December 7, 2018 • 67 mins
Episode 10 of the ISAVE That Podcast, sponsored by AVA ACADEMY, features a conversation with the brains behind MiVAN, the Michigan Vascular Access Network, a clinician who found her niche through AVA and a Beyond the Manuscript segment highlighting a case study set to publish in the winter issue of the Journal of the Association for Vascular Access.
0:00 – A word from AVA ACADEMY, our Episode 10 sponsor.
0:49 – We've reached double digits in the podcast game! Ramzy and Judy join Eric from San Diego to preview Episode 10.
6:18 – A brief word from our Episode 9 sponsor, AVA ACADEMY.
7:15 – Ramzy sits down with Kelly Ann Zazyczny, MSN, RN, NE-BC, CPN, VA-BC™ to discuss how AVA helped shape her career as a clinician.
36:40 – Ramzy checks in again, this time at the November MiVAN symposium in Plymouth, Michigan, where he chats with founders Matt Gibson, RN, CRNI®, VA-BC™ and Jeff Hanks, RN, BSN, VA-BC™ about network best practices.
51:26 – Beyond the Manuscript: Eric interviews Connie Girgenti, RN, BSN, VA-BC™ the author of a case study on mid-thigh femoral PICC placement set to publish in the winter 2018 issue of the Journal of the Association for Vascular Access.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
This episode of ISAVE That Podcast is made possible by the
AVA Academy, debuting in early2019 from the Association for
Vascular Access.
AVA Academy is where you'll findthe best-in-class cutting edge
Vascular Access education fromPICC insertion to our
ultrasound-guided peripheral IVcourse.
For more information, subscribeto the ISAVE That Podcast,
(00:23):
follow AVA on any social mediaplatform and become an AVA
member today.
From the Association forVascular Access, this is the
ISAVE That Podcast.
Ramzy (00:50):
It's Season 1, Episode 10 of the ISAVE That Podcast.
We made it to 10!
Eric (00:53):
Double digits!
Ramzy (00:58):
Double digits.
It's Ramzy Nasrallah, I'm in SanDiego with Judy Thompson.
Eric Seger is in Columbus, Ohio.
Eric (01:05):
Hi!
Judy (01:05):
In the sunny city of Columbus, Ohio.
Eric (01:07):
It's just gorgeous here, you're right.
Ramzy (01:07):
You haven't seen the sun since...
but Ohio State beat Michigan.
We got that on the podcast.
It's now been said, it's nowbeen recorded.
Eric (01:14):
That's right, boom.
But yeah, it's been 40 and rainylast few days, but it's all
right.
It is what it is.
Judy (01:18):
It rained in San Diego.
It did rain last week or thisweek in San Diego.
But we're back to sunshine.
Ramzy (01:25):
Yeah, probably at 3 a.m.
We have a lot to get to.
This is a great episode.
I sat down with Kelly AnnZazyczny in New Hope,
Pennsylvania to talk about theimpact AVA had on her career as
a clinician.
It's actually really, let's backthis up.
I was at AVA this year inColumbus and one of the people
working the Foundation boothgrabbed me and gave me her
(01:45):
business card and said this ladywas really impressive.
She made a donation to TheFoundation.
She wants to talk to you abouthow she can do more for AVA
because of the impact that AVAhas had on her career.
Judy (01:58):
That's awesome.
Ramzy (01:58):
And that was a story I needed to hear.
And that's a story that you allwill hear, as I met her in
Pennsylvania a little while ago,and walked through how she took
a job as a pediatric nursemanager.
And upon accepting it was told'aha!' You also get the Vascular
Access Team.
That was her introduction toVascular Access and she'll talk
about not just how that impactedher personally and her career,
(02:21):
but ultimately it really helpedadvance her career of being at
the forefront to what we callthe gateway to all healthcare
delivery– it starts withVascular Access.
So that's coming up next andEric, you've got a section with,
a Behind The Manuscript sectioncoming up.
Eric (02:37):
I do.
I had a nice conversation withConnie Girgenti.
She has a case study on amid-thigh femoral access, coming
up in the next, or the finalissue of JAVA for 2018, the
winter issue.
So, we spoke a little bit aboutabout that case specifically and
how that's, the mid-thigh workhas really, as I understand, and
(02:59):
Judy you correct me if I'mwrong, really sort of blown up
in recent time.
I know Matt Ostroff was onbefore, he mentioned a while
back in earlier in the season inspeaking with Ramzy about
presenting on his mid-thigh workand we have also published a
case study of his in JAVA.
So, I think that's kind of atopic that's really hot right
(03:20):
now.
Judy (03:21):
Yeah, I agree, Eric.
In fact I talked to Matt quite afew times about it.
I am about to go up to NewJersey and film at his hospital.
We're going to go over mid-thighwork and create a course for
AVA, for our AVA Academy.
So, there's a lot of hubbubabout mid-thigh work.
We're so proud of Matt, proud ofclinicians that are the early
(03:42):
adopters.
So, this is going to beexciting.
I can't wait to read what Conniewrote.
Ramzy (03:47):
She's ahead of it.
Mid-thighs are in the forefrontand we're trying to get ahead of
it, too.
I like that you mentioned, youslid AVA Academy in there too.
In a future episode, we'll betalking in depth about AVA
Academy because that's thething.
Eric (03:57):
Branding, branding.
Ramzy (03:58):
Hashtag branding.
Finally, we have a section todayon the episode on network
excellence.
AVA is virtual and national andglobal, but it is also local.
And last year in the spring Iwas with Vineet Chopra, whose
university lost to Ohio State infootball, last week.
Judy (04:18):
Didn't you just say that?
That's twice now.
Ramzy (04:18):
I did, I wanted to make sure everyone heard that.
Eric (04:22):
Not only did they lose, they gave up 62 points.
Ramzy (04:24):
Sixty-two points.
I can't believe it.
Judy (04:26):
You know, we like Vineet.
What are you doing?
Ramzy (04:28):
We do like Vineet.
Well, this is part of this, itcomes with the territory.
Eric (04:33):
He can come on and defend himself.
Ramzy (04:34):
He can, he'll be filled be on podcast soon.
I was with him in Perth and hementioned to me that there was a
Michigan Journal Club forvascular access that this guy,
Matt Gibson, had started.
And he really thought it shouldbe a network.
In lieu of waiting to get backto the states– Perth is 12 hours
ahead of eastern time– so Ithink we were together at like 9
(04:57):
p.m., and I called Matt in frontof Vineet at 9 a.m.
Green lighted, the MichiganVascular Access Network, which
by the way is called MiVAN, eventhough it should be called
MOTORVAN.
But he and Jeff Hanks, in oneyear's time put together really
what a network should look likefor AVA anywhere you go.
(05:18):
I mean, it's got enthusiasm,leadership, organization,
industry involvement.
I just went to their big annualsymposium.
It was just incredible and Icannot believe it's only a year
old.
So I spent some time with Jeffand Matt talking about best
practices for networks and howthey were able to turn MiVAS,
the Vascular Access SocietyJournal Club that Vineet had
(05:38):
told me about, into MiVAN, areal shooting star of a network
for us in the eastern side ofthe US.
Judy (05:47):
If only it was MOTORVAN.
Ramzy (05:48):
We'll get to it, we'll get there.
Eric (05:50):
Everything I saw from that meeting looked like it was
fantastic and obviously we evendid some stuff with social media
on it.
So, after break though, we'regoing to have Ramzy's
conversation with Kelly Ann'sZazyczny.
So, please stay tuned.
Speaker 1 (06:17):
This episode of ISAVE That Podcast is made possible by
the AVA Academy, debuting earlyin 2019 from the Association for
Vascular Access.
AVA Academy is where you'll findbest-in-class cutting edge
Vascular Access education fromPICC insertion, to our
ultrasound-guided peripheral IVcourse.
As always, you'll still be ableto pick up CE credits through
(06:39):
JAVA articles each quarter andby attending virtual sessions
from scientific meetings.
AVA Academy takes VascularAccess education to the next
level.
We are developing insertion,care and maintenance courses for
the full spectrum of VascularAccess Devices and procedures.
AVA Academy is open to thepublic and AVA members will
receive significant discounts onall education.
(07:00):
For more information, subscribeto ISAVE That Podcast, follow
AVA on any social media platformand become an AVA member today.
Ramzy (07:15):
We are in New Hope, Pennsylvania at SkyRoast Coffee
on Main Street.
There is some ambient noise inthe background.
So if you hear the, the sultrytones of jazz music and people
having coffee conversations,that's not fake.
It's very real.
I am joined today by Kelly AnnZazyczny, who is a nurse at Main
Line Health and was brought tomy attention at conference this
(07:37):
year as I was being pulled inseveral different directions.
I had one of the members of ourFoundation Board of Directors
pull me aside and said, told methat you have to meet this lady.
And I did.
And he was absolutely right.
AVA is something that advancesits cause through storytelling.
And I thought that the podcastaudience would benefit from
(07:58):
hearing Kelly Ann's story of hownot that she went out and found
Vascular Access, but howVascular Access found her.
So, Kelly Ann, thank you forjoining me today.
Kelly Ann (08:07):
Thank you so much for having me.
I'm really feel privileged tohave this opportunity to speak
to you today just because AVAhas become so important in my
professional career.
Ramzy (08:19):
And that's really the crux of the story.
Like how, you know, you didn'tgo out and find AVA, AVA sort of
found you.
Can you talk a little bit abouthow your career pulled you into
being almost a Vascular Accessspecialist without you going out
and seeking it out?
Kelly Ann (08:35):
So, in 2008, I had come to Main Line Health and had
interviewed for a pediatricmanager position.
Being that is my, I will alwayssay that I'm a peds nurse by
heart.
I have worked at the Children'sHospital of Philadelphia and
then had the privilege ofworking Children's Healthcare of
(08:57):
Atlanta.
And so when we moved back upnorth, I had gone back to chop
for a short amount of time, butthen had called a colleague and
she had told me about that theyhad this peds manager position.
So, I interviewed for it andafter several months and really
(09:17):
kind of making the formaldecision to make the move, I
took the position.
And then once I got in it theysaid,'Oh, by the way, the
previous manager was not onlythe peds manager, but she also
had the IV team.'
Ramzy (09:30):
Oh, nice.
Congrats!
Kelly Ann (09:33):
But for me personally, even though I wasn't
a Vascular Access nurse, I had afull appreciation for the
specialty being a peds nurse.
I had great people like AnneMarie Frey, who's very involved
in AVA in the pediatric subgroupwho was an IV nurse at chop,
(09:54):
that I spent many hours with herin the treatment room watching
her put in PICC lines an IVs.
And just really being veryappreciative of their role and
their support and care ofpatients.
And then when I went to Atlanta,you have people like Judy Burns
(10:14):
who actually taught me how toput an IV in because at the time
Choa had gotten rid of their IVteen and then shortly decided
that that really was not a goodidea in pediatrics.
And so they brought it back.
So I always, when I see her atthe conference every year, I'm
like, there's Judy, she taughtme how to put in IVs.
(10:37):
And then I managed a sedationnursing service at Choa.
So, you know, nurses that had tobe skilled in putting in IVs.
So for me, I was like,'OK, Ireally appreciate this.
I can do this.' What I learnedis that, then what happened was,
(10:57):
is that then they startedgetting me fully engaged where
they said,'Well, when Mary washere, we actually had a system
committee and we need a leaderto be the executive sponsor.
Could you be our executivesponsor?'
Ramzy (11:10):
You're find out more and more about your new job.
Kelly Ann (11:11):
Yeah.
'Can you be our executivesponsor so we can have meetings
again?' And I was like,'OK, Iappreciate that.
That they want to get togetheras a system, the four different
teams to kind of talk about bestpractice.' What I learned very
quickly was, is that, even inour own organization, there was
(11:35):
such different philosophies ofpractice.
It wasn't consistent.
It wasn't really consistent withwhat I was reading because the
type of manager or leader that Iam, if I'm going to manage a
group, I have to learn aboutyour work.
So, that kind of scared them alittle bit.
(11:57):
I remember saying to them,'OK,I'm putting on scrubs and I'm
going to follow you around forthe day.' And then I was like,
'OK, well this is a differentcatheter.
Let me try it and put an IV in.'And I got in and I remember the
nurse that I was falling aroundthat was brave enough to take
me.
She said,'You are the firstnurse manager I have ever had
(12:21):
that actually knows how to sticka patient.' And I was like,'Oh,
OK, that's great.'
