an interprofessionalapproach to improving medication ......an interprofessionalapproach to improving...

An Interprofessional Approach to Improving Medication Administration for Optimal Vessel Health and Preservation

An Interprofessional Approach to Improving Medication Administration for Optimal Vessel

Health and Preservation

Judith Jacobi,

Pharm.D., BCCCP, FCCP, MCCM

Senior ConsultantVisante, Inc.

St. Paul, Minnesota

Lori Kaczmarek,

M.S.N., R.N., VA‐BC™

Vascular Access Clinical SpecialistPresident‐Elect, Association for

Vascular Access (AVA)Franklin, Wisconsin

Provided by ASHP Supported by an educational grant from BD

In accordance with ACCME and ACPE Standards for Commercial Support, ASHP policy requires that all faculty, planners, reviewers, staff, and others in a position to control the content of this presentation disclose their relevant financial relationships. • Judith Jacobi ‐ None• Lori Kaczmarek ‐ Consultant for Adhezion Biomedical, LLC

and BD (Becton, Dickinson and Company)

Disclosures

Copyright © 2020 American Society of Health-System Pharmacists, Inc. All rights reserved. 1


1. Describe vascular access options and methods to maximizevascular safety and maintenance.

2. Review key factors for a pharmacist to consider whendiscussing access options for a patient or to consider whenevaluating drug therapy, based on existing IV access.

3. Explain the value of the pharmacist as a collaborator with thevascular access team.

4. Problem solve patient scenarios to optimize safe medicationadministration and vascular access for optimal therapy andcare.

Learning Objectives

Abbreviations

• BSI: Bloodstream Infection• CAJ: Cavoatrial Junction• CLABSI: Central Line‐Associated

Bloodstream Infection• CVC: Central Venous Catheter• DVT: Deep Vein Thrombosis• EMR: Electronic Medical

Record• ICU: Intensive Care Unit• IVDU: Intravenous Drug Use

• PICC: PeripherallyInserted Central Catheter

• PIV: Peripheral IntravenousCatheter

• USG‐PIV: Ultrasound GuidedPeripheral IV

• VAD: Vascular Access Device• VAS: Vascular Access Specialist



What is your practice setting?

a. Community hospitalb. Academic medical centerc. Multi‐hospital systemd. Home caree. Other

What is your role?

a. Generalist Pharmacistb. Clinical Pharmacy Specialistc. Clinical Supervisord. Administratore. Other



a. 0b. 1 ‐ 5c. 6 ‐ 10d. 11 ‐ 25e. More than 25

How often do you address questions about vascular access needs each day?

Vascular Access is Essential

• 5RPIV Bundle™: increased PIV duration and reduced costs– Proficiency– Insertion– Vein & catheter– 5 supplies and technology– Review and assessment– What about the right therapies through this device?

• New devices and insertion sites add complexity• Avoiding complications is essential

Steere L et al. J Assoc Vasc Access 2019; 24:31‐43.



• https://VoicesofVascular.com/• Educational webinars and podcasts• Interprofessional team

– Greg Schears, M.D.– Lori Kaczmarek, M.S.N., R.N., VA‐BC– Emily Levy, patient and advocate– Judith Jacobi, Pharm.D., BCCCP, FCCP, MCCM

#voicesofvascular

Voices of VascularBecause Perspective Changes Everything

Best Practices in Vascular CareLori Kaczmarek, M.S.N., R.N., VA‐BCTM

Photos courtesy L Kaczmarek



Catheter Tip Differentiates Central from Peripheral Venous Access

Chopra V et al. Ann Intern Med. 2015; 163(6 Suppl):S1‐40.

Courtesy of L Kaczmarek

Central

Peripheral

Midline

Courtesy of L Kaczmarek

Peripheral Veins



a. 1b. 2c. 3d. 4e. There is no limit

How many attempts at a peripheral IV are acceptable before referring to a team with greater

expertise?

