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Podcast - Season 1 - Episode 10 - Transcript
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Season 1, Episode 10 Transcript

 

This episode of ISAVE That Podcast is made possible by the AVA Academy, debuting in early 2019 from the Association for Vascular Access. AVA Academy is where you'll find the best-in-class cutting edge Vascular Access education from PICC insertion to our ultrasound-guided peripheral IV course. For more information, subscribe to the ISAVE That Podcast, follow AVA on any social media platform and become an AVA member today.

From the Association for Vascular Access, this is the ISAVE That Podcast.

 

Ramzy: It's Season 1, Episode 10 of the ISAVE That Podcast. We made it to 10!

Eric: Double digits!

Ramzy: Double digits. It's Ramzy Nasrallah, I'm in San Diego with Judy Thompson. Eric Seger is in Columbus, Ohio.

Eric: Hi!

Judy: In the sunny city of Columbus, Ohio.

Eric: It's just gorgeous here, you're right.

Ramzy: 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 now been recorded.

Eric: That's right, boom. But yeah, it's been 40 and rainy last few days, but it's all right. It is what it is.

Judy: It rained in San Diego. It did rain last week or this week in San Diego. But we're back to sunshine.

Ramzy: Yeah, probably at 3 a.m. We have a lot to get to. This is a great episode. I sat down with Kelly Ann Zazyczny in New Hope, Pennsylvania to talk about the impact AVA had on her career as a clinician. It’s actually, really – let's back this up. I was at AVA this year in Columbus and one of the people working the Foundation booth grabbed me and gave me her business card and said this lady was really impressive. She made a donation to The Foundation. She wants to talk to you about how she can do more for AVA because of the impact that AVA has had on her career.

Judy: That's awesome.

Ramzy: And that was a story I needed to hear. And that's a story that you all will hear, as I met her in Pennsylvania a little while ago and walked through how she took a job as a pediatric nurse manager. And upon accepting it was told 'aha!' You also get the Vascular Access Team. That was her introduction to Vascular Access and she'll talk about not just how that impacted her personally and her career, but ultimately it really helped advance her career of being at the forefront to what we call the gateway to all healthcare delivery – it starts with Vascular Access. So that's coming up next and Eric, you've got a section with, a Behind The Manuscript section coming up.

Eric: I do. I had a nice conversation with Connie Girgenti. She has a case study on a mid-thigh femoral access, coming up in the next, or the final issue of JAVA for 2018, the winter issue. So, we spoke a little bit about that case specifically and how that's, the mid-thigh work has really, as I understand, and Judy you correct me if I'm wrong, really sort of blown up in recent time. I know Matt Ostroff was on before, he mentioned a while back in earlier in the season in speaking with Ramzy about presenting on his mid-thigh work and we have also published a case study of his in JAVA. So, I think that's kind of a topic that's really hot right now.

Judy: Yeah, I agree, Eric. In fact, I talked to Matt quite a few times about it. I am about to go up to New Jersey and film at his hospital. We're going to go over mid-thigh work and create a course for AVA, for our AVA Academy. So, there's a lot of hubbub about mid-thigh work. We're so proud of Matt, proud of clinicians that are the early adopters. So, this is going to be exciting. I can't wait to read what Connie wrote.

Ramzy: She's ahead of it. Mid-thighs are in the forefront and we're trying to get ahead of it, too. I like that you mentioned, you slid AVA Academy in there too. In a future episode, we'll be talking in depth about AVA Academy because that's the thing.

Eric: Branding, branding.

Ramzy: Hashtag branding. Finally, we have a section today on the episode on network excellence. AVA is virtual and national and global, but it is also local. And last year in the spring I was with Vineet Chopra, whose university lost to Ohio State in football, last week.

Judy: Didn't you just say that? That's twice now.

Ramzy: I did, I wanted to make sure everyone heard that.

Eric: Not only did they lose, they gave up 62 points.

Ramzy: Sixty-two points. I can't believe it.

Judy: You know, we like Vineet. What are you doing?

Ramzy: We do like Vineet. Well, this is part of this, it comes with the territory.

Eric: He can come on and defend himself.

Ramzy: He can, he'll be filled be on podcast soon. I was with him in Perth and he mentioned to me that there was a Michigan Journal Club for vascular access that this guy, Matt Gibson, had started. And he really thought it should be a network. In lieu of waiting to get back to the states – Perth is 12 hours ahead of eastern time – so I think we were together at like 9 p.m., and I called Matt in front of Vineet at 9 a.m. Green lighted, the Michigan Vascular Access Network, which by the way is called MiVAN, even though it should be called MOTORVAN. But he and Jeff Hanks, in one year's time put together really what a network should look like for AVA anywhere you go. I mean, it's got enthusiasm, leadership, organization, industry involvement. I just went to their big annual symposium. It was just incredible, and I cannot believe it's only a year old. So, I spent some time with Jeff and Matt talking about best practices for networks and how they were able to turn MiVAS, the Vascular Access Society Journal Club that Vineet had told me about, into MiVAN, a real shooting star of a network for us in the eastern side of the US.

