Inpatient Clinical Pathway for Vascular Access
Related Pathway
Patient Requiring IV Access in the Inpatient Setting
KOPH: Contact VAS Charge RN
Emergent IV Access
Urgent IV Access – Stable patient
Access required within 1 hour
- Access required within 4 hours
- Review Difficult Venous Access Definition
- Unstable Patient
- Skilled unit-based resource with immediate call to VAS
- IO consideration
- CAT, Code or Tier activation to manage
- Stable Patient
- Peripheral IV Access
- Notify VAS
- 2 attempts by:
- Skilled unit-based resource
- VAS
- US guidance as clinically indicated
Non-difficult Venous Access
Difficult Venous Access
Unit-based resource,
if available 2 attempts
if available 2 attempts
Failed
Notify VAS
Consider PIV, US guided as clinically indicated by trained provider
Consider PIV, US guided as clinically indicated by trained provider
Failed
Failed
- Immediate consideration of the following:
- Continued PIV attempts including lower extremity, EJ
- Alternatives to IV
- IO placement
- Consult IR Via Epic On-call Finder
- If clinical deterioration imminent, move to Emergent Access for Unstable Patient
- Consider the following:
- Alternatives to IV
- Consult IR Via Epic On-call Finder
- Review guidelines for when to
Consider Central Venous Access
- If clinical deterioration imminent, move to Emergent Access for Unstable Patient
Vascular Access Obtained
Daily Team Assessment to Decide on Optimal Plan for Continued IV Access
Consider patient’s current care plan and vascular history
Review Guidelines for When to Consider Central Venous Access and Guidelines for Catheter Selection
PIV
Central Venous Access
- Daily vascular access assessment on rounds
- Guidelines for when to Consider Central Venous Access
- IR consult as indicated
- Daily vascular access assessment on rounds
- IR consult as indicated
- Consider antimicrobial lock if eligible
-
Resources for Catheter Choice/Placement
- Assessment and Management of Vascular Access Catheters Policy
- Volumes of Intravascular Catheters and Devices for Drawing Specimens and Flushing Intermittent Medications
- Vascular Irritants/Vesicants — Job Aid
- Management of IV infiltration and Extravasation
- Guidelines for Central Venous Access for Apheresis Procedures
- Catheter Size Guide for Central Line Placement
- Resources for Antimicrobial Lock Therapy