The Problem with Reactive IV Therapy Older, sicker, vein‐depleted patients Several hundred injectable drugs available Multiple concurrent therapies often needed Nursing shortage; Lack of competent inserter

Photos courtesy of L Kaczmarek



Typical Vein Size and Blood Flow Rates

Vascular Access Device Selection, Insertion and Management: BARD ACCESS SYSTEMS, p. 12

Vessel Diameter (mm) Blood Flow (mL/min)

Digital/Metacarpal 2.5 10

Cephalic 6 45

Basilic 8 80

Axillary 16 300

Subclavian 19 800

Superior Vena Cava 20 2000 & Turbid

• Peripheral: PIV/Midline/Long‐Dwell/Extended Dwell– All are peripheral catheters– Swelling, infiltration, infection, phlebitis– Peripheral lines that do not give a blood return ⬆ RISK of complications

• Central: PICC, CVC, Port– Lack of blood return or sluggish return– Resistance to infusion and flushing– Pain/swelling in face, neck, or arm– Patient may “hear” the flushing if the line

is malpositioned into the internal jugular

Gorski L et al. Infusion Nurses Society. Infusion therapy standards of practice. J Infus Nurs. 2016 (Jan/Feb); 39(Suppl):1S‐159S. Available at: https://source.yiboshi.com/20170417/1492425631944540325.pdf

Signs of Catheter Failure

Photo courtesy, L Kaczmarek



2.5-4 cm

4.5-6 cm

Above 6 cm

87.5%

31.8%

18.5%

15.0%

2.3%

CVC malfunction and catheter tip positionSigns of Catheter Failure: Central

Petersen J et al. Am J Surg. 1999; 178:38-41.

0.5-2 cm

At or below CAJ

Michigan Appropriateness Guide for Intravenous Catheters (MAGIC)

Chopra V et al. Ann Intern Med. 2015; 163(6 Suppl):S1‐40.

</= 5 days 6‐14 days 15‐30 days >/= 31 days

Peripheral IV (PIV)No preference between

PIV and USG‐PIV

Ultrasound ‐Guided PIV

Non‐Tunneled/Acute CVC

Midline catheter

PICC

Tunneled Catheter

Port

PICC preferred to midline catheter if proposed duration of infusion is >/= to 15 days

PICC preferred to tunneled

catheter and ports for

infusion 15‐30 days

Device TypeProposed Duration of Infusion

USG‐PIV if proposed duration is 6‐14 days

CVC is preferred in critically ill patients or if hemodynamic

monitoring is needed for 6‐14 days

Midline catheter preferred to PICC if proposed duration is </= 14 days



• Kitting: all supplies needed are in ONE kit and systematically organized to reduce human error

• People: Advancing skill and education in assessment, insertion, and monitoring

• Products: Alcohol disinfecting caps, integrated dressings, stabilization devices, needless injection cap designs, chlorhexidine, and new technologies (e.g., subcutaneous engineered devices, tissue adhesives)

CLABSI/BSI Reduction Strategies

• Team approach for assessment, insertion, and maintenance of VADs improves outcomes, patient experience, and healthcare processes.

• Cost‐effective• Improves success• Reduce device failure

Carr P et al. Cochrane Database Syst Rev. 2018; 3:CD011429.

Role of Vascular Access Specialist

Courtesy L Kaczmarek



Phlebitis: red, warm, swelling, tenderness, pain, red “streak” following vein, cord‐like

Mechanical, Chemical, Bacterial and Postinfusion

PIV: shallow depth allows visual assessment, earlier detection

Midline: deeper placement, usually upper arm makes it harder to detect symptoms of phlebitis‐ arm swelling, leakage at site of insertion

CVC: complications usually relate to poor device stabilization, poor aseptic technique, DVT, catheter tip malposition, clotted catheter

Phlebitis

Gorski L et al. Infusion Nurses Society. Infusion therapy standards of practice. J Infus Nurs. 2016 (Jan/Feb); 39(Suppl):1S‐159S. Available at: https://source.yiboshi.com/20170417/1492425631944540325.pdf

Gorski L et al. J Infus Nurs. 2016; 39(suppl 1):s1‐s159.

Visual Infusion Phlebitis ScaleScore Observation

0 IV site appears healthy

1 Slight pain near IV site or slight redness near IV site

2 Two of the following: Pain at IV site, erythema, or swelling

3 Pain along path or cannula and induration

4 All are present and extensive: Pain along path of cannula, erythema, induration, and palpable venous cord

5 All are present and extensive: Pain along path of cannula, erythema, induration, and palpable venous cord, pyrexia



Key Takeaways• Key Takeaway #1

– Vascular access devices are not created equal• Key Takeaway #2

– Ensuring the skills of the clinician inserting the device and using ultrasound guidance improve outcomes from device use

• Key Takeaway #3– Collaborative effort is needed to identify and insert the best device to meet current parenteral treatment needs and preserve the vein integrity to meet future needs