Ramzy (12:27):
That's high praise.
Kelly Ann (12:29):
It was, and what I learned as a nurse leader is
that if I'm going to buildcredibility with the staff, I
need to be able to do the job.
I need to be knee deep in itwith them so that I can really
understand what they'restruggling with.
Like, what is the challenges ofthem being able to give the
(12:52):
great care that they want togive to patients.
I know that's not every nursemanager's philosophy, but for me
it really has worked.
And I feel that I, the successthat we've had at Main Line
Health and the reason why wehave such great outcomes is that
(13:14):
I really try to work alongsidethe staff so that I can really
fully appreciate of what I cando as a nurse leader to support
them in their role so that theycan better take care of their
patients in the best capacity.
Ramzy (13:31):
Managing Vascular Access specialists is helpful if you
are a Vascular Access specialistyourself.
Kelly Ann (13:37):
Right.
Ramzy (13:39):
And this is something that I think is pervasive across
the industry.
I used to sell products.
I've had managers who had neversold before.
It's difficult to acceptcoaching from someone who's
never been in the trenches.
Same thing with if you're anartist reporting into someone
who has no appreciation for art,you want to understand what the
guild is up to.
(13:59):
So, you're a pediatric nursemanager.
You've inherited the IV team,you're now learning about how to
stick patients and thecomplexities that go into
vascular access.
Talk a little bit about thatjourney and how you eventually,
Vascular Access became importantpart of what you did on a daily
(14:20):
basis.
Kelly Ann (14:22):
So, shortly, I guess within the next year, I believe
that the staff were all going toan AVA conference.
It was in National Harbor wasthe one of the first ones I had
gone to.
And so they said, do you want tocome with us?
So, here I was, we drove down,there was a whole group of us
(14:44):
and we went for the conferenceand it was just an amazing
experience for me.
It was the beginning of me thensaying I need to come to these
every year because I got to meetgreat people like Nancy Moureau
and Jack LeDonne and um, myfriends at AVATAR, Claire
(15:08):
(Rickard), where you have theopportunity to interact and
network with some of thefounding leaders of this
specialty.
And get your questions answeredor kind of just brainstorm about
challenges that you're having.
(15:30):
And every time I go, I alwayscome back with a renewed sense
of enthusiasm.
And actually once again, I doscare the staff because I come
in, I'm like,'You'll neverguess! I got a great new idea of
what we're going to do next!'And they're like running for the
door.
'Oh no, she's, she's fired upagain! Here we go!'
Ramzy (15:52):
She went to AVA again!
Kelly Ann (15:53):
I went to AVA again! But, I mean, it really has been
such a tremendous asset becauselike Nancy Moureau's PICC
Excellence– that is ourfoundation.
Every nurse at Main Line Healthhas to do the online training
for PICC insertion andultrasound utilization.
(16:15):
And we use that as ourfoundation education.
For me, that was so helpfulbecause this isn't my area of
expertise.
So, I would have had to eitherspend a lot of extra time trying
to research various educationaltools or platforms and then
tried to get that approved inour organization.
(16:37):
And what happened was, is we hada company actually sponsor it
for us for a year for free.
The membership.
And then from that we were ableto see that there was a lot of
great CEUs and it just helps meprovide consistent education
that I know having worked withNancy and spoken to her on a
(17:00):
regular basis, that this issomebody that I think she has
been pivotal in providingVascular Access education and I
know it's credible and I knowshe's always updating it.
So, it's one less extra thingthat I have to work on.
And so, I've been able to usethat.
(17:22):
The whole target zero like Ihave made that my mission.
In 2008 or 2009 we startedtalking about target zero and
that we can't make excusesanymore about central line
infections and that they justhappen.
(17:42):
That we really have to thinkabout our own professional
accountability and what we'redoing and what our
responsibility is to ourpatients.
They shouldn't be sick and thencome into the hospital and get
another complication because ofus.
Using AVA and the variouslectures that you've had, we
(18:05):
have really elevated ourpractice and in 10 years we've
reduced our CLABSIs by 86%.
We have had two of our hospitalsthat have gone a year and a half
to two years at zero.
Every day where we're trying tosay what can we do and how can
(18:26):
we do it better to protect ourpatients.
And I remember early on, justbeing exposed to different,
having the different partners atyour conferences.
So to me, I love that.
That's like going to a largeflea market and just having
(18:47):
everybody at my finger tipswhere I don't have to sit there
and make phone calls and emailsand try to bring various
different companies in because Iwant to look at a new product.
You have them all there at theconference.
So, actually I usually get thegroup together.
(19:09):
I'm like,'OK, so what are wegonna look at this year?
OK, you go to this booth, andyou go to this booth.' And then
we come back to our systemcommittee and we, we make
decisions about, OK, well theseare the products, this is what
we're having difficulty with.
These are the products thatwe're interested in looking at.
And then, you know, we have theinformation, we have
(19:31):
discussions, then we bring acouple in.
So, that's really been veryhelpful for me because, you
know, it's just challenging toget through the day-to-day.
And I think I've been successfulin changing a lot of our
practice with the support andthe expertise of our Vascular
(19:53):
Access teams because I supportthem going to conferences and
you know, we're all members ofAVA.
So, we're reading the Journal.
The new thing is we're talkingabout the mid-thigh PICC line
and I'm like,'OK, that's next onour agenda.'
Ramzy (20:17):
That's next on our agenda too, by the way, from an
educational standpoint.
It's something Judy Thompson,our Director of Clinical
Education is pursuing to captureprocedure videos specifically
for mid-thigh.
Let's take that further (20:27):
AVA has, I came on a year and a half
ago and I've been trying topreserve just how special the
annual conferences but also makeAVA a 12-month organization.
You live in and we are right nowin eastern Pennsylvania.
There are a couple of AVAnetworks near here.
What has your experience beenlike on the local level with AVA
(20:50):
in Pennsylvania and on the NewJersey border here?
Kelly Ann (20:53):
So, I've been involved for probably the last
year or so.
And that was again the staffsaying,'Hey, we have local
chapters now can you come to themeetings?' And actually, to be
honest with you, it's been verypositive because, I knew, they
had Jack LeDonne show up for oneof theirs.
(21:14):
They had you at one of them.
Ramzy (21:16):
Right.
Mauro Pittiruti, basically, thepope's doctor was there.
Kelly Ann (21:21):
I think that this is actually, I am 100% in support
of this, especially because alot of organizations are not
paying for conferences for theirnursing staff.
So, you have a lot of peoplethat make sacrifices because
they're committed to thespecialty to go to these
(21:43):
conferences and they might notbe able to go every year, but
they save so that they can goevery other year.
And so, I think that it isimportant for us to really have
that grassroots regional type ofprogramming and chapters because
(22:04):
it will only allow more peoplethe opportunity to have at least
a small experience of what youwould get at the national level
when we have our conferencesevery year.
Ramzy (22:20):
So Kelly Ann, picture someone at work and they want to
go to AVA, they can't get thetime off or the support.
How effective do you think thenetworks would be on a local
level to have that person bringpeople from work, bring 3 or 4
colleagues to see what a localAVA network meeting looks like?
How does that, do you thinkthat's an effective way to get
(22:41):
people involved in VascularAccess?
Kelly Ann (22:44):
I do because I think when you see– the people that
are organizing the regional AVAchapters are people that have
attended conferences that arevery experienced, that share the
passion and it just radiates offof them.
(23:06):
And actually even at our localchapter, they I don't know if
they took the dues or they got asponsor, but they actually every
year they kind of raffle off aregistration for AVA so that
somebody might have theopportunity to go to the
conference
Ramzy (23:25):
Our AVA Industry Partners generally will pay for those,
give them through the networks.
And then that's the way to getmore people going to AVA.
And from a, I mean, I came fromindustry, I'll tell you this: My
best customers were AVA members.
Because they get it.
It's a lot easier to talk aboutjust how important
evidence-based interventionsreduce Vascular Access
(23:46):
complications or make theprocedures easier is when
someone understands theprocedure and the gravity of
what's at stake with somethingthat's for all intents and
purposes, the gateway tohealthcare delivery.
Kelly Ann (23:57):
And I think too is that these regional chapters,
they bring people together thatare from other hospitals.
So, you know, we have a veryrobust team and I do support
them to get to go to AVA.
So, they have learned so muchfrom being involved with what
(24:20):
best practices and then they'reable to have those discussions
with people in our own regionand kind of just translate that
information.
So, even if they can'tpersonally attend, I feel like
we're able to reach more peoplebecause you have people that do
attend the conferences that canthen kind of maybe ignite the
(24:44):
interest of other people toeither attend or even just help
support them in their ownjourney of becoming better
practitioners.
Ramzy (24:52):
Right.
It starts at home.
I mean, you got to go toNational Harbor and kind of
caught it there, but if you'regoing every quarter and
connecting with hospitals thatyou're familiar with, it helps
bridge that gap.
So, you started as, you're thepediatric nurse manager, you
found out after you accepted thejob that you had the IV team
and, fast forward a few yearslater, you now oversee all IV
(25:16):
therapy operations at a 4hospital system.
Kelly Ann (25:19):
Yes, that is correct.
Oh, we should also add that overthe last 10 years I've been
asked to speak at various eventsand conferences related to
Vascular Access.
So 2 years ago I did get mycertification because I thought
I needed a little credibility asa specialist.
Ramzy (25:39):
The Vascular Access board certification, yes, from VACC.
This is the kind of story thatI'd like to scream from the
mountain top.
This is what people, what's theface of AVA?
It's people like you, VascularAccess found you, it had a
significant impact on yourcareer.
It's having an impact onpatients in your community.
Kelly Ann Zazyczny (25:59):
We need, we need more of you.
I think that there's a lot ofyou out there that just don't
know it yet.
Kelly Ann (26:04):
I think too is that if anybody needs me to speak to
their manager about theimportance of them really
educating themselves related toVascular Access, I'll be more
than happy to do that.
Because I had a colleague ofmine, she was actually the Dean
(26:25):
of Villanova.
She was actually the longestacting Dean and she passed away
last year, and so I was veryclose with her and intimately
involved with her during herjourney of illness.
And she got to a point wherethere really wasn't many options
to provide her Vascular Accessbecause she was a cancer
(26:47):
survivor twice and just thevarious therapies.
And I just think that what weneed to focus on and try to help
support our healthcarecolleagues is that we need to
look at the long term effects ofthe treatments that we provide
our patients and how this isgoing to impact their
(27:10):
vasculature.
Roy George, who had spoke atAVA, that young man, I actually
became very friendly with him.
He now corresponds with my, myoldest daughter because of their
love of jazz.
I say to him all the time, like,he's my hero.
(27:32):
Because as a peds nurse, we didall these things because we were
trying to help save these kids.
And you never know what happensto them or do they live into
adulthood.
But he's just a prime exampleof, he is an amazing, beautiful
(27:53):
human being that is just doingamazing work in music industry.
But at a cost, right?
So, he survived, but he reallyhas limited vasculature now.
And you know, I pray for himevery day because I would never
want something to happen to himand him be in a situation that,
(28:16):
'Oh, we have a therapy for you,but sorry, you don't have any
veins left.' And the same thingthat happened to Dean
Fitzpatrick is that, with hercardiac and from having
chemotherapy, like all of hervasculature in her upper body
was totally stenosed.
(28:39):
And so, I think that that'sreally where our focus and the
whole mission of this vesselpreservation.
And I know that that's going tobe our work.
I really feel that, uh, my joband I tell the staff now, it's
like I need to provide you atoolkit like where you have soup
(29:02):
to not.
So, I expect before my time isdone that they will be putting
in IOs and advanced centrallines and that.
Our dream is that the physicianwill one day say,'I'm consulting
the Vascular Access team and youchoose what is the best device
(29:24):
for the patient.' Becausereally, unfortunately they don't
really have that understanding.
They just know the therapy theywant to provide.
They don't understand that, thedelivery and that.
We have these patients that havehad multiple PICC lines.
Ramzy (29:45):
Venous depletion, is a very real thing.
Kelly Ann (29:45):
It really is, and it's a really scary thing.
And I remember the first time Iheard that at an AVA conference:
There was a woman who presentedfrom Canada where she was
talking about these dialysispatients and how you have
somebody that's on dialysis andthat we have a treatment for
(30:05):
you.
But guess what?
You don't have any veins left.
