Does Protocol Access of Totally Implantable Venous Access Devices at Emergency Department Affect Patient Care?

Objectives: Patients with Totally Implanted Venous Access Devices (TIVAD) are regularly seen in the emergency department (ED). TIVAD access is an essential nursing skill. TIVAD is accessed by specialized trained inpatient nurses. We hypothesized this process, delays patient care at the ED. This Descriptive study is to determine the timeline taken for patient seen by ED physician till TIVAD accessed and treatment instituted. Material and Methods

Pediatric patients with TIVAD access at ED were included. Patient demographics, triage level, diagnosis, and timeline for patient seen by an ED physician till TIVAD accessed and treatment instituted, as well as the need for immediate alternate vascular access and ICU admission were evaluated. Categorical variables were summarized as frequencies, percentages and compared by Chi-square test. The continuous variables were compared by t-test. The level of statistical significance was set at P < 0.05.

Results: The evaluated 228 patients (50 % males) with a mean age of 61.5 months, a CTAS level of II and III were mostly hematology-oncology (81%) and medical genetic patients (16 %). The main presenting symptoms were fever (65%) and vomiting and diarrhea (20 %). The Median time interval from physician orders to TIVAD access and treatment instituted was (62 and 133 minutes respectively). The majority (64 %) of patients was admitted with less than 5 % to intensive care. Eleven percent needed immediate alternate vascular access for life saving medication (Odds ratio = 3.3 95% CI 0.34 to 25.6). Delay of TIVAD access (more than 30 minutes) was clinically but not statistically significantly associated with a higher triage acuity level and intensive care admission.

Conclusion: Protocol access of totally implantable venous access devices delays patient care. Hence training and privileging of ED nurses to access TIVAD is preferred for optimum timely sensitive health care.