Role of the Pharmacist for Optimal Medication Administration and Safe Use

of Intravascular Devices

Judith Jacobi, Pharm.D., BCCCP, FCCP, MCCM



• Develop policies and procedures for medication delivery– Concentrated electrolytes (e.g. K+, Ca++, Na Bicarb, 3% NaCl)– Hypertonic dextrose (50%)– Standardize infusate concentrations‐ infusions and intermittent minibags

– Define extravasation treatment options and protocols• Assure proper IV access when verifying infusate orders

– Intervene to optimize dilution based on IV site• Label medications for optimal site of administration

Pharmacist Roles in Vascular Access

• Serve on harm reduction teams– Catheter‐associated bloodstream reduction (CLABSI)– Proper use of alternative devices

• Educate on optimal site of IV medication delivery• Modify infusate concentration when access changes

Pharmacist Roles in Vascular Access



• Each facility to consider patient instability, fluid and electrolyte options, duration of therapy, history of difficult access, formulary, to guide CVAD

• Each facility have list of formulary vesicants and irritants• Infusate properties to consider

– Vesicants: blistering, tissue sloughing, necrosis if leaked from vasculature

– Irritants: burning, stinging, pain during infusion = damage within the vein

– Vein damage can lead to extravasationGorski LA et al. J Infus Nurs. 2015; 38:27‐46. Gorski LA et al. J Infus Nurs. 2017; 40:26‐40.

Central Access Utilization Standards

• Likelihood of tissue injury with extravasation– Osmolarity ≥900 mOsm/L– Direct cytotoxic injury

• Cytotoxic chemotherapy• Vancomycin

– pH <5 or >9‐ no longer a criterion– Other medications may cause injury, but literature is incomplete

• Others "Central Line Preferred"– Emergent administration of limited doses/duration– Protocolized PIV therapy

Defining "Central Line Only" Medications



Infusion Nurses Society:Red/Yellow Lists

Gorski LA et al. J Infus Nurs. 2017; 40:26‐40.

Red ListWell‐documented vesicants with multiple

reports of extravasation injury

Yellow ListRecognized as vesicants but fewer reports of

extravasation injuryAngiotensin II Acyclovir

Dobutamine Daptomycin

Dopamine Nafcillin

Epinephrine Pentamidine isethionate

Norepinephrine Vancomycin

Phenylephrine Dextrose ≥10%

Vasopressin Potassium ≥60 mEq/L

Calcium chloride Arginine monochloride

Calcium gluconate Amiodarone

Dextrose ≥12.5% Mannitol ≥20%

Parenteral Nutrition >900 mOsm/L Pentobarbital

Sodium bicarbonate Phenobarbital

Sodium chloride ≥3% Phenytoin

Nonionic Contrast Media (high osmolarity) Promethazine

• Vasopressors in ICU, N=734, mean 49 ± 22 hr. Extravasation 2% without injury, 13% eventual central line, Mix norepinephrine up to 64 mcg/mL– Prospective data collection– Nursing protocol for placement, assessment, maintenance

• Phenylephrine for BP elevation in spinal cord injury, N=20, mean (range) 14.3 hr (1‐54.3 hr), up to 20 mcg/kg/min, Mix 40 mcg/mL

• Vasopressors in ICU, N=202, Extravasation 4%, 46% eventual central line, Median 11.5 hr (varied by drug), Mix norepinephrine up to 64 mcg/mL, phenylephrine up to 400 mcg/mL– Experience led to development of a nursing protocol

Cardenas‐Garcia J et al. J Hosp Med. 2015; 10:581‐5. Delgado T et al. J Crit Care. 2016; 34:107‐10. Lewis T et al. J Intensive Care Med. 2019; 34:26‐33.

Vasopressor via PIV



Suggested Criteria for Vasopressors via PIV

Cardenas‐Garcia J et al. J Hosp Med. 2015; 10:581‐5. Lewis T et al. J Intensive Care Med. 2019; 34:26‐33.

