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News & Press: Association News

What's Wrong With This Picture? Miley Cyrus

Thursday, October 10, 2019  
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This is Miley Cyrus. She is an American actress, singer and songwriter.

Miley grew up in the public eye as a teen idol starring in the Disney Channel series Hannah Montana - named for her character - en route to selling over 70 million records.
She has parlayed her success for numerous philanthropic endeavors, lending her voice to charity singles including Just Stand Up (Cancer) Send it On (Environment) Everybody Hurts and We Are the World 25 (Haiti earthquake). Miley is involved with numerous healthcare causes, including the Elizabeth Glaser Pediatric AIDS Foundation, Elton John AIDS Foundation, Kids Wish Network, the American Red Cross, Make a Wish, Cystic Fibrosis Foundation and St. Jude’s.
Miley has also visited countless, hospitalized fans to raise their spirits. You get the idea. Miley is both a global celebrity and intimately involved and familiar with healthcare delivery.
Unfortunately, recently she was stricken with a case of tonsillitis so severe she was admitted to the hospital. She posted the following images to her Instagram story, which is followed by nearly 100 million of her fans:

To most people - like Miley - this just looks like another hospital tube in her arm. But to trained vascular access professionals, here’s what they see:

This is a peripheral intravenous catheter (PIVC) that’s been placed into her body to deliver medicine as part of treatment for her throat infection. Miley didn’t go to the hospital to just get a PIVC. She got a PIVC because of why she was in the hospital.
Vascular access is necessary for most healthcare delivery. When it’s done improperly, it can be…a wrecking ball.
This PIVC has been placed in her antecubital fossa, which is the inside of where the elbow bends. This insertion site was likely chosen because that vein is prominent and - with young, healthy people like Miley - can be seen with the naked eye. It’s easy to access with a needle.
But that expedience comes at a cost, as anyone with elbows can tell you. Arms are designed for bending (try going 10 minutes without bending your arm if you don’t believe it). As you can see in her other photos, Miley is forced to keep her left arm straight due to the catheter that’s been inserted into it. 
Not bending your arm gets a lot trickier when you’re sleeping, when limbs can take on a life of their own. There are better sites on the body for inserting PIVCs, like in the forearm - which unlike the elbow, does not bend.
Getting picky, a 20-gauge IV was chosen here (as evident by the pink color) where a 22-gauge (that’s smaller) would have done the same job, but with added comfort for the patient and vein. A catheter/vessel ratio tool would have been useful here.
These devices - their insertion, care and maintenance - are the most common invasive procedures in all of healthcare. Hundreds of millions of them get placed every year in America. You’ve probably had at least one in your life.
Miley, a multi-millionaire, celebrity and healthcare philanthropy enthusiast, had hers placed sub-optimally and in an area that created unnecessary discomfort and risk. And she had no idea. This is what normal looks like to most patients, who don’t realize there’s a better, safer and more comfortable way to perform - and receive - vascular access.
She shared her pictures with millions of people, most of whom had no idea either. That’s not OK. The Association for Vascular Access would like to change that.
We are committed to protecting patients through advocacy and education by helping them understand and define what is normal with their PIVCs and other access devices. AVA also educates clinicians on important aspects of vascular access like site and device selection. 
The AVA Foundation helps fund research, scholarships and initiatives that elevate the standard of catheter care and the competence of the people who administer them.
Vascular Access requires dedication and understanding. Miley didn’t go to the hospital to get a PIVC, but she could have ended up staying much longer - and possibly never leaving - because of it.
Fifty people die every day in American hospitals because of complications resulting from their vascular access devices. Miley did not become part of that statistic, but thousands of others do every year. We need to do better, not just for the rich and famous - but for all of us.
This is Miley Cyrus. She is a patient, just like all of us.
To learn more or to join AVA, please visit
(Miley Cyrus has no relationship with AVA or the AVA Foundation, but she can always ask)

SEE ALSO: What's Wrong With This Picture? Andy Murray