That really was impactful forme.
Ramzy (30:10):
Yeah.
You get to watch yourself expirebecause you've run out of veins.
Kelly Ann (30:18):
I'm just starting the message at our organization and
I've spoken to a large systemgroups of physicians to say
you're doing a great job insurvivorship.
You really are.
But what we really need to talkabout is what are the
consequences of the treatmentsthat you provide your patients
(30:40):
longterm?
Because after you say, Yay,you're cancer free, I still now
have 40 years of my life that Icould have another illness that
will require a vascular accessdevice.
Ramzy (30:55):
Right.
As a cancer survivor yourself.
Kelly Ann (30:57):
Yes.
It really has hit home.
Ramzy (30:59):
So you've really helped demonstrate the journey to find
Vascular Access, to VascularAccess finding you.
The passion and the urgencybehind what we do.
If I'm a new nurse or a residentdoctor or a patient advocate or
a stakeholder in healthcare,what would you say, Kelly Ann,
to someone about the importanceof having Vascular Access to be
(31:24):
a foundational part of yourexperience and your awareness
and healthcare?
Kelly Ann (31:29):
I think that it's actually vital for them to get a
baseline education andknowledge.
And if they don't have thatknowledge, because one of the
epidemics in our society todayis nursing schools, medical
schools, they're not teachingthis anymore.
(31:52):
And then they think that you'regoing to learn this on the job.
And there are so manyorganizations that, as a quick
fix for the organization to savemoney, they've gotten rid of
their Vascular Access teams.
But you know, if I could callout to my friends, Claire, I
think that in AVATAR Group, Ithink the next study should be
(32:13):
really looking at thoseorganizations that have Vascular
Access teams, that's kept strongteams and what are their patient
outcomes compared to those thatdon't have them.
I see it every day that theyjust don't have the skillset or
(32:36):
the education or the knowledgeof,'Oh well she said it hurt.'
And then you look at it andyou're like,'OK, that's a
phlebitis.
But things that are so basic tous, for other people, they
really just haven't gotten agood foundation.
And how are we going to createthat partnership where they
(33:02):
might not be the ones being theinserters, but you know, they
definitely have to have a strongknowledge base for the care and
maintenance because as the teamsays to me every day, I can't
look at every peripheral IVevery day.
There's too many of them.
And so we really need to helpstrengthen that education for
(33:25):
that frontline staff.
I think, you know, theconversation I'm having with our
physician group, that whole"seeone, do one, teach one,' to me
that is the standard of teachingright now.
That is the standard of teachingand that is one, a huge
(33:45):
liability for patients.
We had a patient that, we don'tprovide 24 hour, Vascular Access
service.
So, we have patients that comein when we're not here and
they're left to be poked andprodded by residents.
(34:05):
And I'm not trying to beat up onour physician colleagues, but
they haven't been given athorough education on how to
properly do that.
So they've stuck this patientlike 3 or 4 times, probably
didn't use the best technique.
And then the next day I'm comingin and'Oh, let's take, take out
(34:29):
that line because it's a femoralline, it's not good for the
patient.' Now we're providinganother invasive procedure for
them.
You know, we just, I reallythink that we need to look at
that and come up with a betterstrategy.
And my goal at our organizationas I've already just had a
little initial conversation withour system medical vice
(34:55):
president for surgery to say, Iwant us to partner with the
residents.
Like I think you can takeVascular Access nurses and the
residents and the PAs and thephysicians and let's partner
together so that we have aconsistent best practice for
insertion, that we put thoselines in the proper way so that
(35:19):
as Jack would say, then the endusers, the front line staff can
actually care for them properlyand they can manage the care
properly because we put them ina better fashion and we can get
better outcomes.
Ramzy (35:40):
It's a departure from what's now the standard of care.
You weren't beating up on yourphysician group.
That's a story you can tell atjust about any hospital.
Kelly Ann, thanks for your time.
If anyone listening would liketo connect with Kelly Ann, as
she offered, you can just emailpodcast@avainfo.org and we can
broker that connection.
Kelly Ann thanks for your time!
Kelly Ann (35:59):
Thank you so much! It was such a pleasure to speak
with you today.
Eric (36:03):
Up next, we have Ramzy's conversation with Jeff Hanks and
Matt Gibson, the two men behindthe genesis of MiVAN, the
Michigan Vascular nccessnetwork, about how they have
(36:24):
grown that network into what itis today.
Ramzy (36:25):
And I'm joined today by Jeff Hanks and Matt Gibson, the
co-founders of MiVAN, that isthe Michigan Vascular Access
(36:46):
Network.
We are actually at time theannual MiVan conference today in
Plymouth, Michigan.
It is an all day symposium.
It's basically Lollapalooza,who's who in Vascular Access.
This network did not exist 2years ago.
We're here today to learn fromthese 2 guys on what the best
practices are for running aVascular Access network, since
(37:07):
AVA works best at the locallevel where you live and work.
But also how they're able tocreate this community and pull
folks into AVA at a national anda virtual level.
Jeff and Matt, thanks for thetime today and wow, look at the
success you have– we just left apacked exhibit hall that that
was part of a break with vendorsthat came after a packed
(37:30):
symposium hall.
Tell us about where this camefrom and how you got it to the
point where it's just rollingright now.
Jeff (37:37):
So this was originally, Matt and I were working
together, in a hospital and,discovered that we had like
passion about Vascular Accessand education and patient
advocacy.
He started going,'Have you readthis study?
Have you read this study?' Andwe'd both had kind of read the
same stuff.
So, we hit it off from a passionstandpoint and we really wanted
(37:59):
to get a group of peopletogether locally and really push
AVA's agenda out to the localgroup.
Cause we knew we worked with alot of people that wanted to
meet locally, but they reallydidn't even know who AVA was.
There are 60 people where I workand maybe five of them had ever
heard of AVA.
The rest of them were all, I'veheard of INS and things like
(38:22):
that, but they hadn't heard of aspecialty for their own groups.
So, we decided to put thistogether, kind of customer
cowboys and we didn't want anyrules.
So, we decided to put together ajournal club cause what we
wanted to do is bring peopletogether, in a casual setting
and have a dialogue with toplevel researchers and thought
(38:46):
leaders, and expose people tothese minds at an intimate
level.
So we started doing that.
And we did that for about ayear.
It turned out to be wildlysuccessful.
People really enjoyed it.
And about the same time AVAreally started rolling forward
with more support for localnetworks.
(39:07):
So we explored what can we doto, to get a hold of this more
into AVA.
We contacted Cindy and she'sbeen a huge support.
You've been a huge support andwe talk all the time.
We love this thing.
It's a blast.
We're astounded that we had 95people register an 95 people
(39:28):
show up and all the vendorsshowed up.
Not one single person didn'tcome.
Ramzy (39:34):
So from a couple guys passionate about Vascular
Access, to a Journal Club to nowa thriving and burgeoning
network.
Let me ask you (39:42):
AVA's getting better with the name recognition
in facilities, but you mentionedINS and that's an infusion
nursing pillar in thatcommunity.
How do you go about recruitingpeople to become part of AVA?
What is your pitch to them?
I mean, we are amultidisciplinary organization.
Our tagline is Protect thePatient| Educate the Clinician|
(40:03):
Save the Line.
There's a cannula involved.
Who are you seeking out and howdo you help them understand that
they have a home at MiVAN and atAVA for what they do?
Matt (40:14):
Vascular Access gets in your veins.
Ramzy (40:16):
Oh, that's a literal comment.
Matt (40:17):
It is a literal comment.
And it flows out of that.
Jeff (40:21):
It's cheesy, but you know, it was literally true.
Matt (40:23):
It's so true.
And that's how it is for me.
It's something inside of me thatI can't contain.
It's a passion, something thatjust bubbles out.
And this has been my outlet, forme to be able to bring in other
people and whenever you areexcited about something and then
(40:43):
other people get excited aboutit.
And so just from me and Jeffjust sitting at the break room
and talking about thisparticular article in this
research and whatnot, and thenwe just fed off of each other.
For us, I've been an INS member,I've been an AVA member for a
(41:04):
long time.
Both of them, and they're bothimportant to me.
You can't have infusion without,without Vascular Access.
And you can't have vascularaccess without infusion.
They don't exist.
There's no, you know, and sojust it focusing that passion
and whether you're at APIC, orINS or AVA, everyone's welcome.
Ramzy (41:27):
SIR.
Pharmacists.
I mean, multidisciplinary,multidisciplinary.
Matt (41:30):
That's right.
Everybody is welcome andeverybody can take something of
value from the things that we'reoffering and the people who are
speaking.
For me, facilitating that islike, that's why I'm a nurse,
you know, to watch people growand heal.
And that's part of the healingprocess or the growing process
(41:51):
is watching this come from sucha small thing to very
successful.
I, and Jeff I think would saythis too, we get so much from
watching this happen and, andactually watching.
You were there (42:07):
we raised half of the people in that room were
new! Half of the people! And wehave found that transition just
getting people to here andtalking to them about very
important things, things thatthey may be passionate about and
finding that there's even morethan just our local little
(42:28):
network.
That's what's important.
That is really what drives us.
Ramzy (42:34):
You've got, you've got an interventional radiologist
speaking today.
You had a pediatric intensivistthis morning, anesthesia, the
disciplines are represented.
You've got the Great Lakeschapter of INS here actively
advancing its interest becauseinfusion has a home at aAVAva
and you have accommodated thatat the level.
Matt (42:55):
And I'm glad you mentioned that because this is actually
CRNI credits being given inconjunction with the CEs that
we're giving from AVA.
I mean, someone, I'm going towalk out of here with 13 CEUs:
CRNI credits and CEUs combined.
That's a huge value.
Jeff (43:15):
Exactly.
You hit it on the head, youknow, not only is it
multidisciplinary, but what wewant to do is provide maximum
value for people's time andmoney.
Do you have a lot of things todo?
We want to make sure that youget the most out of this and we
want to bridge that gap, withwith our brothers and sisters
from those other groups thathave done a good job with
(43:36):
promoting Vascular Access.
But what you said about who wehave here today in terms of
disciplines is exactly how wemake this happen.
We thoughtfully sat down andsay, what have we done this
year?
Have we pulled in enough IRpeople?
Have we pulled in enoughinfection control people who are
the big names in these subcategories that will really
(43:58):
round us out from amultidisciplinary perspective
and then, and then get them hereor get them to a local event.
And I think that that's beenreally key for people that came,
had not been introduced to agroup like this, discovered that
they could sit next to aninterventional radiologist and
ask questions, that they couldnever feel comfortable or didn't
(44:21):
have time to ask their physicianat work or talk to a national
published a infection practiceperson like Chellie DeVries.
It's just a phenomenal value forthem and experience.
And that's how, that's how wemake a tick.
We're always, it's not about,you know, let's get together and
have some food and have alecture.
(44:43):
No, it is about that.
It is about networking first andforemost, but it's about the
content, it's gotta be relevantscientifically based and
quality.
Matt (44:57):
One of the questions that we asked ourselves about this
was what is current?
And what is important?
And what is controversial?
What are things out there that,that people, it's unclear as to
what the practice should bebecause we got to start talking
(45:17):
about those things that are grayand not just black and white.
And that's another avenue thatwe wanted to bring things here
that people want to hear aboutbut also need to hear about.
Hopefully we'll expand theirthought process and you know,
and improve patient care.
(45:38):
I mean, that's what AVA'stagline is.
Protect the patient.
Ramzy (45:42):
That's the first thing in our tagline.
Let me ask you guys as the twocowboys that are running MiVAN:
What are three things fornetwork excellence, network
management that you think arejust not optional stuff that if
you removed them, MiVAN wouldsuffer.
And if you didn't have them,you'd be a network that needed
(46:03):
to needed some upgrades.
Matt (46:05):
This can be overwhelming.
And so to have the technologicalsupport, and we do use a
software to manage the network.
And it makes our jobs verysimple, much more simple.
It does cost.
It is an expense, but so for usnot to get burned out and to
(46:29):
sustain your leadership.
I think that's the one thing issuper important.
Don't you?
Jeff (46:36):
Yeah, I think that using the tools of the day are huge.
And, you know, social media whatMatt and I've tried to do–
Matt's kind of like the big ideaguy.
Usually he throws out an ideaand I go no way, way too big.
And then we land somewhere inthe middle and it works out.
(47:00):
He has the ideas and we figureout how to make them happen.
