The concept of vessel health and preservation (VHP) is crucial in the context of midline therapy, as it aims to minimize damage to patients’ veins and optimize the selection, insertion, and maintenance of vascular access devices (VADs), including midline catheters.
Timely and Intentional Device Selection
VHP emphasizes the importance of timely and intentional selection of VADs based on individual patient needs and risk assessments. For midline catheters, this involves assessing the patient’s medical history, comorbidities, and the availability of their veins, as well as the treatment plan and duration of therapy. Midlines are suitable for treatment durations up to 14 days and are preferred for medications such as antimicrobials, analgesics, and fluid replacements that are normally tolerated by peripheral veins.
Ultrasound-Guided Insertion
The use of ultrasound-guided insertion is a key component of VHP for midline catheters. This technique increases the success of cannulation, extends dwell time, and reduces insertion-related complications. Ultrasound guidance is particularly beneficial for patients with difficult vascular access.
Ongoing Assessment and Maintenance
VHP includes ongoing assessment and maintenance of the vascular access device to prevent complications. For midline catheters, this involves daily checks for signs of phlebitis, infiltration, and other complications. Proper maintenance can potentially extend the dwell time of midline catheters beyond the typical 14 days if strict controls for insertion and daily checks are in place.
Medication Suitability
VHP guidelines also address the suitability of medications for administration through midline catheters. Midlines should not be used for vesicant drugs, parenteral nutrition, or infusates with an osmolarity greater than 900 mOsm/L. For example, vancomycin can be administered through a midline catheter if diluted to ≤ 4 mg/mL, but prolonged use (> 6-7 days) is not recommended.
Patient-Centered Approach
The VHP framework places the patient at the center of decision-making, ensuring that the selected device aligns with the patient’s specific needs and minimizes the risk of complications. This approach enhances patient safety, satisfaction, and overall experience by preserving veins for future use.
Reducing Complications
By following VHP guidelines, healthcare practitioners can reduce the risk of complications associated with midline catheters, such as phlebitis, thrombosis, and catheter-related bloodstream infections. The use of advanced biomaterials and adherence to VHP principles can further minimize these risks.
In summary, the importance of vessel health and preservation in midline therapy lies in the careful selection, insertion, and maintenance of midline catheters, ensuring optimal patient outcomes, minimizing complications, and preserving vascular health for future medical needs.
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References:
Nickel, B. et al., (2024, January/ February) Infusion Therapy Standards of Practice 9th edition. Journal of Infusion Nursing. https://www.ins1.org/publications/infusion-therapy-standards-of-practice/
Moureau, N. et al., (2012, July- September) Vessel health and preservation (Part 1): a new evidence-based approach to vascular access selection and management. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/22307471/
Hallam, C. et al., (2020, December 14) UK Vessel Health and Preservation (VHP) Framework: a commentary on the updated VHP 2020. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC8274140/