Multidisciplinary management of vascular access devices.

Many problems associated with the use of vascular access devices (VADs) can be circumvented with an organized, systematic approach to management. This paper describes an approach that includes several key components: 1) A nurse coordinator of parenteral therapy (CPT) follows all patients with a VAD; records demographic and clinical data on an ongoing basis; monitors complications and outcomes; serves as a consultant for VAD-related questions; develops policies, procedures, and guidelines for catheter care; and oversees inservice nursing and basic patient education. 2) A data coordinator enters all data into a data base management system, compiles complication and other statistics on a periodic basis, and retrieves selected data for specific purposes. 3) A VAD Committee, composed of the above two individuals, a nurse epidemiologist, and physicians representing medical oncology, hematology, transplantation, pediatrics, and surgery, meets monthly to collectively evaluate and assign cause for complications, consider new products, and discuss policy changes regarding VADs. As a result of this multidisciplinary process, responsibility and accountability for VAD insertion and care are appropriately placed, statistics on complications are compiled, and treatment and policy decisions are made. These outcomes have resulted in a significant reduction in complications, an increase in average catheter life, enhancement of quality assurance, and overall improved patient care.