Judy: If only it was MOTORVAN.

Ramzy: We'll get to it, we'll get there.

Eric: Everything I saw from that meeting looked like it was fantastic and obviously we even did some stuff with social media on it. So, after break though, we're going to have Ramzy's conversation with Kelly Ann's Zazyczny. So, please stay tuned.



This episode of ISAVE That Podcast is made possible by the AVA Academy, debuting early in 2019 from the Association for Vascular Access. AVA Academy is where you'll find best-in-class cutting edge Vascular Access education from PICC insertion, to our ultrasound-guided peripheral IV course. As always, you'll still be able to pick up CE credits through JAVA articles each quarter and by attending virtual sessions from scientific meetings. AVA Academy takes Vascular Access education to the next level. We are developing insertion, care and maintenance courses for the full spectrum of Vascular Access Devices and procedures. AVA Academy is open to the public and AVA members will receive significant discounts on all education. For more information, subscribe to ISAVE That Podcast, follow AVA on any social media platform and become an AVA member today.

Ramzy: We are in New Hope, Pennsylvania at SkyRoast Coffee on Main Street. There is some ambient noise in the background. So, if you hear the, the sultry tones of jazz music and people having coffee conversations, that's not fake. It's very real. I am joined today by Kelly Ann Zazyczny, who is a nurse at Main Line Health and was brought to my attention at conference this year as I was being pulled in several different directions. I had one of the members of our Foundation Board of Directors pull me aside and said, told me that you have to meet this lady. And I did. And he was absolutely right. AVA is something that advances its cause through storytelling. And I thought that the podcast audience would benefit from hearing Kelly Ann's story of how not that she went out and found Vascular Access, but how Vascular Access found her. So, Kelly Ann, thank you for joining me today.

Kelly Ann: Thank you so much for having me. I'm really feel privileged to have this opportunity to speak to you today just because AVA has become so important in my professional career.

Ramzy: And that's really the crux of the story. Like how, you know, you didn't go out and find AVA, AVA sort of found you. Can you talk a little bit about how your career pulled you into being almost a Vascular Access specialist without you going out and seeking it out?

Kelly Ann: So, in 2008, I had come to Main Line Health and had interviewed for a pediatric manager position. Being that is my, I will always say that I'm a peds nurse by heart. I have worked at the Children's Hospital of Philadelphia and then had the privilege of working Children's Healthcare of Atlanta. And so, when we moved back up north, I had gone back to chop for a short amount of time, but then had called a colleague and she had told me about that they had this peds manager position. So, I interviewed for it and after several months and really kind of making the formal decision to make the move, I took the position. And then once I got in it they said, 'Oh, by the way, the previous manager was not only the peds manager, but she also had the IV team.'

Ramzy: Oh, nice. Congrats!

Kelly Ann: But for me personally, even though I wasn't a Vascular Access nurse, I had a full appreciation for the specialty being a peds nurse. I had great people like Anne Marie Frey, who's very involved in AVA in the pediatric subgroup who was an IV nurse at chop, that I spent many hours with her in the treatment room watching her put in PICC lines an IVs. And just really being very appreciative of their role and their support and care of patients. And then when I went to Atlanta, you have people like Judy Burns who actually taught me how to put an IV in because at the time Choa had gotten rid of their IV teen and then shortly decided that that really was not a good idea in pediatrics. And so, they brought it back. So, I always, when I see her at the conference every year, I'm like, there's Judy, she taught me how to put in IVs.

And then I managed a sedation nursing service at Choa. So, you know, nurses that had to be skilled in putting in IVs. So, for me, I was like, 'OK, I really appreciate this. I can do this.' What I learned is that, then what happened was, is that then they started getting me fully engaged where they said, 'Well, when Mary was here, we actually had a system committee and we need a leader to be the executive sponsor. Could you be our executive sponsor?'

Ramzy: You're find out more and more about your new job.

Kelly Ann: Yeah. 'Can you be our executive sponsor so we can have meetings again?' And I was like, 'OK, I appreciate that. That they want to get together as a system, the four different teams to kind of talk about best practice.' What I learned very quickly was, is that, even in our own organization, there was such different philosophies of practice. It wasn't consistent. It wasn't really consistent with what I was reading because the type of manager or leader that I am, if I'm going to manage a group, I have to learn about your work. So, that kind of scared them a little bit. I remember saying to them, 'OK, I'm putting on scrubs and I'm going to follow you around for the day.' And then I was like, 'OK, well this is a different catheter. Let me try it and put an IV in.' And I got in and I remember the nurse that I was falling around that was brave enough to take me. She said, 'You are the first nurse manager I have ever had that actually knows how to stick a patient.' And I was like, 'Oh, OK, that's great.'

Ramzy: That's high praise.

Kelly Ann: It was, and what I learned as a nurse leader is that if I'm going to build credibility with the staff, I need to be able to do the job. I need to be knee deep in it with them so that I can really understand what they're struggling with. Like, what is the challenges of them being able to give the great care that they want to give to patients. I know that's not every nurse manager's philosophy, but for me it really has worked. And I feel that I, the success that we've had at Main Line Health and the reason why we have such great outcomes is that I really try to work alongside the staff so that I can really fully appreciate of what I can do as a nurse leader to support them in their role so that they can better take care of their patients in the best capacity.

