Well it was after midnight before I got to my hotel in Atlanta so I didn't send this out last night. So day late but here it is. Thanks again to everyone that made the conference so great and for those of you who who threatened to beat me up if I didn't do this again this year. :-)

TONY

 

Day 4

 

Pretty good start today: I got to sleep in a little bit. First session was at 08:00: “A Funny Thing Happened on the Way to the SVC: Vascular Anomalies, Occlusions, and Catheter Malpositions” presented by Nancy Costa, RN, BSN, CRNI. A very energy filled presentation. She used a variety of ultrasound, DSA, venograms and radiographs to show the many strange things catheters do to themselves and the wrong turns they can make. It kept you awake and interested.

 

The oral abstract presentations followed. These are presentations by authors of what was a poster presentation. Since they are short four were presented. All of them were very nicely done and informative.

 

Dr. Roberto Biffi started out with “Catheter Related Central Venous Thrombosis: The Development of a Nationwide Consensus Paper in Italy”. Practitioners in Italy did an in-depth review of evidence based studies relating to central venous thrombosis. Their goal was to formulate rated recommendations related for the prevention of thrombosis, much like the CDC Guidelines for the Prevention of Catheter Related Blood Stream Infections which most of us are familiar with. They are now in the process of presenting and disseminating these guidelines to promote best practices in Italy. Very cool work.

 

He was followed by another wondering speaker, Mary J Mang, RN, BSN, CRN. Man did she talk fast. Much like the disclaimers you hear on commercials. But it was very clear and I never had a hard time understanding or keeping up. She described how a computerized system was used in her institution to monitor PICC care. By monitoring and reporting compliance, or lack thereof, with the standards and policies of the institution they were able to facilitate significant improvement with compliance. This improved compliance was reflected by a decrease in the infection rate with a subsequent real, and significant, savings for the institution.

 

The final two abstracts were presented by Marguerite Stats, MD, PhD. She was from Belgium. In a brief geography lesson she explained that much like Canada, Belgium is divided into two different native languages with the north speaking Dutch and the south using French.

 

Her abstract “Functional Comparison of Access Ports with a Classical Design vs. Tangential Outlet – A Single Center Prospective Randomized Study” took a look at implanted ports of these two designs. They examined several factors including flow rates on aspiration, reasons for removal and occlusion rates. Ports were examined post removal and the bowls visually inspected. The study had to be terminated early, due to staffing, so the sample size was smaller than they would have preferred. The statistically analysis found no significant advantage of one design over another.

 

She then went on to the final abstract of the session, “Safety Concerns of Polyurethane Catheters Connected to Totally Implantable Venous Access Devices”. Silicone has a long standing record for safety in long term dwell. They began to notice problems or symptoms of stress with polyurethane catheters attached to implantable ports. They started to carefully examine and preserve all removed ports. The issue they noted most was stress cracking and fractures at the port/catheter junction. Notably one rupture at the pinch point of the Clavicle and first rib was reported. The stretching of the catheter over the port outlet, a normal part of port assembly, presumably may be a contributing factor to the problems. They noted ports with dwell times in excess of 700 days most often had evidence of damage, stress or fatigue while catheters with less than 500 did not. They have reported failures and potential failures to the manufacturer and encourage others to be vigilant and report any signs of failure or pending failure as we should with all devices. The inference is that there may need to be design changes in the port to catheter junction or further refinements in the polyurethane formulations.

 

The traditional end of the conference is the lunch and town hall meeting. I am not sure what we ate but it was real yummy. And I am certain that it was not on my diet. At our table we ended up in a lively discussion about the issue brought up yesterday with blood cultures; to discard or not. We resolved that we really do not know what is right and desperately need well constructed studies in order to establish an evidenced based standard.

 

The town hall meeting traditionally is a time to introduce the incoming BOD and thank the outgoing. There is always some talk about our direction and plans for the coming year as well as review of what has been accomplished. Did you know AVA membership has increased three fold in the past 10 years? The value of our corporate members was emphasized, not only for the financial contributions but for the technology they develop and bring to us that enables us to do what we do as well as we do it. As I have said many times, they are an integral part of our practice and a vital member of our organization.

 

Various awards were handed out including the poster awards and reader’s choice awards. There is more information about these programs on the AVA web site. A surprise one was a drawing for completing the SAVE That Line campaign word search that was distributed in our conference materials. There was even a free conference membership given to one lucky person drawn from all the members that voted in the reader’s choice awards.

 

There were two announcements that were very significant. AVA is moving forward with the development of evidenced based practice standards as well as a certification process for multiple disciplines. A written text would logically follow this process. This is a very exciting and much needed move in our profession. The project is in its early stages so details have not all been set. So watch E-VAN and the AVA web page for details as they develop.

 

In order to facilitate this project financially and to fund research, AVA has created a non-profit foundation. They needed someone to name it after. There are so many deserving persons for this honor. The qualifications or should I say qualities of the winner are too numerous to list but I will say it is someone dedicated to AVA heart, soul and body, not a new comer, and certainly not leaving in the near future. She has proven herself in hard times as well as good times. I congratulate Marcia Wise, RN for earning this honor. She gave us a tearful thank you speech and had me and I suspect the whole room crying right along with her. What an asset Marcia has been to AVA, and still is, and now the foundation will live on allowing AVA to advance our profession to new levels of excellence.

 

So after all that we had to say our final farewells, travel safe and see you next year. For those of you to whom I have tried to give a glimpse of the meeting I hope that you too will join us next year in Arizona. Information is already available on the AVA web page. Start planning now! I apologize if I have made any errors in my ramblings over the past few days; please forgive me if I have I am a tired old man. TTYL

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