Vein diameter >4 mm measured with ultrasoundPIV confirmed via ultrasound to be in vein prior to starting infusionBlood return from PIV prior to starting infusionUpper extremity only, contralateral to BP cuffNo hand, wrist, or antecubital fossa positionCatheter 18 or 20 gaugeAssess PIV access every 2 hours‐ per nursing protocolImmediate alert of provider if extravasation and prompt initiation of local treatment72‐hour maximum duration of PIV for vasopressor• Consider limit on concentration & maximum rate• Consider hourly monitoring

• Amiodarone– pH 4.08– May be a vesicant‐ hyaluronidase intradermal treatment– Use a 0.22 micron filter‐ precipitates at time of infusion– Mix in non DEHP plastic

• Vancomycin– pH = 2.5‐4.5– 1 g per hour advised to reduce risk of red‐neck syndrome– In vitro endothelial cell injury LD50 >5 mg/mL after 24 hr contact (mimics continuous

infusion)• Significant in vitro cell death at 2.5 mg/mL x 24 hr

– LD50 >2.5 mg/mL after 48 hours• Intermittent dosing leads to less cell damage than infusion• Addition of intermittent gentamicin and erythromycin increased injury risk• Addition of imipenem or piperacillin/tazobactam did not increase injury risk

Drouet M et al. Antimicrob Agents Chemother. 2015; 59:4901‐6.Drouet M et al. Antimicrob Agents Chemother. 2015; 59:930‐4.

Common Infusates of Concern via PIV



• Systematic review of literature• Phlebitis risk reported as high as 85% (mean 14%)

– 33% no phlebitis, 5% severe• INS benchmark for acceptability is up to 5%

– Lowest rate with 1.2 mg/mL concentration• Odds ratio 0.09 (95% CI 0.05‐0.18) p<0.001• Concentration 1.8 mg/mL in most reports

• Use of guideline associated with lower phlebitis rates• Filter use associated with lower phlebitis ratesINS = Infusion Nurses Society CI= confidence interval

Oragano CA et al. Crit Care Nurse. 2019; 39:e1‐e12.

Amiodarone via PIV

• Vancomycin 4 mg/mL over 60 min via midline catheter– N=1086 patients– Mean (range) 7.5 (1‐25) days– Phlebitis rate 0.6%, infiltration 1.2%– Suggested avoiding vancomycin 10 mg/mL via PIV or midline catheter• Vancomycin ≤5 mg/ml preferred

• Midline catheter may not be appropriate for prolonged vancomycin (>6‐7 days)

Caparas JV. J Assoc Vasc Access. 2017; 22:38‐ 41.

Vancomycin via PIV



• Treat severe hyponatremia and elevated intracranial pressure

• 1026 mOsm/L• Prospective (16‐20 gauge) up to 50 mL/hr

– N=28 (34 PIV) for 1‐124 hr: 10% IV complications• Retrospective reports of PIV infusion

– N = 157 for median 44 hr: 7% IV complications– N = 66 for median 14 hr (4‐30): 6.1% IV complications reported in median 19 hr (5‐76)

Perez CA, Figueroa SA. J Neurosci Nurs. 2017; 49: 191‐5.Jones GM et al. Am J Crit Care. 2017; 26:37‐42. Dillon RC et al. J Intensive Care Med. 2018; 33:48‐53.

3% NaCl via PIV

Vancomycin administration through a peripheral IV or midline peripheral catheter dictates use of a more dilute concentration than a central line.

a. Trueb. False



• Know your resources for compatibility– What drug concentrations and formulations were tested?– How does that compare to your concentrations?

• What IV sites are available?• Can I change the route of administration?• What is planned duration of therapy?• Is the patient fluid restricted?• What do I do with balanced fluids (Lactated Ringers, Plasma‐

Lyte)?– Limited compatibility data with Plasma‐Lyte

• Manufacturer may have data on file?Dawson R et al. Paediatr Anaesth. 2019; 29:186‐92.

How Should You Manage IV Questions?

Pharmacist Checklist

Jacobi J. Am J Health‐Syst Pharm. 2019 (submitted)



Jacobi J. Am J Health‐Syst Pharm. 2019 (submitted)

Key Takeaways

• Key Takeaway #1– Pharmacists should be aware of available IV access devices and how

to safely prepare and administer medications through these devices• Key Takeaway #2

– Pharmacists have essential medication knowledge, and should contribute this expertise for optimal utilization and vascular safety

• Key Takeaway #3– Vascular access should be managed taking into consideration

immediate and future vascular access needs.