Ramzy: Managing Vascular Access specialists is helpful if you are a Vascular Access specialist yourself.

Kelly Ann: Right.

Ramzy: And this is something that I think is pervasive across the industry. I used to sell products. I've had managers who had never sold before. It's difficult to accept coaching from someone who's never been in the trenches. Same thing with if you're an artist reporting into someone who has no appreciation for art, you want to understand what the guild is up to. So, you're a pediatric nurse manager. You've inherited the IV team, you're now learning about how to stick patients and the complexities that go into vascular access. Talk a little bit about that journey and how you eventually, Vascular Access became important part of what you did on a daily basis.

Kelly Ann: So, shortly, I guess within the next year, I believe that the staff were all going to an AVA conference. It was in National Harbor was the one of the first ones I had gone to. And so, they said, do you want to come with us? So, here I was, we drove down, there was a whole group of us, and we went for the conference and it was just an amazing experience for me. It was the beginning of me then saying I need to come to these every year because I got to meet great people like Nancy Moureau and Jack LeDonne and my friends at AVATAR, Claire (Rickard), where you have the opportunity to interact and network with some of the founding leaders of this specialty. And get your questions answered or kind of just brainstorm about challenges that you're having. And every time I go, I always come back with a renewed sense of enthusiasm. And actually, once again, I do scare the staff because I come in, I'm like, 'You'll never guess! 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 up again! Here we go!'

Ramzy: She went to AVA again!

Kelly Ann: I went to AVA again! But, I mean, it really has been such a tremendous asset because like Nancy Moureau's PICC Excellence – that is our foundation. Every nurse at Main Line Health has to do the online training for PICC insertion and ultrasound utilization. And we use that as our foundation education. For me, that was so helpful because this isn't my area of expertise. So, I would have had to either spend a lot of extra time trying to research various educational tools or platforms and then tried to get that approved in our organization. And what happened was, is we had a company actually sponsor it for us for a year for free. The membership. And then from that we were able to see that there was a lot of great CEUs and it just helps me provide consistent education that I know having worked with Nancy and spoken to her on a regular basis, that this is somebody that I think she has been pivotal in providing Vascular Access education and I know it's credible and I know she's always updating it.

So, it's one less extra thing that I have to work on. And so, I've been able to use that. The whole target zero like I have made that my mission. In 2008 or 2009 we started talking about target zero and that we can't make excuses anymore about central line infections and that they just happen. That we really have to think about our own professional accountability and what we're doing and what our responsibility is to our patients. They shouldn't be sick and then come into the hospital and get another complication because of us. Using AVA and the various lectures that you've had, we have really elevated our practice and in 10 years we've reduced our CLABSIs by 86%. We have had two of our hospitals that have gone a year and a half to two years at zero. Every day where we're trying to say what can we do and how can we do it better to protect our patients.

And I remember early on, just being exposed to different, having the different partners at your conferences. So, to me, I love that. That's like going to a large flea market and just having everybody at my fingertips where I don't have to sit there and make phone calls and emails and try to bring various different companies in because I want to look at a new product. You have them all there at the conference. So, actually I usually get the group together. I'm like, 'OK, so what are we gonna look at this year? OK, you go to this booth, and you go to this booth.' And then we come back to our system committee and we, we make decisions about, OK, well these are the products, this is what we're having difficulty with. These are the products that we're interested in looking at. And then, you know, we have the information, we have discussions, then we bring a couple in. So, that's really been very helpful for me because, you know, it's just challenging to get through the day-to-day. And I think I've been successful in changing a lot of our practice with the support and the expertise of our Vascular Access teams because I support them going to conferences and you know, we're all members of AVA. So, we're reading the Journal. The new thing is we're talking about the mid-thigh PICC line and I'm like, 'OK, that's next on our agenda.'

Ramzy: 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 capture procedure videos specifically for mid-thigh. Let's take that further: AVA has, I came on a year and a half ago and I've been trying to preserve just how special the annual conferences but also make AVA a 12-month organization. You live in and we are right now in eastern Pennsylvania. There are a couple of AVA networks near here. What has your experience been like on the local level with AVA in Pennsylvania and on the New Jersey border here?

Kelly Ann: So, I've been involved for probably the last year or so. And that was again the staff saying, 'Hey, we have local chapters now can you come to the meetings?' And actually, to be honest with you, it's been very positive because, I knew, they had Jack LeDonne show up for one of theirs. They had you at one of them.

Ramzy: Right. Mauro Pittiruti, basically, the pope's doctor was there.

Kelly Ann: I think that this is actually, I am 100% in support of this, especially because a lot of organizations are not paying for conferences for their nursing staff. So, you have a lot of people that make sacrifices because they're committed to the specialty to go to these conferences and they might not be able to go every year, but they save so that they can go every other year. And so, I think that it is important for us to really have that grassroots regional type of programming and chapters because it will only allow more people the opportunity to have at least a small experience of what you would get at the national level when we have our conferences every year.

