presented by Lisa Gorski
This course provides home care nurses with essential knowledge required to safely manage patients who require vascular access devices (VAD). This course begins with the presentation of a model for home infusion therapy, describing how vascular access device care fits into the larger picture for provision of safe home infusion therapy. Participants will learn about the importance of vascular access device selection and the main categories of central VADs (CVAD) and peripheral catheters placed for home infusion therapy. The required care and maintenance, including key areas for assessment and setting the stage for effective patient education, are addressed. This presentation is followed by Part II, where potential complications will be explored including signs and symptoms, preventative interventions, and management.
Lisa Gorski MS, RN, HHCNS-BC, CRNI, FAAN, has worked for over 30 years as a Clinical Nurse Specialist (CNS) for Wheaton Franciscan Home Health & Hospice, now part of Ascension at Home in Milwaukee, Wisconsin. As a CNS, she has developed and oversees the home infusion therapy program, provides staff education, is involved in agency quality assessment, performance improvement, infection control and surveillance, and also provides direct patient care. Lisa received both her bachelor’s and master’s degree from the University of Milwaukee, Wisconsin College of Nursing. Her graduate school work focused on the chronically ill patient population. Within her home care agency, she has also focused extensively on preventing hospitalizations, including a focus on the heart failure and chronic obstructive pulmonary disease patient populations. Lisa served on the American Nurses Association committee and helped develop the American Nurses Association Home Health Nursing Scope and Standards of Practice, most recently published in 2015. Lisa is the author of over 50 book chapters and journal articles on home care and infusion therapy topics. She is also the author of several books, including the 7th edition of the Manual of IV Therapeutics: Evidence-Based Practice for Infusion Therapy (2018) and the 2017 book: Fast Facts for Nurses About Home Infusion Therapy. Lisa has been actively involved with the Infusion Nurses Society (INS) for many years. She served as the 2007-2008 INS President, is the 2017-2019 Chairperson of the Infusion Nurses Certification Corporation, is the chair of the INS Standards of Practice Committee, and led the INS Vesicant Task Force. She is an editor for INS 2010 textbook, Infusion Nursing: An Evidence-Based Approach and also for the forthcoming 2019 edition, which is in progress. In 2006, Lisa was inducted as a Fellow into the American Academy of Nursing. She was named the 2003 CRNI of the Year by INS and the 2011 CNS of the Year by the National Association of Clinical Nurse Specialists. She speaks nationally and internationally on standards development, infusion therapy/vascular access, and home health care. Over the past few years, Lisa has presented well-received presentations addressing standards of practice relative to care of vascular access devices and infusion administration in the US, China, Europe, and Middle Eastern and Latin American countries.
The Gorski Model for Safe Home Infusion Therapy predicts that positive outcomes, which include the absence of infusion therapy–related complications, patient satisfaction, and health care provider satisfaction, are maximized when four aspects of care are addressed during the home care planning process and during the process of providing care. These include (a) appropriate patient selection; (b) effective patient education; (c) meticulous patient care, comprehensive assessment, and monitoring and; (d) interprofessional communication and collaboration.
Reliable vascular access is a major factor allowing for the success of home infusion therapy. Selecting the most appropriate vascular access device is a critical decision that impacts the clinical outcome as well as the patient experience and satisfaction with care, and this decision requires critical thinking and analysis of multiple factors.
Categories of CVADs commonly placed for home infusion therapy include peripherally inserted central catheters (PICC), subcutaneously tunneled CVADs, and implanted vascular access ports. Peripheral catheters include the commonly placed “short” peripheral catheter and midline catheters which are an increasingly common VAD choice for patients who require home antimicrobial therapies. Case scenarios will be used to illustrate VAD selection.
Proper care and maintenance of any VAD is necessary to reduce the risk of catheter related complications. This includes ongoing assessment, site care/dressing changes, site rotation in the case of short peripheral catheters, implanted port access, maintaining catheter patency, and in some cases, withdrawal of blood for laboratory studies. Strategies for effective teaching of patients and family members about VAD care are emphasized.
Effective patient education is essential to the safe provision of infusion therapy and VAD management in a home care setting. Strategies for effective teaching of patients and family members about VAD care are addressed and presented in the context of a case scenario.