Nurses and most of the general public know that Florence Nightingale is known as the Lady with the Lamp. But did you realize that she could also be called the Lady with the Pie Chart? She was known for her mathematical genius and use of statistics. She transformed those numbers from boring, meaningless tables to colorful diagrams and was able to demonstrate that more British soldiers were dying from disease than battlefield wounds. Click here to see some of her work. While we celebrate her work and her birthday on May 12, we can still learn from her example. Notice that she is collecting and using her own internal data. She did not use data from the American Revolution or the War of 1812, but data from the hospital in Scutari during the Crimean War. Can you just image the backlash from those British army generals if she has used data from other wars? I can hear comments like a different war, a different climate, different continent, different types of guns, etc. Translate this to your current situation and it is really not that much different. Data from your facility on infusion-related outcomes such as complication rates, productivity and workload, and medication errors will be stronger than data from outside. Data from published studies are beneficial for benchmarking – are we better or worse than what is published? You will not know the answer unless you collect and analyze your own statistics. Internal data is about your patient population, skills and issues with your staff, and deficits or achievements in your own processes. Unlike Miss Nightingale, we now have computers, Excel and PowerPoint to enliven our data. Just imagine what she could have accomplished with our present data tools. The sky is the limit for what we can achieve as nurses inserting and managing vascular access devices and delivering infusion therapies! Happy Birthday, Miss Nightingale and thanks for your legacy! Within the past few years, advertising for many new types of midline catheters state the dwell time of up to 29 days. Does this mean that the catheter should be removed on or before the 29th day? The answer is a definite NO. The 2016 Infusion Therapy Standards of Practice states, “VADs are not removed based solely on length of dwell time because there is no known optimum dwell time.” Then what is the basis for this statement about midline dwell time of 29 days? That answer comes from a guidance document released by the FDA in 1995. This document included a list of information that must be included in the manufacturer’s original submission to the FDA to obtain clearance to sell the device in the United States. The manufacturer must classify the device into one of two groups – “Class II for short-term intravascular catheters (less than 30 days), Unclassified for long-term (more than 30 days) percutaneous intravascular catheters”. This classification is made long before there is any clinical use of the device, therefore clinical outcomes are not known when this submission is made. Reasons for removal of all VADs should be based on clinical findings. What does the insertion site look like? Are there any complaints from the patient about the device? Is it still functioning without resistance to flushing and producing a blood return that is the color and consistency of whole blood? Is the catheter still needed for the patient’s plan of care? These are the factors to consider about removal of any VAD including midline catheters. So forget the clock or calendar to determine when the catheter should be removed. Learn more about Midline Catheters in our newly updated course, Midline Catheters: What, Why, When. |
Author: Lynn HadawayLynn Hadaway is an international thought leader in infusion therapy and vascular access, having been in this practice for more than 40 years. Her experience comes from hospital-based infusion teams, device manufacturers, and continuing education services. Her journal and textbook publications are extensive. She also maintains board certification in infusion nursing (CRNI) and nursing professional development (RN-BC). Categories
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May 2019
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