Ramzy: So, Kelly Ann, picture someone at work and they want to go to AVA, they can't get the time off or the support. How effective do you think the networks would be on a local level to have that person bring people from work, bring three or four colleagues to see what a local AVA network meeting looks like? How does that, do you think that's an effective way to get people involved in Vascular Access?

Kelly Ann: I do because I think when you see – the people that are organizing the regional AVA chapters are people that have attended conferences that are very experienced, that share the passion and it just radiates off of them. And actually, even at our local chapter, they I don't know if they took the dues or they got a sponsor, but they actually every year they kind of raffle off a registration for AVA so that somebody might have the opportunity to go to the conference.

Ramzy: Our AVA Industry Partners generally will pay for those, give them through the networks. And then that's the way to get more people going to AVA. And from a, I mean, I came from industry, I'll tell you this: My best customers were AVA members. Because they get it. It's a lot easier to talk about just how important evidence-based interventions reduce Vascular Access complications or make the procedures easier is when someone understands the procedure and the gravity of what's at stake with something that's for all intents and purposes, the gateway to healthcare delivery.

Kelly Ann: And I think too is that these regional chapters, they bring people together that are from other hospitals. So, you know, we have a very robust team and I do support them to get to go to AVA. So, they have learned so much from being involved with what best practices and then they're able to have those discussions with people in our own region and kind of just translate that information. So, even if they can't personally attend, I feel like we're able to reach more people because you have people that do attend the conferences that can then kind of maybe ignite the interest of other people to either attend or even just help support them in their own journey of becoming better practitioners.

Ramzy: Right. It starts at home. I mean, you got to go to National Harbor and kind of caught it there, but if you're going every quarter and connecting with hospitals that you're familiar with, it helps bridge that gap. So, you started as, you're the pediatric nurse manager, you found out after you accepted the job that you had the IV team and, fast forward a few years later, you now oversee all IV therapy operations at a four hospital system.

Kelly Ann: Yes, that is correct. Oh, we should also add that over the last 10 years I've been asked to speak at various events and conferences related to Vascular Access. So, 2 years ago I did get my certification because I thought I needed a little credibility as a specialist.

Ramzy: The Vascular Access board certification, yes, from VACC. This is the kind of story that I'd like to scream from the mountain top. This is what people, what's the face of AVA? It's people like you, Vascular Access found you, it had a significant impact on your career. It's having an impact on patients in your community. Kelly Ann Zazyczny: We need, we need more of you. I think that there's a lot of you out there that just don't know it yet.

Kelly Ann: I think too is that if anybody needs me to speak to their manager about the importance of them really educating themselves related to Vascular Access, I'll be more than happy to do that. Because I had a colleague of mine, she was actually the Dean of Villanova. She was actually the longest acting Dean and she passed away last year, and so I was very close with her and intimately involved with her during her journey of illness. And she got to a point where there really wasn't many options to provide her Vascular Access because she was a cancer survivor twice and just the various therapies. And I just think that what we need to focus on and try to help support our healthcare colleagues is that we need to look at the long term effects of the treatments that we provide our patients and how this is going to impact their vasculature.

Kelly Ann: Roy George, who had spoken at AVA, that young man, I actually became very friendly with him. He now corresponds with my, my oldest daughter because of their love of jazz. I say to him all the time, like, he's my hero. Because as a peds nurse, we did all these things because we were trying to help save these kids. And you never know what happens to them or do they live into adulthood. But he's just a prime example of, he is an amazing, beautiful human being that is just doing amazing work in music industry. But at a cost, right? So, he survived, but he really has limited vasculature now. And you know, I pray for him every day because I would never want something to happen to him and him be in a situation that, 'Oh, we have a therapy for you, but sorry, you don't have any veins left.'

Kelly Ann: And the same thing that happened to Dean Fitzpatrick is that, with her cardiac and from having chemotherapy, like all of her vasculature in her upper body was totally stenosed. And so, I think that that's really where our focus and the whole mission of this vessel preservation. And I know that that's going to be our work. I really feel that, uh, my job and I tell the staff now, it's like I need to provide you a toolkit like where you have soup to not. So, I expect before my time is done that they will be putting in IOs and advanced central lines and that. Our dream is that the physician will one day say, 'I'm consulting the Vascular Access team and you choose what is the best device for the patient.' Because really, unfortunately they don't really have that understanding. They just know the therapy they want to provide. They don't understand that, the delivery and that. We have these patients that have had multiple PICC lines.

Ramzy: Venous depletion is a very real thing.

Kelly Ann: It really is, and it's a really scary thing. And I remember the first time I heard that at an AVA conference: There was a woman who presented from Canada where she was talking about these dialysis patients and how you have somebody that's on dialysis and that we have a treatment for you. But guess what? You don't have any veins left. That really was impactful for me.

Ramzy: Yeah. You get to watch yourself expire because you've run out of veins.

