A dedicated consultant-led vascular access team significantly reduces out-of-hours and emergency permanent central venous access insertions.
OBJECTIVE
The insertion of a permanent central venous access device (PCVAD i.e. Broviac or Hickman lines and vascuports) is often considered a low priority and performed as an emergency. In 2004, a vascular access team (VAT), responsible for all PCVAD insertions, was established in our institution to address this.


METHODS
Data were collected retrospectively on all PCVAD insertions in 2 periods (January 2002-December 2003 and January 2005-December 2006). This included procedure, list type, surgeon grade, and operative time.


RESULTS
During 2002 to 2003 and 2005 to 2006, 465 and 569 PCVADs were inserted, respectively (22% increase). After introduction of the VAT, the percentage of lines inserted during emergency lists fell from 24% (n = 112) to 13% (n = 72), and out-of-hours fell from 6% (n = 29) to 3% (n = 17; P < .05), respectively. Median time taken for PCVAD insertion in 2005 to 2006 was significantly less if using an elective list compared with insertions performed on an emergency list (elective, 67 [56-82] minutes vs emergency, 85 (65-110) minutes; P < .05).


CONCLUSIONS
Introduction of a VAT has led to a significant decrease in emergency and out-of-hours PCVAD insertions, despite an increase in overall activity for the period. The median time taken for elective insertions is significantly less than emergency insertions, which has increased the efficiency of vascular access provision at our institution.
Department of Pediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, B4 6NH Birmingham, UK.
John M
JM
Wells
Wajid B
WB
Jawaid
Peter
P
Bromley
James
J
Bennett
G Surren
GS
Arul
D039602:After-Hours Care / Q000706:statistics & numerical data; D002405:Catheterization, Central Venous / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D003253:Consultants / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D010348:Patient Care Team / Q000592:standards; D012189:Retrospective Studies; D013997:Time Factors; D013996:Time and Motion Studies