• Discuss patient scenarios• Choose best answer based on available information

• Summarize findings and guidance

Small Group Discussion

Role of the Pharmacist for Optimal Medication Administration and Safe Use

of Intravascular Devices:Scenario 1

Lori Kaczmarek, M.S.N., R.N., VA‐BCTM



• AM is an adult patient with a 3‐lumen central catheter• Medications

– Plasma‐Lyte 75 mL/hr– Norepinephrine– Vasopressin– Propofol– Vancomycin every 12 hr– Piperacillin/tazobactam every 8 hr (infused over 4 hr)– Intermittent hydromorphone, famotidine

• Patient now needs KCl replacement for K = 3 mEq/L

Scenario 1: Septic Shock

Select a combination of infusates to meet the needs of this patient (see compatibility info and combination options in your handout)

• Do you routinely check the EMR for presence of acentral line when verifying vasopressor orders?• How easy is it to find this data?

• What do you do when you do not have compatibilityinformation or there is discordant information?

• Does this patient need additional IV access options?

Small Group Discussion


Scenario 1


Table 2. Pharmacist Catheter Assessment Checklist

CURRENT & PLANNED LINES & MEDICATIONS

Central line, day #______ Insertion date:

Device types and lumens

PICC:_______ Lumens:_____ # Lumens in Use:_____

CVC:_______ Lumens:_____ # Lumens in Use:______

Midline::_______

PIV:__________

Last 24hr IV complications Infiltration_____ Multiple restarts______ Phlebitis_______ Bacteremia______ Catheter Occlusion______ (if yes, was it treated successfully?)_____

Difficult venous access patient? Yes_______

CHECKLIST (IF ELEMENT IS PRESENT= INCREASED NEED FOR CENTRAL LINE)

PIV or Midline complications in last 24 hr and patient identified as difficult vascular access

Oral/Enteral route NOT an option to replace IV medication

Patient requires maximally concentrated infusates

Vasopressor medications are infusing Could infuse through PIV or Midline with RN program for frequent site assessment or extravasation monitoring device.a

Vancomycin needed at least daily for up to 6 additional days May infuse through PIV or Midline if ≤ 4 mg/ml.a

Extremely high (> 8) or low pH (<3) medications needed

Parenteral nutrition (> 900 mOsm/L) infusing Central line required

Frequent electrolyte replacement is needed May infuse through PIV or Midline if adequately diluted, consider oral/enteral route

High osmolarity fluids infusing (e.g. calcium, bicarbonate, dextrose ≥12.5%, sodium ≥ 3%)

3% Sodium may infuse through PIV or Midline with RN program for frequent site assessment or extravasation monitoring device.a

Amiodarone infusion for prolonged duration (risk of phlebitis increases with duration of infusion even if 1.8 mg/ml)

PIV or Midline an option if < 2 mg/ml with in-line filter.a

Prolonged antimicrobial therapy (likely > 2 weeks) Consider PICC placement early enough to limit multiple peripheral IV failures.

Need for frequent phlebotomy especially with difficult vascular access

Cytotoxic oncologic therapy needed

Unstable patient, at risk for clinical deterioration

PICC peripherally-inserted central catheter, CVC central venous catheter, PIV peripheral intravenous a: Prefer ultrasound guided PIV insertion, and Midline is not an option for all patients- consult vascular access team. Midline catheters should be treated as PIV devices when it comes to medication selection and dilution

Disclaimer: This tool does not identify all possible reasons to insert or maintain a central line.

9/29/2019



Do your pharmacists routinely check the EMR for presence of a central line when verifying vasopressor orders?

a. Never b. Sometimes/selected medicationsc. Up to each pharmacistd. Most of the timee. Always

What would you suggest for IV access in Scenario 1?

a. Current access (3 lumens is adequate)b. Needs 1 more site, suggest ultrasound‐placed PIVc. Needs 1 more site, suggest a PIV without

ultrasoundd. I don’t know



• Know your policies!• No absolutes regarding patient care• Are you willing to extrapolate compatibility data from lactated ringers solution to Plasma‐Lyte?

• What do you do with IV compatibility reported as "no data" or "variable"?

Scenario 1 Discussion

• Investigate which central venous catheters, peripherally inserted central catheters, or midline catheters are utilized at my institution.

• Review any protocols or guidelines in pharmacy or at my institution on appropriate medication administration via central venous catheters, peripheral IV catheters, and midline catheters.

• Read the Infusion Nurses Society (INS) Infusion Therapy Standards of Practice(2016) for practice criteria for the infusion team and the updated list of noncytotoxic vesicant medications/solutions from 2017.