Kelly Ann: I'm just starting the message at our organization and I've spoken to a large system groups of physicians to say you're doing a great job in survivorship. You really are. But what we really need to talk about is what are the consequences of the treatments that you provide your patients long term? Because after you say, Yay, you're cancer free, I still now have 40 years of my life that I could have another illness that will require a vascular access device.

Ramzy: Right. As a cancer survivor yourself.

Kelly Ann: Yes. It really has hit home.

Ramzy: So, you've really helped demonstrate the journey to find Vascular Access, to Vascular Access finding you. The passion and the urgency behind what we do. If I'm a new nurse or a resident doctor or a patient advocate or a stakeholder in healthcare, what would you say, Kelly Ann, to someone about the importance of having Vascular Access to be a foundational part of your experience and your awareness and healthcare?

Kelly Ann: I think that it's actually vital for them to get a baseline education and knowledge. And if they don't have that knowledge, because one of the epidemics in our society today is nursing schools, medical schools, they're not teaching this anymore. And then they think that you're going to learn this on the job. And there are so many organizations that, as a quick fix for the organization to save money, they've gotten rid of their Vascular Access teams. But you know, if I could call out to my friends, Claire, I think that in AVATAR Group, I think the next study should be really looking at those organizations that have Vascular Access teams, that's kept strong teams and what are their patient outcomes compared to those that don't have them. I see it every day that they just don't have the skillset or the education or the knowledge of, 'Oh well she said it hurt.' And then you look at it and you're like, 'OK, that's a phlebitis. But things that are so basic to us, for other people, they really just haven't gotten a good foundation. And how are we going to create that partnership where they might not be the ones being the inserters, but you know, they definitely have to have a strong knowledge base for the care and maintenance because as the team says to me every day, I can't look at every peripheral IV every day. There's too many of them. And so, we really need to help strengthen that education for that frontline staff. I think, you know, the conversation I'm having with our physician group, that whole "see one, do one, teach one,' to me that is the standard of teaching right now. That is the standard of teaching and that is one, a huge liability for patients.

We had a patient that, we don't provide 24 hour, Vascular Access service. So, we have patients that come in when we're not here and they're left to be poked and prodded by residents. And I'm not trying to beat up on our physician colleagues, but they haven't been given a thorough education on how to properly do that. So, they've stuck this patient like three or four times, probably didn't use the best technique. And then the next day I'm coming in and 'Oh, let's take, take out that line because it's a femoral line, it's not good for the patient.' Now we're providing another invasive procedure for them. You know, we just, I really think that we need to look at that and come up with a better strategy. And my goal at our organization as I've already just had a little initial conversation with our system medical vice president for surgery to say, I want us to partner with the residents. Like I think you can take Vascular Access nurses and the residents and the PAs and the physicians and let's partner together so that we have a consistent best practice for insertion, that we put those lines in the proper way so that as Jack would say, then the end users, the front line staff can actually care for them properly and they can manage the care properly because we put them in a better fashion and we can get better outcomes.

Ramzy: It's a departure from what's now the standard of care. You weren't beating up on your physician group. That's a story you can tell at just about any hospital. Kelly Ann, thanks for your time. If anyone listening would like to connect with Kelly Ann, as she offered, you can just email podcast@avainfo.org and we can broker that connection. Kelly Ann thanks for your time!

Kelly Ann: Thank you so much! It was such a pleasure to speak with you today.

Up next, we have Ramzy's conversation with Jeff Hanks and Matt Gibson, the two men behind the genesis of MiVAN, the Michigan Vascular Access network, about how they have grown that network into what it is today.



Ramzy: And I'm joined today by Jeff Hanks and Matt Gibson, the co-founders of MiVAN, that is the Michigan Vascular Access Network. We are actually at time the annual 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 2 years ago. We're here today to learn from these 2 guys on what the best practices are for running a Vascular Access network, since AVA works best at the local level where you live and work. But also, how they're able to create this community and pull folks into AVA at a national and a virtual level. Jeff and Matt, thanks for the time today and wow, look at the success you have – we just left a packed exhibit hall that that was part of a break with vendors that came after a packed symposium hall. Tell us about where this came from and how you got it to the point where it's just rolling right now.

Jeff: So, this was originally, Matt and I were working together, in a hospital and, discovered that we had like passion about Vascular Access and education and patient advocacy. He started going, 'Have you read this study? Have you read this study?' And we'd both had kind of read the same stuff. So, we hit it off from a passion standpoint and we really wanted to get a group of people together locally and really push AVA's agenda out to the local group. Cause we knew we worked with a lot of people that wanted to meet locally, but they really didn't even know who AVA was. There are 60 people where I work and maybe five of them had ever heard of AVA. The rest of them were all, I've heard of INS and things like that, but they hadn't heard of a specialty for their own groups.