We've got a small group ofpeople that we trust.
That's extremely important.
We couldn't do this on our own.
We built a leadership team tohelp showcase events.
And we didn't have, what wedidn't do that's different is we
didn't have an election.
(47:21):
We looked around us and we said,who is around us that No.
1 wants to help?
And No.
2 Has a skill set that we needthat maybe we don't have.
And let's build a team that,that rounds out all the things
that we need.
So that's what we did.
Matt (47:40):
We didn't want it to fizzle out.
Ramzy (47:44):
Right.
And burnout is real in everydaylife.
It's not just volunteer work.
Matt (47:49):
Having the technological support has minimized the amount
of people that we do need toinvolve.
Because you know, things that wehave done with a couple of
clicks may have taken, you know,eight or 10 people to do versus
the two of us.
Ramzy (48:06):
And you have levels of compliance with regard to the
legal stuff as part of an AVAnetwork, the 501(c)6 stuff.
You have access to CindyAnderson who is AVA's Director
of Affiliates.
Can you talk a little bit abouthow you strategically use Cindy
and how she helps MiVAN exceedyour expectations?
Matt (48:26):
Cindy is like the glue for us.
She helps us stick everythingtogether.
There is a business in this.
We are nurses, we're notparticularly just excellent
business people.
So Cindy brings in that piece tohelp guide us, direct us, and
(48:49):
mentor us, make sure that we areachieving what we need to
achieve from a structuraloperational side.
And really it gives me a reliefbecause we lean on her, so we
don't have to know.
We need the passion and we needthe drive and we need the
perseverance and the time.
Ramzy (49:10):
And the best practice, and the guardrails and the
guidance.
Matt (49:14):
That's right.
All of those things, that's whatthe clinicians and what we, Jeff
and I, have in spades.
The part that we did not is theoperational, the business and
that's what Cindy does for us.
She really helps us to form thisand make it smooth.
(49:35):
And there's a lot of rules thatwe don't know or we don't
understand.
And she keeps us on track, youknow, so she can pull us back in
and say,'Hey, this is what youneed to do.
This is a great try.
You know what you did wasfantastic but we don't need to
do that again.' And pulls usback in and really guides us and
(49:55):
supports like no like no other.
Ramzy (49:58):
The affiliate program that Cindy runs for AVA– we want
to make sure that we put you inthe best position to do what the
MiVANs of the world are nowdoing, which is to advance the
enthusiasm of AVA's mission onthe local level, protect more
patients to get more cliniciansengaged in Vascular Access all
of the disciplines andultimately transform health care
(50:20):
where you live and work.
One of the things that AVA'spromising to do, is committed to
doing in 2019, is to get ournetworks better networked so you
can learn from each other.
And that's really the catalystbehind this session with with
these two guys, these cowboyshere in Michigan.
If you would like to connectwith Jeff and Matt, you can send
an email to podcast@avainfo.organd we will broker that meeting.
(50:44):
AVA Is committed to thrivingnetworks.
Prosperous networks that helpdrive AVA mission, AVA's
membership and ultimatelyprotect the patients.
So Jeff and Matt, thanks foryour time today and we'll head
back into the MiVAN annualmeeting.
Matt (50:58):
Awesome.
Thanks!
Eric (51:04):
We're going to take a quick break but stay tuned for
our Beyond the Manuscriptsegment featuring my
conversation with ConnieGirgenti on her case study that
set to publish in the winterissue of the Journal of the
Association for Vascular Access.
(51:26):
And welcome back.
This is Eric Seger, on theBeyond the Manuscript Segment of
the ISAVE That Podcast.
I have the pleasure of beingjoined today by Connie Girgenti
a Vascular Access specialist atSt.
Joseph's Medical Center.
How are you doing, Connie?
I know you had a canceled flightthis morning because Mother
Nature is coming down with avengeance with snow down in
(51:47):
Chicago.
Connie (51:48):
Yes.
It's brutal.
It's pretty today.
It won't be as soon as you haveto start traveling in it for
sure.
Eric (51:55):
Right.
Well maybe not Mother Nature,but Old Man Winter is who I
should mentioned because it'sbecoming his season.
So, we're here to chat a littlebit about your case study that
is about to be published in thewinter issue of JAVA, which is
due out in a little bit, inabout a week or two.
And you did some work with your,your mid-thigh femoral PICC
(52:17):
placement, correct?
Connie (52:18):
Yes, yes, yes.
Excited to have that publishedand share the story about it.
Yeah.
Eric (52:24):
Yeah.
So, tell me a little bit aboutthat case.
How did gaining access for aPICC line via the mid-thigh
femoral vein sort of come intothe equation with you and your
team?
Connie (52:34):
Yeah, it was actually very interesting.
I was given the privilege tospend a couple of days with Matt
Ostroff in New Jersey and he andI, well he placed the mid-thigh
fem PICCs, but it was aneducational opportunity for me.
I thought it was a novelplacement and didn't really
(52:57):
think that I would need toconsider that.
But we got a call for a verycritically ill patient in the
ICU.
He was a young guy, he had endstage renal disease, HIV, rectal
cancer, status post-port removaldue to MRSA bacteremia.
So, just a very, very sickpatient.
(53:23):
Our kind of quick visualassessment, he had a AV Fistula
in one arm, his left arm andthen his right arm was just
bruised– it was pretty sad– fromall the peripheral attempts.
And then, we thought,'Well, allright, we'll do our assessment
(53:48):
with ultrasound' and our rapidassessment of his neck and
chest, you know, kind ofrevealed the same thing that we
had thought would be going on asa Vascular Access specialist in
that he had some stenosis at theconfluence of his internal
jugular and brachiocephalic,Subclavian and brachiocephalic
veins.
(54:09):
So, we knew, we were like,'thisis going to be tough.' We're a
team that plays the centrallines, too– in the IJ axillary,
Subclavian vein and femoralvein.
So, we thought, well, this'll bethe traditional CVC placement.
But it does come with the risksof infection and the inability
(54:31):
to maintain the dressing andthose types of things.
And then I thought, I said to mycolleague,'I think we need to
consider mid-thigh.' So, itwasn't like, you know, we went
into this, we're going to go dothese mid-thigh fem PICCs.
We know, they're novel, we knowthat a lot of people are not
(54:53):
doing them.
So it didn't, it really was bychance that I had the
opportunity to be with MattOstroff and then was presented
with this patient because if itwould have been reversed, I
think we would have put in atraditional CVC in the groin.
Eric (55:10):
I believe Matt had something earlier this year
published on the mid-thigh femwork as well.
He had a couple of other casesand he did some things that AVA
with that in September.
It seems like it was a perfectlytime situation for you.
And I know you mentioned and youwrote in your manuscript that
(55:31):
the patient had some scarringfrom a port as well.
So, it sounds like you sort ofneeded to find another avenue to
gain access.
That's really interesting.
Connie (55:43):
Not only did he have port removal, but he had
multiple temporary dialysisscars.
You could just tell from hisupper chest that we were not
going to be successful in upperaccess.
Eric (55:56):
So, would that, as far as trying to figure out where you
would gain access, would youcall that sort of the largest
hurdle you and your team facedduring this whole process?
Connie (56:08):
Yeah, I think well in our own fear, too, right?
We had never done it.
I had seen a few done.
But as nurses that place centrallines, we knew that we were
going to treat this vein on thethigh like we would any other
access site, the sameprecautions and prepping would
(56:30):
be the same.
My hands were shaking.
I had my teammate, Sheri Peroni,there who was excited to have
the option.
She hadn't thought about thistype of access before.
Typically, I think in thesecases, Vascular Access nurses
(56:52):
will kind of walk away and say,'Oh, not a PICC candidate.' So,
we were excited, but I thinkreasonably nervous.
My hands were a little shaky.
Eric (57:04):
That's completely understandable.
How did you and your team ensurecontinued safety once you
actually were able to place thePICC?
I know, I think it dwelled inthere for a little over two
weeks, correct?
Connie (57:23):
Yeah.
Three weeks.
What we did was, um, well whenwe, after we placed it of
course, there's always thoselearning opportunities.
So we gathered as many nurses,physicians immediately to
explain what we did.
(57:44):
This is what it looks like.
Of course, everyone loved thefact that it was out of the
groin.
The site was optimized and easyto care for, but we also took
ownership of this line and weround on it every day.
We had, everyone knows how toreach us by pager and cell
phone.
But we followed it every day andhad learning opportunities with
(58:05):
anybody who would listen to us.
The patient's mother was at thebedside all the time, too.
So, we of course educated herand told her if someone didn't
...
and this was just a PICC in adifferent spot.
So, the care and maintenance wasthe same, but we let her know if
(58:25):
for some reason she felt unsureabout someone that, that she
could page us or asked us to bepaged.
We're not a 24/7 team yet.
So, we did the best we could.
Eric (58:38):
I'm sure she appreciated any information you all were
able to provide for her.
And I think from what I've readand just attending the annual
Scientific Meeting a few monthsago, I think this mid-thigh
stuff is kind of a new, it'skind of a big wave right now in
Vascular Access.
(58:58):
Is that correct to say?
Connie (59:01):
It's definitely on the, this is early adapters.
The bell curve, right?
The very early adapters.
I think we still, we do get alittle bit of criticism still.
Which is unfortunate.
And I think the one point that Idid want to make was that this
(59:21):
was multidisciplinaryco-collaboration.
There were five people makingthe decision for placing this
particular mid-thigh fem PICC.
I had called Matt Ostroff on thephone, Sheri called
Interventional Radiology andspoke to Noah, one of our docs
in IR.
And then we had the intensivist.
(59:42):
So, there were five of uscollaborating on this device.
So it is, I would still say it'sdefinitely, it's an emerging
access site.
You know, as a pediatric nurse,Eric, this was never new for me.
Like the surgeons at Children'swhere I worked, they never put
(01:00:03):
in a femoral line.
They always access lower on thethigh.
So, I feel like this has beenaround for quite a long time,
but I think as far as adults,placing them, it is definitely
an emerging access site.
And you know, I think about JackLeDonne when I think of this
(01:00:24):
site too, because how many timesat AVA or at a local network
meeting, do we hear optimizingexit sites?
Right?
We're not just throwing the linein and walking away.
We have to make sure that thoseafter us can actually care for
the line.
So yeah, it's important.
Eric (01:00:47):
It's extremely important.
So, obviously we're in the midstof publishing your case study.
For those people that read it,what do you want them to take
away from your experience?
Obviously you wrote about it, itwas great.
And is it sort of hoping otherVascular Access specialists sort
(01:01:09):
of have an open mind andconsider this as an option for
access or is there somethingelse?
Connie (01:01:14):
Absolutely.
I think first and foremost,Sheri and I, we both published
this and in no way are wesuggesting that everyone should
just go out and start placingmid-thigh fem pics.
I think collaboration,advocating for your patient with
your physicians to ensure youplace the right device.
(01:01:38):
Learn about it.
But I really do think it'simportant for our specialty to
survive in the healthcareclimate that we're faced with
that we do expand and we don'tjust walk away and say this
patient is not a PICC candidate.
But it's through relationshipsand mentoring and
(01:02:01):
multidisciplinary collaborationthat we can expand to this site
and ensure that our patients aregetting the right device.
I think what helped us is thatwe were already placing central
lines.
Our physicians at our hospitalvalue our specialty.
They trust our judgment.
(01:02:22):
So, I think with those things inplace, we were able to move to
the mid-thigh placement as wellas central lines.
But I think that I wouldencourage all nurses to consider
this.
And when I first saw it, Ididn't think it was going to be
something that I was going to dothe following week.
(01:02:44):
But I think we should be havingthese conversations and I hope
Matt's publication as well asthis case study– clinicians can
take this to their IR doctors,their ICU physicians and say
this is a viable option toreduce bloodstream infections to
(01:03:06):
increase the ease of care andmaintenance.
Just as we continue to grow ourspecialty.
I would hope that everyone thatreads it and just knows that
it's something they should bethinking about.
Maybe they can't do it today,but start taking those steps
towards doing this for the rightpatient for the right reasons.
(01:03:26):
For sure.
Eric (01:03:27):
Definitely, and they should act the way you did too
as far as calling Matt andasking him since he has
experience in it and they'llknow that you have experience in
it as well.
And if they have any questionsabout a potential candidate for
PICC placement in the mid-thigh,they could give you a call on
that.
