance on the appropriate
Use of Michigan Appropriateness devices at the time of order entry.
Guide for Intravenous Catheters in
pediatrics (miniMAGIC) to guide
consultation with a conversant catheters. This order set allowed for basis of infusion properties, patient
specialist is appropriate, and it is real-time clinical monitoring and characteristics, length of treatment,
recommended that skilled provider feedback.5 For clinicians and current vessel health. In health
pharmacists participate in decisions seeking to integrate miniMAGIC into services where pediatric VA
about incompatibility. pediatric practice, the use of digital specialists are recognized, miniMAGIC
integration into the electronic will guide all interdisciplinary
Non-VA specialists often do not
health system may improve device planning conversations.
understand the nuances of various
compliance with appropriate device miniMAGIC provides the most
VADs, for example, the difference
selection. comprehensive and realistic
between a peripheral intravenous
opportunity to guide device selection
catheter and a midline, assuming they Future Research Implications to reduce unnecessary insertion
recognize a midline to be a peripheral
There are many evidence gaps in the attempts and complications during
device. Although the definition of
literature specific to pediatric VA and treatment. These recommendations
nonperipherally compatible infusates
device selection. These voids become do not necessarily reflect the policy
is unsettled, the fact remains that
more evident in miniMAGIC, of the American Academy of
certain drugs can damage the
specifically where there are areas of Pediatrics.
vascular endothelium.4 Use of the
“uncertainty.” Of the total 1234
general categories (peripherally
scenarios reviewed by the panelists in ACKNOWLEDGMENTS
compatible and nonperipherally
the second round, the panel We acknowledge the facilitators
compatible) intentionally avoids
concluded with 137 uncertain of miniMAGIC, Drs Amanda Ullman,
assignment of individual drug
scenarios (18.2%) and disagreed on Steven Bernstein, and Vineet
risk. The selection of a VAD for
18 clinical scenarios (2.4%). These Chopra, whose efforts to
nonperipherally compatible drug
areas of uncertainty represent explain the methodology and
infusates is based on current best
practice variance and may help moderate the discussion made the
practices and will be modified as the
identify opportunities for further development of this guide possible
exact interplay between drugs and
research for VA clinicians. On the and enjoyable.
catheter type becomes available
basis of ratings of uncertainty and/or
(Table 1).
a lack of appropriate options, areas of
consideration for future research ABBREVIATIONS
Electronic Medical Records
and/or product development by VA
Although the content provided miniMAGIC: Michigan
specialists include midline use, device
in miniMAGIC provides a Appropriateness
options for patients requiring
comprehensive resource for device Guide for Intravenous
frequent blood draws, device
selection, many health care providers Catheters in
selection for children with congenital
and leaders must seek realistic pediatrics
heart conditions, and site selection by
solutions for integration into practice. VA: vascular access
age and device.
With the implementation and VAD: vascular access device
advancement of the adult Michigan
Appropriateness Guide for PRACTICE CHANGE
Intravenous Catheters, the research The implementation of miniMAGIC REFERENCES
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3. Schults JA, Rickard CM, Kleidon T, Infusion Nurses Society Vesicant Task single-lumen peripherally inserted
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PEDIATRICS Volume 145, number s3, June 2020 S287Vascular Access by Specialists
Tricia M. Kleidon, Darcy Doellman, Stephanie Pitts and Marc Stranz
Pediatrics 2020;145;S285
DOI: 10.1542/peds.2019-3474J
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/145/Supplement_3/S285
References This article cites 5 articles, 0 of which you can access for free at:
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Downloaded from www.aappublications.org/news by guest on November 2, 2021Vascular Access by Specialists
Tricia M. Kleidon, Darcy Doellman, Stephanie Pitts and Marc Stranz
Pediatrics 2020;145;S285
DOI: 10.1542/peds.2019-3474J
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/145/Supplement_3/S285
Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. Pediatrics is owned, published, and trademarked by
the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2020
by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.
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