So, we decided to put this together, kind of customer cowboys and we didn't want any rules. So, we decided to put together a journal club cause what we wanted to do is bring people together, in a casual setting and have a dialogue with top level researchers and thought leaders and expose people to these minds at an intimate level. So, we started doing that. And we did that for about a year. It turned out to be wildly successful. People really enjoyed it. And about the same time AVA really started rolling forward with more support for local networks. So we explored what can we do to, to get a hold of this more into AVA. We contacted Cindy and she's been a huge support. You've been a huge support and we talk all the time. We love this thing. It's a blast. We're astounded that we had 95 people register and 95 people show up and all the vendors showed up. Not one single person didn't come.

Ramzy: So, from a couple guys passionate about Vascular Access, to a Journal Club to now a thriving and burgeoning network. Let me ask you: AVA's getting better with the name recognition in facilities, but you mentioned INS and that's an infusion nursing pillar in that community. How do you go about recruiting people to become part of AVA? What is your pitch to them? I mean, we are a multidisciplinary organization. Our tagline is Protect the Patient | Educate the Clinician | Save the Line. There's a cannula involved. Who are you seeking out and how do you help them understand that they have a home at MiVAN and at AVA for what they do?

Matt: Vascular Access gets in your veins.

Ramzy: Oh, that's a literal comment.

Matt: It is a literal comment. And it flows out of that.

Jeff: It's cheesy, but you know, it was literally true.

Matt: It's so true. And that's how it is for me. It's something inside of me that I can't contain. It's a passion, something that just bubbles out. And this has been my outlet, for me to be able to bring in other people and whenever you are excited about something and then other people get excited about it. And so just from me and Jeff just sitting at the break room and talking about this particular article in this research and whatnot, and then we just fed off of each other. For us, I've been an INS member, I've been an AVA member for a long time. Both of them, and they're both important to me. You can't have infusion without, without Vascular Access. And you can't have vascular access without infusion. They don't exist. There's no, you know, and so just it focusing that passion and whether you're at APIC, or INS or AVA, everyone's welcome.

Ramzy: SIR. Pharmacists. I mean, multidisciplinary is multidisciplinary.

Matt: That's right. Everybody is welcome and everybody can take something of value from the things that we're offering and the people who are speaking. For me, facilitating that is like, that's why I'm a nurse, you know, to watch people grow and heal. And that's part of the healing process or the growing process is watching this come from such a small thing to very successful. I, and Jeff I think would say this too, we get so much from watching this happen and, and actually watching. You were there: we raised half of the people in that room were new! Half of the people! And we have found that transition just getting people to here and talking to them about very important things, things that they may be passionate about and finding that there's even more than just our local little network. That's what's important. That is really what drives us.

Ramzy: You've got, you've got an interventional radiologist speaking today. You had a pediatric intensivist this morning, anesthesia, the disciplines are represented. You've got the Great Lakes chapter of INS here actively advancing its interest because infusion has a home at aAVAva and you have accommodated that at the level.

Matt: And I'm glad you mentioned that because this is actually CRNI credits being given in conjunction with the CEs that we're giving from AVA. I mean, someone, I'm going to walk out of here with 13 CEUs: CRNI credits and CEUs combined. That's a huge value.

Jeff: Exactly. You hit it on the head, you know, not only is it multidisciplinary, but what we want to do is provide maximum value for people's time and money. Do you have a lot of things to do? We want to make sure that you get the most out of this and we want to bridge that gap, with our brothers and sisters from those other groups that have done a good job with promoting Vascular Access. But what you said about who we have here today in terms of disciplines is exactly how we make this happen. We thoughtfully sat down and say, what have we done this year? Have we pulled in enough IR people? Have we pulled in enough infection control people who are the big names in these sub categories that will really round us out from a multidisciplinary perspective and then, and then get them here or get them to a local event?

Jeff: And I think that that's been really key for people that came, had not been introduced to a group like this, discovered that they could sit next to an interventional radiologist and ask questions, that they could never feel comfortable or didn't have time to ask their physician at work or talk to a national published infection practice person like Chellie DeVries. It's just a phenomenal value for them and experience. And that's how, that's how we make a tick. We're always, it's not about, you know, let's get together and have some food and have a lecture. No, it is about that. It is about networking first and foremost, but it's about the content, it's gotta be relevant scientifically based and quality.

Matt: 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 be because we got to start talking about those things that are gray and not just black and white. And that's another avenue that we wanted to bring things here that people want to hear about but also need to hear about. Hopefully we'll expand their thought process and improve patient care. I mean, that's what AVA's tagline is. Protect the patient.

Ramzy: That's the first thing in our tagline. Let me ask you guys as the two cowboys that are running MiVAN: What are three things for network excellence, network management that you think are just not optional stuff that if you removed them, MiVAN would suffer. And if you didn't have them, you'd be a network that needed some upgrades.

Matt: This can be overwhelming. And so, to have the technological support, and we do use a software to manage the network. And it makes our jobs very simple, much more simple. It does cost. It is an expense, but so for us not to get burned out and to sustain your leadership. I think that's the one thing is super important. Don't you?

Jeff: Yeah, I think that using the tools of the day are huge. And, you know, social media what Matt and I've tried to do – Matt's kind of like the big idea guy. Usually he throws out an idea and I go no way, way too big. And then we land somewhere in the middle and it works out. He has the ideas and we figure out how to make them happen. We've got a small group of people that we trust. That's extremely important. We couldn't do this on our own. We built a leadership team to help showcase events.