It seems like another way thatclinicians such as yourself can
continue to put forth the besteffort to, to benefit patients.
(01:03:50):
That's really great.
Well, Connie, I reallyappreciate you taking the time
this morning to chat with me alittle bit about your case study
on the mid-thigh femoral PICCplacement.
For those of you listening tothis podcast, you can check out
Connie's published article in afew weeks in the Journal of the
Association for Vascular Access,both in your mailbox if you
(01:04:13):
receive the printed copy as wellas online via email and on the
AVA journal website.
Connie, thanks so much for yourtime this morning and stay warm
up there with all the snowhappening in Chicago.
Connie (01:04:26):
Absolutely.
Thank you, Eric.
It's been a privilege.
This episode of ISAVE That Podcast is made possible by the
AVA Academy, debuting in early2019 from the Association for
Vascular Access.
AVA Academy is where you'll findthe best-in-class cutting edge
Vascular Access education fromPICC insertion to our
ultrasound-guided peripheral IVcourse.
For more information, subscribeto the ISAVE That Podcast,
(00:23):
follow AVA on any social mediaplatform and become an AVA
member today.
From the Association forVascular Access, this is the
ISAVE That Podcast.
Ramzy (00:50):
It's Season 1, Episode 10 of the ISAVE That Podcast.
We made it to 10!
Eric (00:53):
Double digits!
Ramzy (00:58):
Double digits.
It's Ramzy Nasrallah, I'm in SanDiego with Judy Thompson.
Eric Seger is in Columbus, Ohio.
Eric (01:05):
Hi!
Judy (01:05):
In the sunny city of Columbus, Ohio.
Eric (01:07):
It's just gorgeous here, you're right.
Ramzy (01:07):
You haven't seen the sun since...
but Ohio State beat Michigan.
We got that on the podcast.
It's now been said, it's nowbeen recorded.
Eric (01:14):
That's right, boom.
But yeah, it's been 40 and rainylast few days, but it's all
right.
It is what it is.
Judy (01:18):
It rained in San Diego.
It did rain last week or thisweek in San Diego.
But we're back to sunshine.
Ramzy (01:25):
Yeah, probably at 3 a.m.
We have a lot to get to.
This is a great episode.
I sat down with Kelly AnnZazyczny in New Hope,
Pennsylvania to talk about theimpact AVA had on her career as
a clinician.
It's actually really, let's backthis up.
I was at AVA this year inColumbus and one of the people
working the Foundation boothgrabbed me and gave me her
(01:45):
business card and said this ladywas really impressive.
She made a donation to TheFoundation.
She wants to talk to you abouthow she can do more for AVA
because of the impact that AVAhas had on her career.
Judy (01:58):
That's awesome.
Ramzy (01:58):
And that was a story I needed to hear.
And that's a story that you allwill hear, as I met her in
Pennsylvania a little while ago,and walked through how she took
a job as a pediatric nursemanager.
And upon accepting it was told'aha!' You also get the Vascular
Access Team.
That was her introduction toVascular Access and she'll talk
about not just how that impactedher personally and her career,
(02:21):
but ultimately it really helpedadvance her career of being at
the forefront to what we callthe gateway to all healthcare
delivery– it starts withVascular Access.
So that's coming up next andEric, you've got a section with,
a Behind The Manuscript sectioncoming up.
Eric (02:37):
I do.
I had a nice conversation withConnie Girgenti.
She has a case study on amid-thigh femoral access, coming
up in the next, or the finalissue of JAVA for 2018, the
winter issue.
So, we spoke a little bit aboutabout that case specifically and
how that's, the mid-thigh workhas really, as I understand, and
(02:59):
Judy you correct me if I'mwrong, really sort of blown up
in recent time.
I know Matt Ostroff was onbefore, he mentioned a while
back in earlier in the season inspeaking with Ramzy about
presenting on his mid-thigh workand we have also published a
case study of his in JAVA.
So, I think that's kind of atopic that's really hot right
(03:20):
now.
Judy (03:21):
Yeah, I agree, Eric.
In fact I talked to Matt quite afew times about it.
I am about to go up to NewJersey and film at his hospital.
We're going to go over mid-thighwork and create a course for
AVA, for our AVA Academy.
So, there's a lot of hubbubabout mid-thigh work.
We're so proud of Matt, proud ofclinicians that are the early
(03:42):
adopters.
So, this is going to beexciting.
I can't wait to read what Conniewrote.
Ramzy (03:47):
She's ahead of it.
Mid-thighs are in the forefrontand we're trying to get ahead of
it, too.
I like that you mentioned, youslid AVA Academy in there too.
In a future episode, we'll betalking in depth about AVA
Academy because that's thething.
Eric (03:57):
Branding, branding.
Ramzy (03:58):
Hashtag branding.
Finally, we have a section todayon the episode on network
excellence.
AVA is virtual and national andglobal, but it is also local.
And last year in the spring Iwas with Vineet Chopra, whose
university lost to Ohio State infootball, last week.
Judy (04:18):
Didn't you just say that?
That's twice now.
Ramzy (04:18):
I did, I wanted to make sure everyone heard that.
Eric (04:22):
Not only did they lose, they gave up 62 points.
Ramzy (04:24):
Sixty-two points.
I can't believe it.
Judy (04:26):
You know, we like Vineet.
What are you doing?
Ramzy (04:28):
We do like Vineet.
Well, this is part of this, itcomes with the territory.
Eric (04:33):
He can come on and defend himself.
Ramzy (04:34):
He can, he'll be filled be on podcast soon.
I was with him in Perth and hementioned to me that there was a
Michigan Journal Club forvascular access that this guy,
Matt Gibson, had started.
And he really thought it shouldbe a network.
In lieu of waiting to get backto the states– Perth is 12 hours
ahead of eastern time– so Ithink we were together at like 9
(04:57):
p.m., and I called Matt in frontof Vineet at 9 a.m.
Green lighted, the MichiganVascular Access Network, which
by the way is called MiVAN, eventhough it should be called
MOTORVAN.
But he and Jeff Hanks, in oneyear's time put together really
what a network should look likefor AVA anywhere you go.
(05:18):
I mean, it's got enthusiasm,leadership, organization,
industry involvement.
I just went to their big annualsymposium.
It was just incredible and Icannot believe it's only a year
old.
So I spent some time with Jeffand Matt talking about best
practices for networks and howthey were able to turn MiVAS,
the Vascular Access SocietyJournal Club that Vineet had
(05:38):
told me about, into MiVAN, areal shooting star of a network
for us in the eastern side ofthe US.
Judy (05:47):
If only it was MOTORVAN.
Ramzy (05:48):
We'll get to it, we'll get there.
Eric (05:50):
Everything I saw from that meeting looked like it was
fantastic and obviously we evendid some stuff with social media
on it.
So, after break though, we'regoing to have Ramzy's
conversation with Kelly Ann'sZazyczny.
So, please stay tuned.
Speaker 1 (06:17):
This episode of ISAVE That Podcast is made possible by
the AVA Academy, debuting earlyin 2019 from the Association for
Vascular Access.
AVA Academy is where you'll findbest-in-class cutting edge
Vascular Access education fromPICC insertion, to our
ultrasound-guided peripheral IVcourse.
As always, you'll still be ableto pick up CE credits through
(06:39):
JAVA articles each quarter andby attending virtual sessions
from scientific meetings.
AVA Academy takes VascularAccess education to the next
level.
We are developing insertion,care and maintenance courses for
the full spectrum of VascularAccess Devices and procedures.
AVA Academy is open to thepublic and AVA members will
receive significant discounts onall education.
(07:00):
For more information, subscribeto ISAVE That Podcast, follow
AVA on any social media platformand become an AVA member today.
Ramzy (07:15):
We are in New Hope, Pennsylvania at SkyRoast Coffee
on Main Street.
There is some ambient noise inthe background.
So if you hear the, the sultrytones of jazz music and people
having coffee conversations,that's not fake.
It's very real.
I am joined today by Kelly AnnZazyczny, who is a nurse at Main
Line Health and was brought tomy attention at conference this
(07:37):
year as I was being pulled inseveral different directions.
I had one of the members of ourFoundation Board of Directors
pull me aside and said, told methat you have to meet this lady.
And I did.
And he was absolutely right.
AVA is something that advancesits cause through storytelling.
And I thought that the podcastaudience would benefit from
(07:58):
hearing Kelly Ann's story of hownot that she went out and found
Vascular Access, but howVascular Access found her.
So, Kelly Ann, thank you forjoining me today.
Kelly Ann (08:07):
Thank you so much for having me.
I'm really feel privileged tohave this opportunity to speak
to you today just because AVAhas become so important in my
professional career.
Ramzy (08:19):
And that's really the crux of the story.
Like how, you know, you didn'tgo out and find AVA, AVA sort of
found you.
Can you talk a little bit abouthow your career pulled you into
being almost a Vascular Accessspecialist without you going out
and seeking it out?
Kelly Ann (08:35):
So, in 2008, I had come to Main Line Health and had
interviewed for a pediatricmanager position.
Being that is my, I will alwayssay that I'm a peds nurse by
heart.
I have worked at the Children'sHospital of Philadelphia and
then had the privilege ofworking Children's Healthcare of
(08:57):
Atlanta.
And so when we moved back upnorth, I had gone back to chop
for a short amount of time, butthen had called a colleague and
she had told me about that theyhad this peds manager position.
So, I interviewed for it andafter several months and really
(09:17):
kind of making the formaldecision to make the move, I
took the position.
And then once I got in it theysaid,'Oh, by the way, the
previous manager was not onlythe peds manager, but she also
had the IV team.'
Ramzy (09:30):
Oh, nice.
Congrats!
Kelly Ann (09:33):
But for me personally, even though I wasn't
a Vascular Access nurse, I had afull appreciation for the
specialty being a peds nurse.
I had great people like AnneMarie Frey, who's very involved
in AVA in the pediatric subgroupwho was an IV nurse at chop,
(09:54):
that I spent many hours with herin the treatment room watching
her put in PICC lines an IVs.
And just really being veryappreciative of their role and
their support and care ofpatients.
And then when I went to Atlanta,you have people like Judy Burns
(10:14):
who actually taught me how toput an IV in because at the time
Choa had gotten rid of their IVteen and then shortly decided
that that really was not a goodidea in pediatrics.
And so they brought it back.
So I always, when I see her atthe conference every year, I'm
like, there's Judy, she taughtme how to put in IVs.
(10:37):
And then I managed a sedationnursing service at Choa.
So, you know, nurses that had tobe skilled in putting in IVs.
So for me, I was like,'OK, Ireally appreciate this.
I can do this.' What I learnedis that, then what happened was,
(10:57):
is that then they startedgetting me fully engaged where
they said,'Well, when Mary washere, we actually had a system
committee and we need a leaderto be the executive sponsor.
Could you be our executivesponsor?'
Ramzy (11:10):
You're find out more and more about your new job.
Kelly Ann (11:11):
Yeah.
'Can you be our executivesponsor so we can have meetings
again?' And I was like,'OK, Iappreciate that.
That they want to get togetheras a system, the four different
teams to kind of talk about bestpractice.' What I learned very
quickly was, is that, even inour own organization, there was
(11:35):
such different philosophies ofpractice.
It wasn't consistent.
It wasn't really consistent withwhat I was reading because the
type of manager or leader that Iam, if I'm going to manage a
group, I have to learn aboutyour work.
So, that kind of scared them alittle bit.
(11:57):
I remember saying to them,'OK,I'm putting on scrubs and I'm
going to follow you around forthe day.' And then I was like,
'OK, well this is a differentcatheter.
Let me try it and put an IV in.'And I got in and I remember the
nurse that I was falling aroundthat was brave enough to take
me.
She said,'You are the firstnurse manager I have ever had
(12:21):
that actually knows how to sticka patient.' And I was like,'Oh,
OK, that's great.'
Ramzy (12:27):
That's high praise.
Kelly Ann (12:29):
It was, and what I learned as a nurse leader is
that if I'm going to buildcredibility with the staff, I
need to be able to do the job.
I need to be knee deep in itwith them so that I can really
understand what they'restruggling with.
Like, what is the challenges ofthem being able to give the
(12:52):
great care that they want togive to patients.
I know that's not every nursemanager's philosophy, but for me
it really has worked.
And I feel that I, the successthat we've had at Main Line
Health and the reason why wehave such great outcomes is that
(13:14):
I really try to work alongsidethe staff so that I can really
fully appreciate of what I cando as a nurse leader to support
them in their role so that theycan better take care of their
patients in the best capacity.
