Children’s Mercy’s ‘Save the Vein’ Program
According to the Centers for Disease Control, almost 10,000 children and adolescents in the United States are living with end stage kidney disease (ESKD). For those who have experienced kidney failure since childhood, healthy and patent veins often serve as their lifeline.
“It’s well-known in pediatric nephrology that as these children reach adulthood, their veins are often worn out because of injury caused by repeated IVs and unavailable to serve as a vascular access for dialysis,” said Dr. Bradley Warady, Director, Division of Pediatric Nephrology. “This issue contributes to their long-term morbidity and mortality.”
To address this potentially life-threatening problem, Children’s Mercy implemented a unique quality improvement (QI) initiative in September, 2018 called “Save the Vein” to help preserve the veins of children with chronic kidney disease (CKD) and ESKD by preferentially using the dominant arm for lab draws and IV placement, while preserving the veins of the non-dominant arm.
“In the past, we just put IVs in the best vein available,” said Dr. Warady. “When we looked at the experience of our hospitalized patients with CKD/ESKD over a six month period prior to initiating “Save the Vein”, we found that it was 50-50 as to whether the IV was placed in the dominant arm. It became clear that there was no strategy to preserve veins and the perfect opportunity to approach this issue from a QI perspective.”
A multidisciplinary “Save the Vein” team was formed and was led by JoLynn Grimes, RN and Dr. Warady from Nephrology, with representatives from Nephrology, ED, PICU, Infusion team, Same Day Surgery, Operating Room, 5 Sutherland, Interventional Radiology, Vascular Access team (VAT), Pre-admission Testing and Child Life. Patients with advanced CKD had critical information notes placed in the electronic medical record to alert clinicians about the vein preservation strategies, and all hospitalized “Save the Vein” patients had a pink wristband placed on the non-dominant arm to indicate which arm should not be used for vascular access, if possible. Education regarding the initiative was also provided to clinicians throughout Children’s Mercy, in addition to patients and parents. Finally, audits of IV placement were conducted and reviewed by the “Save the Vein” team monthly.
“Children with chronic kidney disease typically require multiple IVs throughout their childhood as a result of their complex disease, so it’s important to institute a strategy to preserve veins in these children in case they need a fistula (an artery and vein surgically placed together for hemodialysis) when they’re older, says Dr. Warady”. What we're trying to do through our actions today is lessen the long-term medical burden for these kids, who ideally have a long life ahead of them”.
The two year results of “Save the Vein”, which were presented at the Annual Dialysis Conference in early March by Ms. Grimes and which were recently published in the American Journal of Kidney Diseases and first authored by Nisha Singh, MD, are evidence of what can be achieved by a group of providers at Children’s Mercy who are passionate about improving an important aspect of patient care. Over the two years, the percentage of IVs placed in the dominant (preferred) arm increased from 47% to 93% for all targeted patients, and in those patients < 5 years, dominant arm placement increased from 25% to 94%. The VAT placed more than 1/3 of the IVs to make it possible to place the IV in the desired arm without any child experiencing more than 2 attempts at IV placement. The success of “Save the Vein” has resulted in many pediatric kidney programs across the nation now instituting a similar program
Dr. Warady says that while the focus of “Save the Vein” is on children with kidney disease, he can eventually see the program becoming a hospital-wide initiative about vein preservation.
“There’s a lot of other kids with chronic illnesses that are high-risk for vascular access related issues over their lifetime. And while we can’t change their disease, by paying attention to the sometime overlooked importance of vascular health, we can help make a significant difference in the long-term outcome of these children.”
Learn more about the Division of Pediatric Nephrology at Children's Mercy, one of the top-ranked kidney care programs in the nation.