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What's wrong with this picture?

PREVIOUSLY, IN WHAT'S WRONG WITH THIS PICTURE: Aaron Rodgers

This is Sir Andy Murray. He is a three-time Grand Slam tournament winner, 2012 and 2016 Olympic gold medalist, Davis Cup champion and former No. 1 ranked tennis player in the world.

With 45 singles tournament titles and more than 600 career victories to his name, Andy holds endorsement deals with Under Armor, Jaguar, Head, Standard Life and many more. You get it – Andy is a huge deal in the tennis world.

Unfortunately, earlier in 2019 he announced he may retire in the coming months due to nagging hip pain. If everything works out, the 31-year old phenom wants Wimbledon in July to be his final tournament. He is expected to retire with accumulated wealth approaching $165 million.

However, Andy’s preparations for that tournament are currently on hold after he underwent resurfacing surgery on his right hip on Monday. He posted this photo from his hospital room following surgery.

This photo has over 300,000 likes on Instagram alone - but it’s unlikely anyone with a working knowledge of how vascular access devices should be inserted and maintained liked anything about what’s pictured above.

To most patients – like Andy – he appears to be showing off some hospital tubes in his arm. But here is what trained vascular access professionals see:

Perhaps we are being picky, but 50 people die every day in America as a result of complications related to hospital tubes like the ones Andy is showing off in this photo.

These are peripheral intravenous catheters (PIV) that have been placed into his body to deliver medicine as part of his surgery to repair his hip. He didn’t go to the hospital to just get a PIV. He got a PIV because of why he was in the hospital.

We are not sure why he has what appears to be two PIVs in the same vein.

Vascular Access is a vital part of the healthcare people receive. It supports your therapy. It helps keep you alive. It can also cause catastrophic problems and even kill you if it isn’t done properly.

  • First, Andy is a right-handed tennis pro. That arm is largely responsible for the millions he has earned throughout his career. The clinician who placed the PIV (again, there are two for some reason) should have taken this into consideration and used his left arm.
  • Second, blood pressure cuffs can harbor pathogens that lead to infections. The arm without the PIVs should have been used. Had his left arm been cannulated, it would be in the right place on his right arm. Inflated blood pressure cuffs also interrupt and diminish blood flow. This can impair drug delivery infused below and the combined cannulas also decrease blood flow. All can contribute to deep vein thrombosis (DVT).
  • Third, Andy has hairy arms. They should have been clipped prior to cannulation.
  • Fourth, there is blood visible in one of his cannulas, which needs to be flushed. It is also secured with tape. There are better options for securing PIVs. PIVs get dislodged at an alarming rate.
  • Fifth, the dressings - and tape - are clearly not occlusive and should be changed.
  • Sixth, stopcocks should be removed immediately following surgery. They do not disinfect ports and are known to increase intraluminal infection risk.

Both PIVs were placed in the forearm and do not terminate in an area of flexion, like Andy’s elbow or wrist - so the site selection, albeit on a professional athlete’s dominant arm - appears to be sound. When PIVs are placed in the hand or terminate in the wrist, any bending risks pistoning the catheter which could lead to phlebitis, dislodgment, embolism, infiltration and infection.

The insertion of devices like Andy's is the most common invasive procedure in all of healthcare. Hundreds of millions of them get placed every year around the world. You’ve probably had at least one in your life.

Andy, a multi-millionaire and celebrity, shared photos of his PIVs and probably had no idea just how sub-optimal his vascular access care was. The hundreds of thousands of fans who liked the photo probably had no idea either.

This is happening every day in hospitals and clinics everywhere, in part because vascular access is not adequately covered in nursing or medical school. This specialty and vital component of healthcare delivery is generally learned on-the-job by watching other clinicians perform insertions, care and maintenance.

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 PIVs 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. Andy went to the hospital for hip surgery, not to get a PIV - but he 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. Andy 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 Andy Murray. He is a patient, just like all of us.

To learn more or to join AVA, please visit www.joinAVAnow.com.

(Andy Murray has no relationship with AVA or the AVA Foundation, but he can always ask)