Ramzy (13:31):
Managing Vascular Access specialists is helpful if you
are a Vascular Access specialistyourself.
Kelly Ann (13:37):
Right.
Ramzy (13:39):
And this is something that I think is pervasive across
the industry.
I used to sell products.
I've had managers who had neversold before.
It's difficult to acceptcoaching from someone who's
never been in the trenches.
Same thing with if you're anartist reporting into someone
who has no appreciation for art,you want to understand what the
guild is up to.
(13:59):
So, you're a pediatric nursemanager.
You've inherited the IV team,you're now learning about how to
stick patients and thecomplexities that go into
vascular access.
Talk a little bit about thatjourney and how you eventually,
Vascular Access became importantpart of what you did on a daily
(14:20):
basis.
Kelly Ann (14:22):
So, shortly, I guess within the next year, I believe
that the staff were all going toan AVA conference.
It was in National Harbor wasthe one of the first ones I had
gone to.
And so they said, do you want tocome with us?
So, here I was, we drove down,there was a whole group of us
(14:44):
and we went for the conferenceand it was just an amazing
experience for me.
It was the beginning of me thensaying I need to come to these
every year because I got to meetgreat people like Nancy Moureau
and Jack LeDonne and um, myfriends at AVATAR, Claire
(15:08):
(Rickard), where you have theopportunity to interact and
network with some of thefounding leaders of this
specialty.
And get your questions answeredor kind of just brainstorm about
challenges that you're having.
(15:30):
And every time I go, I alwayscome back with a renewed sense
of enthusiasm.
And actually once again, I doscare the staff because I come
in, I'm like,'You'll neverguess! I got a great new idea of
what we're going to do next!'And they're like running for the
door.
'Oh no, she's, she's fired upagain! Here we go!'
Ramzy (15:52):
She went to AVA again!
Kelly Ann (15:53):
I went to AVA again! But, I mean, it really has been
such a tremendous asset becauselike Nancy Moureau's PICC
Excellence– that is ourfoundation.
Every nurse at Main Line Healthhas to do the online training
for PICC insertion andultrasound utilization.
(16:15):
And we use that as ourfoundation education.
For me, that was so helpfulbecause this isn't my area of
expertise.
So, I would have had to eitherspend a lot of extra time trying
to research various educationaltools or platforms and then
tried to get that approved inour organization.
(16:37):
And what happened was, is we hada company actually sponsor it
for us for a year for free.
The membership.
And then from that we were ableto see that there was a lot of
great CEUs and it just helps meprovide consistent education
that I know having worked withNancy and spoken to her on a
(17:00):
regular basis, that this issomebody that I think she has
been pivotal in providingVascular Access education and I
know it's credible and I knowshe's always updating it.
So, it's one less extra thingthat I have to work on.
And so, I've been able to usethat.
(17:22):
The whole target zero like Ihave made that my mission.
In 2008 or 2009 we startedtalking about target zero and
that we can't make excusesanymore about central line
infections and that they justhappen.
(17:42):
That we really have to thinkabout our own professional
accountability and what we'redoing and what our
responsibility is to ourpatients.
They shouldn't be sick and thencome into the hospital and get
another complication because ofus.
Using AVA and the variouslectures that you've had, we
(18:05):
have really elevated ourpractice and in 10 years we've
reduced our CLABSIs by 86%.
We have had two of our hospitalsthat have gone a year and a half
to two years at zero.
Every day where we're trying tosay what can we do and how can
(18:26):
we do it better to protect ourpatients.
And I remember early on, justbeing exposed to different,
having the different partners atyour conferences.
So to me, I love that.
That's like going to a largeflea market and just having
(18:47):
everybody at my finger tipswhere I don't have to sit there
and make phone calls and emailsand try to bring various
different companies in because Iwant to look at a new product.
You have them all there at theconference.
So, actually I usually get thegroup together.
(19:09):
I'm like,'OK, so what are wegonna look at this year?
OK, you go to this booth, andyou go to this booth.' And then
we come back to our systemcommittee and we, we make
decisions about, OK, well theseare the products, this is what
we're having difficulty with.
These are the products thatwe're interested in looking at.
And then, you know, we have theinformation, we have
(19:31):
discussions, then we bring acouple in.
So, that's really been veryhelpful for me because, you
know, it's just challenging toget through the day-to-day.
And I think I've been successfulin changing a lot of our
practice with the support andthe expertise of our Vascular
(19:53):
Access teams because I supportthem going to conferences and
you know, we're all members ofAVA.
So, we're reading the Journal.
The new thing is we're talkingabout the mid-thigh PICC line
and I'm like,'OK, that's next onour agenda.'
Ramzy (20:17):
That's next on our agenda too, by the way, from an
educational standpoint.
It's something Judy Thompson,our Director of Clinical
Education is pursuing to captureprocedure videos specifically
for mid-thigh.
Let's take that further (20:27):
AVA has, I came on a year and a half
ago and I've been trying topreserve just how special the
annual conferences but also makeAVA a 12-month organization.
You live in and we are right nowin eastern Pennsylvania.
There are a couple of AVAnetworks near here.
What has your experience beenlike on the local level with AVA
(20:50):
in Pennsylvania and on the NewJersey border here?
Kelly Ann (20:53):
So, I've been involved for probably the last
year or so.
And that was again the staffsaying,'Hey, we have local
chapters now can you come to themeetings?' And actually, to be
honest with you, it's been verypositive because, I knew, they
had Jack LeDonne show up for oneof theirs.
(21:14):
They had you at one of them.
Ramzy (21:16):
Right.
Mauro Pittiruti, basically, thepope's doctor was there.
Kelly Ann (21:21):
I think that this is actually, I am 100% in support
of this, especially because alot of organizations are not
paying for conferences for theirnursing staff.
So, you have a lot of peoplethat make sacrifices because
they're committed to thespecialty to go to these
(21:43):
conferences and they might notbe able to go every year, but
they save so that they can goevery other year.
And so, I think that it isimportant for us to really have
that grassroots regional type ofprogramming and chapters because
(22:04):
it will only allow more peoplethe opportunity to have at least
a small experience of what youwould get at the national level
when we have our conferencesevery year.
Ramzy (22:20):
So Kelly Ann, picture someone at work and they want to
go to AVA, they can't get thetime off or the support.
How effective do you think thenetworks would be on a local
level to have that person bringpeople from work, bring 3 or 4
colleagues to see what a localAVA network meeting looks like?
How does that, do you thinkthat's an effective way to get
(22:41):
people involved in VascularAccess?
Kelly Ann (22:44):
I do because I think when you see– the people that
are organizing the regional AVAchapters are people that have
attended conferences that arevery experienced, that share the
passion and it just radiates offof them.
(23:06):
And actually even at our localchapter, they I don't know if
they took the dues or they got asponsor, but they actually every
year they kind of raffle off aregistration for AVA so that
somebody might have theopportunity to go to the
conference
Ramzy (23:25):
Our AVA Industry Partners generally will pay for those,
give them through the networks.
And then that's the way to getmore people going to AVA.
And from a, I mean, I came fromindustry, I'll tell you this: My
best customers were AVA members.
Because they get it.
It's a lot easier to talk aboutjust how important
evidence-based interventionsreduce Vascular Access
(23:46):
complications or make theprocedures easier is when
someone understands theprocedure and the gravity of
what's at stake with somethingthat's for all intents and
purposes, the gateway tohealthcare delivery.
Kelly Ann (23:57):
And I think too is that these regional chapters,
they bring people together thatare from other hospitals.
So, you know, we have a veryrobust team and I do support
them to get to go to AVA.
So, they have learned so muchfrom being involved with what
(24:20):
best practices and then they'reable to have those discussions
with people in our own regionand kind of just translate that
information.
So, even if they can'tpersonally attend, I feel like
we're able to reach more peoplebecause you have people that do
attend the conferences that canthen kind of maybe ignite the
(24:44):
interest of other people toeither attend or even just help
support them in their ownjourney of becoming better
practitioners.
Ramzy (24:52):
Right.
It starts at home.
I mean, you got to go toNational Harbor and kind of
caught it there, but if you'regoing every quarter and
connecting with hospitals thatyou're familiar with, it helps
bridge that gap.
So, you started as, you're thepediatric nurse manager, you
found out after you accepted thejob that you had the IV team
and, fast forward a few yearslater, you now oversee all IV
(25:16):
therapy operations at a 4hospital system.
Kelly Ann (25:19):
Yes, that is correct.
Oh, we should also add that overthe last 10 years I've been
asked to speak at various eventsand conferences related to
Vascular Access.
So 2 years ago I did get mycertification because I thought
I needed a little credibility asa specialist.
Ramzy (25:39):
The Vascular Access board certification, yes, from VACC.
This is the kind of story thatI'd like to scream from the
mountain top.
This is what people, what's theface of AVA?
It's people like you, VascularAccess found you, it had a
significant impact on yourcareer.
It's having an impact onpatients in your community.
Kelly Ann Zazyczny (25:59):
We need, we need more of you.
I think that there's a lot ofyou out there that just don't
know it yet.
Kelly Ann (26:04):
I think too is that if anybody needs me to speak to
their manager about theimportance of them really
educating themselves related toVascular Access, I'll be more
than happy to do that.
Because I had a colleague ofmine, she was actually the Dean
(26:25):
of Villanova.
She was actually the longestacting Dean and she passed away
last year, and so I was veryclose with her and intimately
involved with her during herjourney of illness.
And she got to a point wherethere really wasn't many options
to provide her Vascular Accessbecause she was a cancer
(26:47):
survivor twice and just thevarious therapies.
And I just think that what weneed to focus on and try to help
support our healthcarecolleagues is that we need to
look at the long term effects ofthe treatments that we provide
our patients and how this isgoing to impact their
(27:10):
vasculature.
Roy George, who had spoke atAVA, that young man, I actually
became very friendly with him.
He now corresponds with my, myoldest daughter because of their
love of jazz.
I say to him all the time, like,he's my hero.
(27:32):
Because as a peds nurse, we didall these things because we were
trying to help save these kids.
And you never know what happensto them or do they live into
adulthood.
But he's just a prime exampleof, he is an amazing, beautiful
(27:53):
human being that is just doingamazing work in music industry.
But at a cost, right?
So, he survived, but he reallyhas limited vasculature now.
And you know, I pray for himevery day because I would never
want something to happen to himand him be in a situation that,
(28:16):
'Oh, we have a therapy for you,but sorry, you don't have any
veins left.' And the same thingthat happened to Dean
Fitzpatrick is that, with hercardiac and from having
chemotherapy, like all of hervasculature in her upper body
was totally stenosed.
(28:39):
And so, I think that that'sreally where our focus and the
whole mission of this vesselpreservation.
And I know that that's going tobe our work.
I really feel that, uh, my joband I tell the staff now, it's
like I need to provide you atoolkit like where you have soup
(29:02):
to not.
So, I expect before my time isdone that they will be putting
in IOs and advanced centrallines and that.
Our dream is that the physicianwill one day say,'I'm consulting
the Vascular Access team and youchoose what is the best device
(29:24):
for the patient.' Becausereally, unfortunately they don't
really have that understanding.
They just know the therapy theywant to provide.
They don't understand that, thedelivery and that.
We have these patients that havehad multiple PICC lines.
Ramzy (29:45):
Venous depletion, is a very real thing.
Kelly Ann (29:45):
It really is, and it's a really scary thing.
And I remember the first time Iheard that at an AVA conference:
There was a woman who presentedfrom Canada where she was
talking about these dialysispatients and how you have
somebody that's on dialysis andthat we have a treatment for
(30:05):
you.
But guess what?
You don't have any veins left.
That really was impactful forme.
Ramzy (30:10):
Yeah.
You get to watch yourself expirebecause you've run out of veins.
Kelly Ann (30:18):
I'm just starting the message at our organization and
I've spoken to a large systemgroups of physicians to say
you're doing a great job insurvivorship.
You really are.
But what we really need to talkabout is what are the
consequences of the treatmentsthat you provide your patients
(30:40):
longterm?
Because after you say, Yay,you're cancer free, I still now
have 40 years of my life that Icould have another illness that
will require a vascular accessdevice.
Ramzy (30:55):
Right.
As a cancer survivor yourself.
Kelly Ann (30:57):
Yes.
It really has hit home.