Jeff: And we didn't have, what we didn't do that's different is we didn't have an election. 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 need that 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: We didn't want it to fizzle out.

Ramzy: Right. And burnout is real in everyday life. It's not just volunteer work.

Matt: Having the technological support has minimized the amount of people that we do need to involve. Because you know, things that we have done with a couple of clicks may have taken, you know, eight or 10 people to do versus the two of us.

Ramzy: And you have levels of compliance with regard to the legal stuff as part of an AVA network, the 501(c)6 stuff. You have access to Cindy Anderson who is AVA's Director of Affiliates. Can you talk a little bit about how you strategically use Cindy and how she helps MiVAN exceed your expectations?

Matt: Cindy is like the glue for us. She helps us stick everything together. There is a business in this. We are nurses, we're not particularly just excellent business people. So, Cindy brings in that piece to help guide us, direct us, and mentor us, make sure that we are achieving what we need to achieve from a structural operational side. And really it gives me a relief because we lean on her, so we don't have to know. We need the passion and we need the drive and we need the perseverance and the time.

Ramzy: And the best practice, and the guardrails and the guidance.

Matt: That's right. All of those things, that's what the clinicians and what we, Jeff and I, have in spades. The part that we did not is the operational, the business and that's what Cindy does for us. She really helps us to form this and make it smooth. And there's a lot of rules that we don't know or we don't understand. And she keeps us on track, you know, so she can pull us back in and say, 'Hey, this is what you need to do. This is a great try. You know what you did was fantastic, but we don't need to do that again.' And pulls us back in and really guides us and supports like no like no other.

Ramzy: The affiliate program that Cindy runs for AVA – we want to make sure that we put you in the best position to do what the MiVANs of the world are now doing, which is to advance the enthusiasm of AVA's mission on the local level, protect more patients to get more clinicians engaged in Vascular Access all of the disciplines and ultimately transform health care where you live and work. One of the things that AVA's promising to do, is committed to doing in 2019, is to get our networks better networked so you can learn from each other. And that's really the catalyst behind this session with these two guys, these cowboys here in Michigan. If you would like to connect with Jeff and Matt, you can send an email to podcast@avainfo.org and we will broker that meeting. AVA Is committed to thriving networks. Prosperous networks that help drive AVA mission, AVA's membership and ultimately protect the patients. So, Jeff and Matt, thanks for your time today and we'll head back into the MiVAN annual meeting.

Matt: Awesome. Thanks!

We're going to take a quick break but stay tuned for our Beyond the Manuscript segment featuring my conversation with Connie Girgenti on her case study that set to publish in the winter issue of the Journal of the Association for Vascular Access.




Eric: And welcome back. This is Eric Seger, on the Beyond the Manuscript Segment of the ISAVE That Podcast. I have the pleasure of being joined today by Connie Girgenti a Vascular Access specialist at St. Joseph's Medical Center. How are you doing, Connie? I know you had a canceled flight this morning because Mother Nature is coming down with a vengeance with snow down in Chicago.

Connie: Yes. It's brutal. It's pretty today. It won't be as soon as you have to start traveling in it for sure.

Eric: Right. Well maybe not Mother Nature, but Old Man Winter is who I should mentioned because it's becoming his season. So, we're here to chat a little bit about your case study that is about to be published in the winter issue of JAVA, which is due out in a little bit, in about a week or two. And you did some work with your mid-thigh femoral PICC placement, correct?

Connie: Yes, yes, yes. Excited to have that published and share the story about it. Yeah.

Eric: Yeah. So, tell me a little bit about that case. How did gaining access for a PICC line via the mid-thigh femoral vein sort of come into the equation with you and your team?

Connie: Yeah, it was actually very interesting. I was given the privilege to spend a couple of days with Matt Ostroff in New Jersey and he and I, well he placed the mid-thigh fem PICCs, but it was an educational opportunity for me. I thought it was a novel placement and didn't really think that I would need to consider that. But we got a call for a very critically ill patient in the ICU. He was a young guy, he had end stage renal disease, HIV, rectal cancer, status post-port removal due to MRSA bacteremia. So, just a very, very sick patient. Our kind of quick visual assessment, he had a AV Fistula in one arm, his left arm and then his right arm was just bruised – it was pretty sad – from all the peripheral attempts. And then, we thought, 'Well, all right, we'll do our assessment with ultrasound' and our rapid assessment of his neck and chest, you know, kind of revealed the same thing that we had thought would be going on as a Vascular Access specialist in that he had some stenosis at the confluence of his internal jugular and brachiocephalic, Subclavian and brachiocephalic veins.

Connie: So, we knew, we were like, 'this is going to be tough.' We're a team that plays the central lines, too – in the IJ axillary, Subclavian vein and femoral vein. So, we thought, well, this'll be the traditional CVC placement. But it does come with the risks of infection and the inability to maintain the dressing and those types of things. And then I thought, I said to my colleague, 'I think we need to consider mid-thigh.' So, it wasn't like, you know, we went into this, we're going to go do these mid-thigh fem PICCs. We know, they're novel, we know that a lot of people are not doing them. So, it didn't, it really was by chance that I had the opportunity to be with Matt Ostroff and then was presented with this patient because if it would have been reversed, I think we would have put in a traditional CVC in the groin.