• Volunteer to serve on the vascular access team at my institution if pharmacy is not already involved.

• Review and update any protocols/policies at my institution on medication dilution for peripheral and central administration.

Consider these practice changes. Which will you make?



• Ayers P, Adams S, Boullata J et al. A.S.P.E.N. parenteral nutrition safety consensus recommendations. JPEN J Parenter Enteral Nutr. 2014; 38:296‐333.

• Association for Vascular Access (AVA). (2019). Resource Guide for Vascular Access: Recommended Study Guide for Vascular Access Board Certification (Vol. 3). Herriman, UT

• Boullata JI, Gilbert K, Sacks G et al. A.S.P.E.N. clinical guidelines: parenteral nutrition ordering, order review, compounding, labeling, and dispensing. JPEN J Parenter Enteral Nutr. 2014; 38:334‐77.

• Carr P, Higgins N, Cooke M, Mihala G, Rickard C. Vascular access specialist teams for device insertion and prevention of failure. Cochrane Database Syst Rev. 2018; 3:CD011429.

• Chopra V, Flanders SA, Saint S et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Ann Intern Med. 2015; 163(6 suppl):S1‐S40.

• Ensuring the Safe Use of Parenteral Nutrition, resources at www.ashp.org/Pharmacy‐Practice/Resource‐Centers/Clinical‐Pharmacy‐Resources/Nutrition‐Support

• Gorski LA, Stranz M, Cook LS et al. Development of an evidence‐based list of noncytotoxic vesicant medications and solutions. J Infus Nurs. 2017; 40:26‐40.

• Hallam C, Weston V, Denton A et al. Development of the UK vessel health and preservation (VHP) framework: a multi‐organisational collaborative. J Infect Prev. 2016; 17:65‐72.

• Infusion Nurses Society. Infusion therapy standards of practice. J Infus Nurs. 2016; 39(Suppl):1S‐159S.• Loubani OM, Green RS. A systematic review of extravasation and local tissue injury from administration of vasopressors

through peripheral intravenous catheters and central venous catheters. J Crit Care. 2015;30:653.e9‐653.e17.

Selected Resources



Copyright © 2020 American Society of Health‐System Pharmacists, Inc. 28

Assessment Test

This assessment test has been provided as a study aid only. Follow the prompts at the end of the presentation to claim credit. Credit must be claimed within 60 days of completing the activity.

1. According to the MAGIC criteria, a patient who needs 17 more days of cefazolin at a rehabilitation facilityshould have IV access options prioritized in which order?a. Midline, PIV, PICCb. PIV, midline, PICCc. PICC, midline, ultrasound‐placed PIVd. PICC is the only optione. Midline, ultrasound‐placed PIV, midline

2. What would you put in a protocol for administration of vasopressors via an ultrasound‐placed PIV?a. Concentration limit, antecubital site onlyb. Concentration limit, maximum 5 daysc. Infusion rate limit, every 4‐hour assessmentd. Concentration limit, upper arm site only

3. Which of the following is the LEAST helpful way for a pharmacist to contribute to vascular safety?a. Update a list of "central line only" medicationsb. Develop a protocol for treatment of extravasationc. Call the nurse every time a STAT vasopressor order is received to check for a central lined. Include route of administration parameters in infusate order information in the medication recorde. Intervene to reduce vancomycin concentration when a central line is removed

4. The goal of vascular access insertion and management is to:a. Achieve any venous access as quickly as possibleb. Place one device that meets the need for the duration of therapyc. Rotate PIV sites every 48‐72 hoursd. Avoid central access whenever possible

5. What measure does not improve the success of placing and maintaining a PIV?a. Use of ultrasoundb. Avoiding areas of flexionc. Applying a stabilization deviced. Use of a dressing that allows direct visualizatione. Applying an antibiotic ointment to the insertion site


Copyright © 2020 American Society of Health‐System Pharmacists, Inc. 29

6. The physician ordered intravenous therapy. What factors should be used to determine the best vascularaccess device?a. The drug and concentration (collaborate with pharmacist)b. Planned duration of therapy (collaborate with treatment provider)c. Clinical setting where infusion will be delivered (collaborate with social worker/discharge coordinator)d. Vascular access assessment (collaborate with vascular access specialist)e. All of the above

Lori A. Kaczmarek, M.S.N., R.N., VA-BC Vascular Access Clinical Specialist President-Elect, Association for Vascular Access (AVA) Franklin, Wisconsin