Ramzy (30:59):
So you've really helped demonstrate the journey to find
Vascular Access, to VascularAccess finding you.
The passion and the urgencybehind what we do.
If I'm a new nurse or a residentdoctor or a patient advocate or
a stakeholder in healthcare,what would you say, Kelly Ann,
to someone about the importanceof having Vascular Access to be
(31:24):
a foundational part of yourexperience and your awareness
and healthcare?
Kelly Ann (31:29):
I think that it's actually vital for them to get a
baseline education andknowledge.
And if they don't have thatknowledge, because one of the
epidemics in our society todayis nursing schools, medical
schools, they're not teachingthis anymore.
(31:52):
And then they think that you'regoing to learn this on the job.
And there are so manyorganizations that, as a quick
fix for the organization to savemoney, they've gotten rid of
their Vascular Access teams.
But you know, if I could callout to my friends, Claire, I
think that in AVATAR Group, Ithink the next study should be
(32:13):
really looking at thoseorganizations that have Vascular
Access teams, that's kept strongteams and what are their patient
outcomes compared to those thatdon't have them.
I see it every day that theyjust don't have the skillset or
(32:36):
the education or the knowledgeof,'Oh well she said it hurt.'
And then you look at it andyou're like,'OK, that's a
phlebitis.
But things that are so basic tous, for other people, they
really just haven't gotten agood foundation.
And how are we going to createthat partnership where they
(33:02):
might not be the ones being theinserters, but you know, they
definitely have to have a strongknowledge base for the care and
maintenance because as the teamsays to me every day, I can't
look at every peripheral IVevery day.
There's too many of them.
And so we really need to helpstrengthen that education for
(33:25):
that frontline staff.
I think, you know, theconversation I'm having with our
physician group, that whole"seeone, do one, teach one,' to me
that is the standard of teachingright now.
That is the standard of teachingand that is one, a huge
(33:45):
liability for patients.
We had a patient that, we don'tprovide 24 hour, Vascular Access
service.
So, we have patients that comein when we're not here and
they're left to be poked andprodded by residents.
(34:05):
And I'm not trying to beat up onour physician colleagues, but
they haven't been given athorough education on how to
properly do that.
So they've stuck this patientlike 3 or 4 times, probably
didn't use the best technique.
And then the next day I'm comingin and'Oh, let's take, take out
(34:29):
that line because it's a femoralline, it's not good for the
patient.' Now we're providinganother invasive procedure for
them.
You know, we just, I reallythink that we need to look at
that and come up with a betterstrategy.
And my goal at our organizationas I've already just had a
little initial conversation withour system medical vice
(34:55):
president for surgery to say, Iwant us to partner with the
residents.
Like I think you can takeVascular Access nurses and the
residents and the PAs and thephysicians and let's partner
together so that we have aconsistent best practice for
insertion, that we put thoselines in the proper way so that
(35:19):
as Jack would say, then the endusers, the front line staff can
actually care for them properlyand they can manage the care
properly because we put them ina better fashion and we can get
better outcomes.
Ramzy (35:40):
It's a departure from what's now the standard of care.
You weren't beating up on yourphysician group.
That's a story you can tell atjust about any hospital.
Kelly Ann, thanks for your time.
If anyone listening would liketo connect with Kelly Ann, as
she offered, you can just emailpodcast@avainfo.org and we can
broker that connection.
Kelly Ann thanks for your time!
Kelly Ann (35:59):
Thank you so much! It was such a pleasure to speak
with you today.
Eric (36:03):
Up next, we have Ramzy's conversation with Jeff Hanks and
Matt Gibson, the two men behindthe genesis of MiVAN, the
Michigan Vascular nccessnetwork, about how they have
(36:24):
grown that network into what itis today.
Ramzy (36:25):
And I'm joined today by Jeff Hanks and Matt Gibson, the
co-founders of MiVAN, that isthe Michigan Vascular Access
(36:46):
Network.
We are actually at time theannual MiVan conference today in
Plymouth, Michigan.
It is an all day symposium.
It's basically Lollapalooza,who's who in Vascular Access.
This network did not exist 2years ago.
We're here today to learn fromthese 2 guys on what the best
practices are for running aVascular Access network, since
(37:07):
AVA works best at the locallevel where you live and work.
But also how they're able tocreate this community and pull
folks into AVA at a national anda virtual level.
Jeff and Matt, thanks for thetime today and wow, look at the
success you have– we just left apacked exhibit hall that that
was part of a break with vendorsthat came after a packed
(37:30):
symposium hall.
Tell us about where this camefrom and how you got it to the
point where it's just rollingright now.
Jeff (37:37):
So this was originally, Matt and I were working
together, in a hospital and,discovered that we had like
passion about Vascular Accessand education and patient
advocacy.
He started going,'Have you readthis study?
Have you read this study?' Andwe'd both had kind of read the
same stuff.
So, we hit it off from a passionstandpoint and we really wanted
(37:59):
to get a group of peopletogether locally and really push
AVA's agenda out to the localgroup.
Cause we knew we worked with alot of people that wanted to
meet locally, but they reallydidn't even know who AVA was.
There are 60 people where I workand maybe five of them had ever
heard of AVA.
The rest of them were all, I'veheard of INS and things like
(38:22):
that, but they hadn't heard of aspecialty for their own groups.
So, we decided to put thistogether, kind of customer
cowboys and we didn't want anyrules.
So, we decided to put together ajournal club cause what we
wanted to do is bring peopletogether, in a casual setting
and have a dialogue with toplevel researchers and thought
(38:46):
leaders, and expose people tothese minds at an intimate
level.
So we started doing that.
And we did that for about ayear.
It turned out to be wildlysuccessful.
People really enjoyed it.
And about the same time AVAreally started rolling forward
with more support for localnetworks.
(39:07):
So we explored what can we doto, to get a hold of this more
into AVA.
We contacted Cindy and she'sbeen a huge support.
You've been a huge support andwe talk all the time.
We love this thing.
It's a blast.
We're astounded that we had 95people register an 95 people
(39:28):
show up and all the vendorsshowed up.
Not one single person didn'tcome.
Ramzy (39:34):
So from a couple guys passionate about Vascular
Access, to a Journal Club to nowa thriving and burgeoning
network.
Let me ask you (39:42):
AVA's getting better with the name recognition
in facilities, but you mentionedINS and that's an infusion
nursing pillar in thatcommunity.
How do you go about recruitingpeople to become part of AVA?
What is your pitch to them?
I mean, we are amultidisciplinary organization.
Our tagline is Protect thePatient| Educate the Clinician|
(40:03):
Save the Line.
There's a cannula involved.
Who are you seeking out and howdo you help them understand that
they have a home at MiVAN and atAVA for what they do?
Matt (40:14):
Vascular Access gets in your veins.
Ramzy (40:16):
Oh, that's a literal comment.
Matt (40:17):
It is a literal comment.
And it flows out of that.
Jeff (40:21):
It's cheesy, but you know, it was literally true.
Matt (40:23):
It's so true.
And that's how it is for me.
It's something inside of me thatI can't contain.
It's a passion, something thatjust bubbles out.
And this has been my outlet, forme to be able to bring in other
people and whenever you areexcited about something and then
(40:43):
other people get excited aboutit.
And so just from me and Jeffjust sitting at the break room
and talking about thisparticular article in this
research and whatnot, and thenwe just fed off of each other.
For us, I've been an INS member,I've been an AVA member for a
(41:04):
long time.
Both of them, and they're bothimportant to me.
You can't have infusion without,without Vascular Access.
And you can't have vascularaccess without infusion.
They don't exist.
There's no, you know, and sojust it focusing that passion
and whether you're at APIC, orINS or AVA, everyone's welcome.
Ramzy (41:27):
SIR.
Pharmacists.
I mean, multidisciplinary,multidisciplinary.
Matt (41:30):
That's right.
Everybody is welcome andeverybody can take something of
value from the things that we'reoffering and the people who are
speaking.
For me, facilitating that islike, that's why I'm a nurse,
you know, to watch people growand heal.
And that's part of the healingprocess or the growing process
(41:51):
is watching this come from sucha small thing to very
successful.
I, and Jeff I think would saythis too, we get so much from
watching this happen and, andactually watching.
You were there (42:07):
we raised half of the people in that room were
new! Half of the people! And wehave found that transition just
getting people to here andtalking to them about very
important things, things thatthey may be passionate about and
finding that there's even morethan just our local little
(42:28):
network.
That's what's important.
That is really what drives us.
Ramzy (42:34):
You've got, you've got an interventional radiologist
speaking today.
You had a pediatric intensivistthis morning, anesthesia, the
disciplines are represented.
You've got the Great Lakeschapter of INS here actively
advancing its interest becauseinfusion has a home at aAVAva
and you have accommodated thatat the level.
Matt (42:55):
And I'm glad you mentioned that because this is actually
CRNI credits being given inconjunction with the CEs that
we're giving from AVA.
I mean, someone, I'm going towalk out of here with 13 CEUs:
CRNI credits and CEUs combined.
That's a huge value.
Jeff (43:15):
Exactly.
You hit it on the head, youknow, not only is it
multidisciplinary, but what wewant to do is provide maximum
value for people's time andmoney.
Do you have a lot of things todo?
We want to make sure that youget the most out of this and we
want to bridge that gap, withwith our brothers and sisters
from those other groups thathave done a good job with
(43:36):
promoting Vascular Access.
But what you said about who wehave here today in terms of
disciplines is exactly how wemake this happen.
We thoughtfully sat down andsay, what have we done this
year?
Have we pulled in enough IRpeople?
Have we pulled in enoughinfection control people who are
the big names in these subcategories that will really
(43:58):
round us out from amultidisciplinary perspective
and then, and then get them hereor get them to a local event.
And I think that that's beenreally key for people that came,
had not been introduced to agroup like this, discovered that
they could sit next to aninterventional radiologist and
ask questions, that they couldnever feel comfortable or didn't
(44:21):
have time to ask their physicianat work or talk to a national
published a infection practiceperson like Chellie DeVries.
It's just a phenomenal value forthem and experience.
And that's how, that's how wemake a tick.
We're always, it's not about,you know, let's get together and
have some food and have alecture.
(44:43):
No, it is about that.
It is about networking first andforemost, but it's about the
content, it's gotta be relevantscientifically based and
quality.
Matt (44:57):
One of the questions that we asked ourselves about this
was what is current?
And what is important?
And what is controversial?
What are things out there that,that people, it's unclear as to
what the practice should bebecause we got to start talking
(45:17):
about those things that are grayand not just black and white.
And that's another avenue thatwe wanted to bring things here
that people want to hear aboutbut also need to hear about.
Hopefully we'll expand theirthought process and you know,
and improve patient care.
(45:38):
I mean, that's what AVA'stagline is.
Protect the patient.
Ramzy (45:42):
That's the first thing in our tagline.
Let me ask you guys as the twocowboys that are running MiVAN:
What are three things fornetwork excellence, network
management that you think arejust not optional stuff that if
you removed them, MiVAN wouldsuffer.
And if you didn't have them,you'd be a network that needed
(46:03):
to needed some upgrades.
Matt (46:05):
This can be overwhelming.
And so to have the technologicalsupport, and we do use a
software to manage the network.
And it makes our jobs verysimple, much more simple.
It does cost.
It is an expense, but so for usnot to get burned out and to
(46:29):
sustain your leadership.
I think that's the one thing issuper important.
Don't you?
Jeff (46:36):
Yeah, I think that using the tools of the day are huge.
And, you know, social media whatMatt and I've tried to do–
Matt's kind of like the big ideaguy.
Usually he throws out an ideaand I go no way, way too big.
And then we land somewhere inthe middle and it works out.
(47:00):
He has the ideas and we figureout how to make them happen.
We've got a small group ofpeople that we trust.
That's extremely important.
We couldn't do this on our own.
We built a leadership team tohelp showcase events.
And we didn't have, what wedidn't do that's different is we
didn't have an election.
(47:21):
We looked around us and we said,who is around us that No.
1 wants to help?
And No.
2 Has a skill set that we needthat maybe we don't have.
And let's build a team that,that rounds out all the things
that we need.
So that's what we did.
Matt (47:40):
We didn't want it to fizzle out.
Ramzy (47:44):
Right.
And burnout is real in everydaylife.
It's not just volunteer work.
Matt (47:49):
Having the technological support has minimized the amount
of people that we do need toinvolve.
