Vascular Access Clinical Pathway — Inpatient

Daily Team Assessment to Decide on Optimal Plan for
Continued IV Access

The clinician team should review vascular access needs of the individual patient daily in order to evaluate the continued need for IV access, to plan ahead for PICC line placement when needed, and to remove devices when they are no longer needed for care to minimize patient discomfort and risk for harm. The FLOC and bedside RN should document the IV access plan daily in the EPIC medical record. The inpatient non-ICU teams can consult VAS as needed for further support.

Required Team Members

Bedside RN
FLOC
Attending physician must be notified if not present and a change is made to the vascular access plan

Discussion Items

Type of Current IV Access	PIV PICC Non-tunneled CVC Dialysis or apheresis catheter Implanted port Tunneled CVC
Current IV Therapy	Hydration Antibiotics Analgesia, sedation Vasopressors Chemotherapy TPN Irritants and vesicants
Medication Compatibility	Consider Y-site compatibility Consult with Pharmacy regarding compatibility options to minimize number of access points
Duration of Therapy	Guidelines for When to Consider Central Venous Access
Complications or Other Concerns	PIV Infiltration Phlebitis Extravasation Site infection CLABSI VTE Unintentional dislodgement
Need for CVC	More permanent CVC needed, schedule
Number of Lumens, Access Sites	Consider physical limitations to obtaining access Refer to: Central Venous Catheter Selection
Plan	Determine appropriate actions to address complications, concerns, or need for CVC Daily discussion of vascular access needs

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.