Judith Jacobi, Pharm.D., BCCCP, FCCP, MCCM Sr. Consultant Visante, Inc. Voices of Vascular Collaborator Lebanon, Indiana

About the Faculty

Judith Jacobi, Pharm.D., BCCCP, FCCP, MCCM is Senior Consultant at Visante, Inc. and is contributing to several projects for pharmaceutical and device companies. Through Visante, she became a Collaborator on the multidisciplinary Voices of Vascular (VoV) initiative. The VoV project is focused around education of health professionals about vascular health and preservation and optimal use of intravascular devices. As the pharmacist in this group, her priority is safe infusion of medications through peripheral and midline catheters.

Dr. Jacobi is an experienced Board Certified Critical Care Pharmacist. She has practiced in many types of critical care units throughout her 38-year career, most recently at Indiana University Health Methodist Hospital in Indianapolis, Indiana. She was Program Director of an ASHP-accredited Critical Care Pharmacy Residency and trained 29 residents, along with nu-merous Doctor of Pharmacy students as Affiliate Faculty for Purdue University and Butler University.

Dr. Jacobi trained as a pharmacist at Purdue University and received her Doctor of Pharmacy degree from the University of Minnesota and was one of the first critical care pharmacy residents trained at The Ohio State University. She was named a Distinguished Alumnus of Purdue’s College of Pharmacy and received the Glen J. Sperandio Award for the Advancement of Pharmacy. She was also awarded the Outstanding Achievement Award from the President of the University of Minnesota.

Dr. Jacobi is a Past-President of the American College of Clinical Pharmacy (ACCP). She authored two of ACCP’s Pharmacotherapy Self-Assessment Program (PSAP) chap-ters and served as expert reviewer for two others. Dr. Jacobi was the recipient of the Clinical Practice Award in 2006. She is a long-term member and Fellow of ACCP. Dr. Jacobi is a Past-President of the Society of Critical Care Medicine (SCCM)(the first pharmacist to serve in that role, and the second non-physician) and was a founding member of the Clinical Pharmacy and Pharmacology Section. Her other SCCM activi-ties include authorship of the 2002 Clinical Practice Guideline for the Sustained Use of Sedatives and Analgesics, the 2012 Guidelines for Insulin Infusion Therapy in Critical Care and has worked on several other guidelines. She is a Master Fellow of SCCM. Dr. Jacobi is also a member of the American Society of Health-System Pharmacists. She serves on the editorial boards of Critical Care Medicine, Critical Care Explorations and Phar-macy Practice News and is a reviewer for many other journals.

Lori Kaczmarek, M.S.N., R.N., VA-BCTM is a Vascular Access Clinical Specialist, Speaker and Consultant based in Milwaukee, Wisconsin. Currently, she consults for Adhezion Biomedical, LLC, in Wyomissing, Pennsylvania and Becton, Dickinson and Company in Franklin Lakes, New Jersey.

Ms. Kaczmarek’s experience includes directing vascular access nurse teams in hospital/acute care, long-term care and sub-acute care across several Midwest states in addition to placing vascular access devices. Her nursing career includes two decades practice in cardiac and transplant critical care settings.

Ms. Kaczmarek holds a Master of Science in Nursing with specialty focus in Health Care Informatics and has presented at national and international venues on topics relating to vascular access data collection and management, vascular access devices and current research, standards for vascular access, team organization, and team communication. She is board-certified in Vascular Access since 2011.

Ms. Kaczmarek is a member of, and President-Elect for, the Association for Vascular Access (AVA) national board of directors and served as Interim President of the Association for Vascular Access Foundation (AVAF) board. She is also a member of the Infusion Nurse Society (INS), Canadian Vascular Access Association (CVAA), Wisconsin Vascular Access Network (WISVAN) and Illinois Vascular Access Network (IVAN). Ms. Kaczmarek is an honored member of Sigma Theta Tau, International Honor Society of Nursing.

ACCREDITATIONThe American Society of Health-System Pharmacists (ASHP) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

www.ashpadvantage.com/vesselhealth

n ACPE #0204-0000-19-428-H05-P n 1.5 contact hours I Application-based n Qualifies for Patient Safety CE

D113400ASHP.indd 2 11/11/19 12:31 AM

Release date: March 2, 2020Expiration date: March 2, 2021

an interprofessionalapproach to improving medication ......an interprofessionalapproach to improving...

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