Because you know, things that wehave done with a couple of
clicks may have taken, you know,eight or 10 people to do versus
the two of us.
Ramzy (48:06):
And you have levels of compliance with regard to the
legal stuff as part of an AVAnetwork, the 501(c)6 stuff.
You have access to CindyAnderson who is AVA's Director
of Affiliates.
Can you talk a little bit abouthow you strategically use Cindy
and how she helps MiVAN exceedyour expectations?
Matt (48:26):
Cindy is like the glue for us.
She helps us stick everythingtogether.
There is a business in this.
We are nurses, we're notparticularly just excellent
business people.
So Cindy brings in that piece tohelp guide us, direct us, and
(48:49):
mentor us, make sure that we areachieving what we need to
achieve from a structuraloperational side.
And really it gives me a reliefbecause we lean on her, so we
don't have to know.
We need the passion and we needthe drive and we need the
perseverance and the time.
Ramzy (49:10):
And the best practice, and the guardrails and the
guidance.
Matt (49:14):
That's right.
All of those things, that's whatthe clinicians and what we, Jeff
and I, have in spades.
The part that we did not is theoperational, the business and
that's what Cindy does for us.
She really helps us to form thisand make it smooth.
(49:35):
And there's a lot of rules thatwe don't know or we don't
understand.
And she keeps us on track, youknow, so she can pull us back in
and say,'Hey, this is what youneed to do.
This is a great try.
You know what you did wasfantastic but we don't need to
do that again.' And pulls usback in and really guides us and
(49:55):
supports like no like no other.
Ramzy (49:58):
The affiliate program that Cindy runs for AVA– we want
to make sure that we put you inthe best position to do what the
MiVANs of the world are nowdoing, which is to advance the
enthusiasm of AVA's mission onthe local level, protect more
patients to get more cliniciansengaged in Vascular Access all
of the disciplines andultimately transform health care
(50:20):
where you live and work.
One of the things that AVA'spromising to do, is committed to
doing in 2019, is to get ournetworks better networked so you
can learn from each other.
And that's really the catalystbehind this session with with
these two guys, these cowboyshere in Michigan.
If you would like to connectwith Jeff and Matt, you can send
an email to podcast@avainfo.organd we will broker that meeting.
(50:44):
AVA Is committed to thrivingnetworks.
Prosperous networks that helpdrive AVA mission, AVA's
membership and ultimatelyprotect the patients.
So Jeff and Matt, thanks foryour time today and we'll head
back into the MiVAN annualmeeting.
Matt (50:58):
Awesome.
Thanks!
Eric (51:04):
We're going to take a quick break but stay tuned for
our Beyond the Manuscriptsegment featuring my
conversation with ConnieGirgenti on her case study that
set to publish in the winterissue of the Journal of the
Association for Vascular Access.
(51:26):
And welcome back.
This is Eric Seger, on theBeyond the Manuscript Segment of
the ISAVE That Podcast.
I have the pleasure of beingjoined today by Connie Girgenti
a Vascular Access specialist atSt.
Joseph's Medical Center.
How are you doing, Connie?
I know you had a canceled flightthis morning because Mother
Nature is coming down with avengeance with snow down in
(51:47):
Chicago.
Connie (51:48):
Yes.
It's brutal.
It's pretty today.
It won't be as soon as you haveto start traveling in it for
sure.
Eric (51:55):
Right.
Well maybe not Mother Nature,but Old Man Winter is who I
should mentioned because it'sbecoming his season.
So, we're here to chat a littlebit about your case study that
is about to be published in thewinter issue of JAVA, which is
due out in a little bit, inabout a week or two.
And you did some work with your,your mid-thigh femoral PICC
(52:17):
placement, correct?
Connie (52:18):
Yes, yes, yes.
Excited to have that publishedand share the story about it.
Yeah.
Eric (52:24):
Yeah.
So, tell me a little bit aboutthat case.
How did gaining access for aPICC line via the mid-thigh
femoral vein sort of come intothe equation with you and your
team?
Connie (52:34):
Yeah, it was actually very interesting.
I was given the privilege tospend a couple of days with Matt
Ostroff in New Jersey and he andI, well he placed the mid-thigh
fem PICCs, but it was aneducational opportunity for me.
I thought it was a novelplacement and didn't really
(52:57):
think that I would need toconsider that.
But we got a call for a verycritically ill patient in the
ICU.
He was a young guy, he had endstage renal disease, HIV, rectal
cancer, status post-port removaldue to MRSA bacteremia.
So, just a very, very sickpatient.
(53:23):
Our kind of quick visualassessment, he had a AV Fistula
in one arm, his left arm andthen his right arm was just
bruised– it was pretty sad– fromall the peripheral attempts.
And then, we thought,'Well, allright, we'll do our assessment
(53:48):
with ultrasound' and our rapidassessment of his neck and
chest, you know, kind ofrevealed the same thing that we
had thought would be going on asa Vascular Access specialist in
that he had some stenosis at theconfluence of his internal
jugular and brachiocephalic,Subclavian and brachiocephalic
veins.
(54:09):
So, we knew, we were like,'thisis going to be tough.' We're a
team that plays the centrallines, too– in the IJ axillary,
Subclavian vein and femoralvein.
So, we thought, well, this'll bethe traditional CVC placement.
But it does come with the risksof infection and the inability
(54:31):
to maintain the dressing andthose types of things.
And then I thought, I said to mycolleague,'I think we need to
consider mid-thigh.' So, itwasn't like, you know, we went
into this, we're going to go dothese mid-thigh fem PICCs.
We know, they're novel, we knowthat a lot of people are not
(54:53):
doing them.
So it didn't, it really was bychance that I had the
opportunity to be with MattOstroff and then was presented
with this patient because if itwould have been reversed, I
think we would have put in atraditional CVC in the groin.
Eric (55:10):
I believe Matt had something earlier this year
published on the mid-thigh femwork as well.
He had a couple of other casesand he did some things that AVA
with that in September.
It seems like it was a perfectlytime situation for you.
And I know you mentioned and youwrote in your manuscript that
(55:31):
the patient had some scarringfrom a port as well.
So, it sounds like you sort ofneeded to find another avenue to
gain access.
That's really interesting.
Connie (55:43):
Not only did he have port removal, but he had
multiple temporary dialysisscars.
You could just tell from hisupper chest that we were not
going to be successful in upperaccess.
Eric (55:56):
So, would that, as far as trying to figure out where you
would gain access, would youcall that sort of the largest
hurdle you and your team facedduring this whole process?
Connie (56:08):
Yeah, I think well in our own fear, too, right?
We had never done it.
I had seen a few done.
But as nurses that place centrallines, we knew that we were
going to treat this vein on thethigh like we would any other
access site, the sameprecautions and prepping would
(56:30):
be the same.
My hands were shaking.
I had my teammate, Sheri Peroni,there who was excited to have
the option.
She hadn't thought about thistype of access before.
Typically, I think in thesecases, Vascular Access nurses
(56:52):
will kind of walk away and say,'Oh, not a PICC candidate.' So,
we were excited, but I thinkreasonably nervous.
My hands were a little shaky.
Eric (57:04):
That's completely understandable.
How did you and your team ensurecontinued safety once you
actually were able to place thePICC?
I know, I think it dwelled inthere for a little over two
weeks, correct?
Connie (57:23):
Yeah.
Three weeks.
What we did was, um, well whenwe, after we placed it of
course, there's always thoselearning opportunities.
So we gathered as many nurses,physicians immediately to
explain what we did.
(57:44):
This is what it looks like.
Of course, everyone loved thefact that it was out of the
groin.
The site was optimized and easyto care for, but we also took
ownership of this line and weround on it every day.
We had, everyone knows how toreach us by pager and cell
phone.
But we followed it every day andhad learning opportunities with
(58:05):
anybody who would listen to us.
The patient's mother was at thebedside all the time, too.
So, we of course educated herand told her if someone didn't
...
and this was just a PICC in adifferent spot.
So, the care and maintenance wasthe same, but we let her know if
(58:25):
for some reason she felt unsureabout someone that, that she
could page us or asked us to bepaged.
We're not a 24/7 team yet.
So, we did the best we could.
Eric (58:38):
I'm sure she appreciated any information you all were
able to provide for her.
And I think from what I've readand just attending the annual
Scientific Meeting a few monthsago, I think this mid-thigh
stuff is kind of a new, it'skind of a big wave right now in
Vascular Access.
(58:58):
Is that correct to say?
Connie (59:01):
It's definitely on the, this is early adapters.
The bell curve, right?
The very early adapters.
I think we still, we do get alittle bit of criticism still.
Which is unfortunate.
And I think the one point that Idid want to make was that this
(59:21):
was multidisciplinaryco-collaboration.
There were five people makingthe decision for placing this
particular mid-thigh fem PICC.
I had called Matt Ostroff on thephone, Sheri called
Interventional Radiology andspoke to Noah, one of our docs
in IR.
And then we had the intensivist.
(59:42):
So, there were five of uscollaborating on this device.
So it is, I would still say it'sdefinitely, it's an emerging
access site.
You know, as a pediatric nurse,Eric, this was never new for me.
Like the surgeons at Children'swhere I worked, they never put
(01:00:03):
in a femoral line.
They always access lower on thethigh.
So, I feel like this has beenaround for quite a long time,
but I think as far as adults,placing them, it is definitely
an emerging access site.
And you know, I think about JackLeDonne when I think of this
(01:00:24):
site too, because how many timesat AVA or at a local network
meeting, do we hear optimizingexit sites?
Right?
We're not just throwing the linein and walking away.
We have to make sure that thoseafter us can actually care for
the line.
So yeah, it's important.
Eric (01:00:47):
It's extremely important.
So, obviously we're in the midstof publishing your case study.
For those people that read it,what do you want them to take
away from your experience?
Obviously you wrote about it, itwas great.
And is it sort of hoping otherVascular Access specialists sort
(01:01:09):
of have an open mind andconsider this as an option for
access or is there somethingelse?
Connie (01:01:14):
Absolutely.
I think first and foremost,Sheri and I, we both published
this and in no way are wesuggesting that everyone should
just go out and start placingmid-thigh fem pics.
I think collaboration,advocating for your patient with
your physicians to ensure youplace the right device.
(01:01:38):
Learn about it.
But I really do think it'simportant for our specialty to
survive in the healthcareclimate that we're faced with
that we do expand and we don'tjust walk away and say this
patient is not a PICC candidate.
But it's through relationshipsand mentoring and
(01:02:01):
multidisciplinary collaborationthat we can expand to this site
and ensure that our patients aregetting the right device.
I think what helped us is thatwe were already placing central
lines.
Our physicians at our hospitalvalue our specialty.
They trust our judgment.
(01:02:22):
So, I think with those things inplace, we were able to move to
the mid-thigh placement as wellas central lines.
But I think that I wouldencourage all nurses to consider
this.
And when I first saw it, Ididn't think it was going to be
something that I was going to dothe following week.
(01:02:44):
But I think we should be havingthese conversations and I hope
Matt's publication as well asthis case study– clinicians can
take this to their IR doctors,their ICU physicians and say
this is a viable option toreduce bloodstream infections to
(01:03:06):
increase the ease of care andmaintenance.
Just as we continue to grow ourspecialty.
I would hope that everyone thatreads it and just knows that
it's something they should bethinking about.
Maybe they can't do it today,but start taking those steps
towards doing this for the rightpatient for the right reasons.
(01:03:26):
For sure.
Eric (01:03:27):
Definitely, and they should act the way you did too
as far as calling Matt andasking him since he has
experience in it and they'llknow that you have experience in
it as well.
And if they have any questionsabout a potential candidate for
PICC placement in the mid-thigh,they could give you a call on
that.
It seems like another way thatclinicians such as yourself can
continue to put forth the besteffort to, to benefit patients.
(01:03:50):
That's really great.
Well, Connie, I reallyappreciate you taking the time
this morning to chat with me alittle bit about your case study
on the mid-thigh femoral PICCplacement.
For those of you listening tothis podcast, you can check out
Connie's published article in afew weeks in the Journal of the
Association for Vascular Access,both in your mailbox if you
(01:04:13):
receive the printed copy as wellas online via email and on the
AVA journal website.
Connie, thanks so much for yourtime this morning and stay warm
up there with all the snowhappening in Chicago.
Connie (01:04:26):
Absolutely.
Thank you, Eric.
It's been a privilege.
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