Inpatient Clinical Pathway for Vascular Access
Goals and Metrics
Related Pathway
Guidelines for:

Patient Requiring IV Access in the Inpatient Setting

KOPH: Contact VAS Charge RN
Emergent IV Access
Urgent IV Access – Stable patient
Access required within 1 hour
  • Unstable Patient
  • Skilled unit-based resource with immediate call to VAS
  • IO consideration
  • CAT, Code or Tier activation to manage
  • Stable Patient
  • Peripheral IV Access
    • Notify VAS
    • 2 attempts by:
    • US guidance as clinically indicated
Non-difficult Venous Access
Difficult Venous Access
Unit-based resource,
if available 2 attempts
Failed
Notify VAS
Consider PIV, US guided as clinically indicated by trained provider
Failed
Team Huddle (Tier 0)
Failed
Team Huddle (Tier 0)
  • Immediate consideration of the following:
    • Continued PIV attempts including lower extremity, EJ
    • Alternatives to IV
    • IO placement
    • Consult IR Via Epic On-call Finder
  • If clinical deterioration imminent, move to Emergent Access for Unstable Patient
  • Consider the following:
  • If clinical deterioration imminent, move to Emergent Access for Unstable Patient
Vascular Access Obtained

Daily Team Assessment to Decide on Optimal Plan for Continued IV Access
Consider patient’s current care plan and vascular history
Review Guidelines for When to Consider Central Venous Access and Guidelines for Catheter Selection

PIV
Central Venous Access
  • Daily vascular access assessment on rounds
  • Guidelines for when to Consider Central Venous Access
  • IR consult as indicated
  • Daily vascular access assessment on rounds
  • IR consult as indicated
  • Alternatives to IV
  • IM, SQ Route
  • Oral, NG, GT
  • Pain Control
  • Distraction/Child Life
  • Sucrose
  • LMX
  • Pain Ease
  • Buzzy
  • J - Tip
Posted: May 2017
Revised: April 2022
Authors: J. Lavelle, MD; AM. Cahill, MD; T. Conlon, MD; C. Czajka, RN; M. Mullin, RN, M. Greenfield, MD; L. Riede, RN; A. Shepherd, RN; C. Jefferies, RN; A. Srinivasan, MD