Guest Editorial

Article Outline

• Copyright

Vascular issues are an item that the bedside caregivers in the neonatal intensive care unit (NICU) deal with every day and often every hour. Rarely is a baby admitted to the NICU without having some kind of vascular access needed. We use vascular access for everything from antibiotics to nutrition. The care and maintenance of this access has become such an everyday occurrence that many of us forget that the results of this intervention can have devastating results. A peer of mine speaks about how we are involved in the “sacred” moments of the lives of the babies and their families … the birth of their child, the life that the family lives while in the unit, and either the joy at the discharge of that baby or the sorrow at the loss of that baby. With so much happening with the patients we care for, there is a potential to minimize the interventions that are such an integral part of our daily routine in the NICU. Because the use of vascular access is such an everyday occurrence to us, we need to remember that it is not a normal thing to have an intravascular (IV) or PICC line in place, and that the body can and does react to this process, and if we are not careful, there will be devastating results.

We start this issue out with a discussion by Janet Pettit as to the assessment and decision making that should go into deciding the best vascular access for an infant. Ms Pettit urges us to change the ways in which we make decisions regarding vascular placement. Although traditionally we have wanted to get a peripheral IV placed as soon as possible, which may require several attempts and several different sites during the course of the therapy; the shift we need to make in our thinking is to think about what is the goal of therapy and what access will best meet that goal.

Sandy Sundquist Beauman and Anne Swanson have an excellent review of the anatomy and physiology of the vasculature system. The authors also address a number of topics that many would consider “basic” but which every bedside nurse should review if they place any kind of peripheral device in an infant. In my own unit, I foresee this article being a mandatory read for every new nurse on the unit and a great resource that the experienced nurse should read to keep themselves aware of information that may have changed or been added to since the last time they read about peripheral lines.

Robin Clifton-Koeppel addresses the types of wounding and potential long-term damage that are a result of extravasation of peripheral IVs. Evidenced-based information on the care of these wounds is demonstrated to be in short supply by Ms Clifton-Koeppel, but she also offers options and information that can be used to guide care for this type of injury and also identifies areas for further research.

Janet Pettit in her second article addresses the use of peripherally inserted central catheters (PICCs) placed in the lower limbs. PICCs, although not without complications, have had a lower profile for serious complications. Ms Pettit points out the need for an accurate assessment and level of expertise needed to identify the neurologic symptoms that are becoming associated with lower limb placement.

The 2 closing articles address specific items in the global issue that many of us struggle with of how to improve the care we deliver to our patients. Elizabeth Sharpe looks at how to get a PICC team up and running to improve the outcomes for those babies who require a PICC and improve satisfaction for the nurses placing those lines. Her article actually reflects points that Ms Pettit had made about staff competency and timely placement. Anne Swanson addresses the issue that has many NICUs in a quandary, which is replacing our individualized drip medication concentrations with standardized concentrations. Ms Swanson outlines a method and manner in which to look at the issue and address the problem to meet compliance on this issue that Joint Commission on accreditation of healthcare organizations (JCAHO) is asking all of us to do.

This issue only had the opportunity to address a small slice of the items related to vascular access. There are more topics that we all need to remind ourselves to investigate and research, to find out what is available as we look to continue to improve our personal practice and how our individual units practice. I once had a NICU orientee ask me, “Why, if there are national standards doesn't everyone practice the same?” That was certainly one of the most difficult questions I ever had to answer! It does make one wonder why we do not all follow what has been defined as best practice and why it may take some of us so long to follow guidelines that have been research based and established. Hopefully, this issue will present you with information regarding best practice, research options, and methods for improving practice for yourself and your units.