Waiting time for intravenous catheters significantly cut by new nursing team

Nursing Vascular Access Team also helps to minimize discomfort to patients

A new JGH nursing team has helped slash the waiting time for inserting intravenous catheters, while easing the discomfort that some patients may experience during the procedure.

On average, a JGH patient used to wait three to four days to receive a peripherally inserted central catheter (commonly known as a PICC line), a long, thin tube that is introduced into a vein in the arm. Insertion continues until the tube’s tip arrives at the large central veins near the heart, where medication can be delivered or other treatments performed.

Ever since members of the specialized Nursing Vascular Access Team began inserting PICC lines in September, waiting times have been dropping steadily to an average of just 16 hours, says Sonia Boccardi, Clinical-Administrative Coordinator in the Nursing Directorate.

Previously, Ms. Boccardi explains, unavoidable delays occurred because the numerous requests for the insertion of PICC lines could be fulfilled only by an interventional radiologist or by a consulting physician from the Intensive Care Unit. The insertion of catheters was just one of the many tasks those professionals had to perform.

The process has now been accelerated due to the availability of qualified nurses, who focus exclusively on performing the procedure.

Joanne Charbonneau, Nursing Consultant for the Nursing Vascular Access Team, says all nurses are adept at inserting a short catheter into veins that can be seen through the surface of the skin.

However, when unexpected difficulties sometimes occur, the repeated and unsuccessful attempts by a general nurse to find a vein can be painful to patients. This dilemma has now been minimized through the support of the Nursing Vascular Access Team.

Nurses go wherever they’re needed

The team consists of nurses Carla Peters and Benjamin Rolea, as well as Ms. Boccardi and Ms. Charbonneau, who can be called to any in-patient hospital room and to the Emergency Department.

Its members complete a crucial step in various clinical procedures, such as preparing patients for chemotherapy; making it possible for medication to be administered to very sick individuals (such as those in Intensive Care); and enabling patients to receive total parenteral nutrition (nourishment taken intravenously).

If space at the beside is limited, or if creating a sterile environment in a semi-private room is impractical, the patient is transported to the Peri-Operative Unit for the insertion. However, if more complex management is required, the patient is referred to an interventional radiologist.

“Our objective,” Ms. Charbonneau says, “is to improve safety, minimize complications and maximize the patient’s comfort. Our team’s nurses go wherever they’re needed in the hospital to be sure the right catheter is inserted as promptly as possible, resulting in the right treatment for the patient.”

In this regard, the activities of the Nursing Vascular Access Team are in line with Care Everywhere, the broad approach to care that is intrinsic to the activities of CIUSSS West-Central Montreal.

Members of staff live up to the ideals of Care Everywhere in striving to achieve the right outcomes by providing the right care at the right time in the location that is the safest, most appropriate and most convenient for the users of health care and social services.

Making the most of nurses’ expertise

The need for this type of team had been recognized since the late 2010s, says Ms. Boccardi. However, the necessity became even more apparent last year, when the hospital’s C4 Command Centre identified delays in inserting PICC lines as a cause of slowdowns in patient flow.

This prompted the Department of Nursing to organize the new team. After two months of planning, the team’s nurses began inserting short and midline catheters in June 2024, followed three months later by the insertion of PICC lines.

According to Ms. Charbonneau, there are two other healthcare facilities in Quebec where nurses insert PICC lines, but this is done only after a physician has assessed the patient and ordered the insertion.

What makes the JGH unique, she continues, is that the nurses conduct the assessment, determine the type of catheter to be inserted, and meet with the physician and other members of the treating team to discuss their recommendation.

In almost every instance, Ms. Charbonneau says, the proposal of the nurse from the Nursing Vascular Access Team is accepted and implemented. In case of a disagreement, the physician has the final say, but a situation of this sort rarely arises.

 “When initiatives are introduced, it sometimes takes a while for momentum to build,” says Ms. Boccardi. “But in this case, our nurses were enthusiastic about the new team right from the start, because they understood the importance of its role.

“It’s very gratifying to see how passionate they are about their work, especially since they’re doing so much to speed up the process of returning our patients to the comfort of their homes as quickly as is appropriate for them.”