Eric: I believe Matt had something earlier this year published on the mid-thigh fem work as well. He had a couple of other cases and he did some things that AVA with that in September. It seems like it was a perfectly time situation for you. And I know you mentioned, and you wrote in your manuscript that the patient had some scarring from a port as well. So, it sounds like you sort of needed to find another avenue to gain access. That's really interesting.

Connie: Not only did he have port removal, but he had multiple temporary dialysis scars. You could just tell from his upper chest that we were not going to be successful in upper access.

Eric: So, would that, as far as trying to figure out where you would gain access, would you call that sort of the largest hurdle you and your team faced during this whole process?

Connie: 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 central lines, we knew that we were going to treat this vein on the thigh like we would any other access site, the same precautions and prepping would be the same. My hands were shaking. I had my teammate, Sheri Pieroni, there who was excited to have the option. She hadn't thought about this type of access before. Typically, I think in these cases, Vascular Access nurses will kind of walk away and say, 'Oh, not a PICC candidate.' So, we were excited, but I think reasonably nervous. My hands were a little shaky.

Eric: That's completely understandable. How did you and your team ensure continued safety once you actually were able to place the PICC? I know, I think it dwelled in there for a little over two weeks, correct?

Connie: Yeah. Three weeks. What we did was, um, well when we, after we placed it of course, there's always those learning opportunities. So, we gathered as many nurses, physicians immediately to explain what we did. This is what it looks like. Of course, everyone loved the fact that it was out of the groin. The site was optimized and easy to care for, but we also took ownership of this line and we round on it every day. We had, everyone knows how to reach us by pager and cell phone. But we followed it every day and had learning opportunities with anybody who would listen to us. The patient's mother was at the bedside all the time, too. So, we of course educated her and told her if someone didn't ... and this was just a PICC in a different spot. So, the care and maintenance was the same, but we let her know if for some reason she felt unsure about someone that, that she could page us or asked us to be paged. We're not a 24/7 team yet. So, we did the best we could.

Eric: I'm sure she appreciated any information you all were able to provide for her. And I think from what I've read and just attending the annual Scientific Meeting a few months ago, I think this mid-thigh stuff is kind of a new, it's kind of a big wave right now in Vascular Access. Is that correct to say?

Connie: It's definitely on the, this is early adapters. The bell curve, right? The very early adapters. I think we still, we do get a little bit of criticism still. Which is unfortunate. And I think the one point that I did want to make was that this was multidisciplinary co-collaboration. There were five people making the decision for placing this particular mid-thigh fem PICC. I had called Matt Ostroff on the phone, Sheri called Interventional Radiology and spoke to Noah, one of our docs in IR. And then we had the intensivist. So, there were five of us collaborating on this device. So it is, I would still say it's definitely, it's an emerging access site. You know, as a pediatric nurse, Eric, this was never new for me. Like the surgeons at Children's where I worked, they never put in a femoral line. They always access lower on the thigh. So, I feel like this has been around 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 Jack LeDonne when I think of this site too, because how many times at AVA or at a local network meeting, do we hear optimizing exit sites? Right? We're not just throwing the line in and walking away. We have to make sure that those after us can actually care for the line. So yeah, it's important.

Eric: It's extremely important. So, obviously we're in the midst of 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, it was great. And is it sort of hoping other Vascular Access specialists sort of have an open mind and consider this as an option for access or is there something else?

Connie: Absolutely. I think first and foremost, Sheri and I, we both published this and in no way are we suggesting that everyone should just go out and start placing mid-thigh fem pics. I think collaboration, advocating for your patient with your physicians to ensure you place the right device. Learn about it. But I really do think it's important for our specialty to survive in the healthcare climate that we're faced with that we do expand and we don't just walk away and say this patient is not a PICC candidate. But it's through relationships and mentoring and multidisciplinary collaboration that we can expand to this site and ensure that our patients are getting the right device.

Connie: I think what helped us is that we were already placing central lines. Our physicians at our hospital value our specialty. They trust our judgment. So, I think with those things in place, we were able to move to the mid-thigh placement as well as central lines. But I think that I would encourage all nurses to consider this. And when I first saw it, I didn't think it was going to be something that I was going to do the following week. But I think we should be having these conversations and I hope Matt's publication as well as this case study – clinicians can take this to their IR doctors, their ICU physicians and say this is a viable option to reduce bloodstream infections to increase the ease of care and maintenance. Just as we continue to grow our specialty. I would hope that everyone that reads it and just knows that it's something they should be thinking about. Maybe they can't do it today but start taking those steps towards doing this for the right patient for the right reasons. For sure.

Eric: Definitely, and they should act the way you did too as far as calling Matt and asking him since he has experience in it, and they'll know that you have experience in it as well. And if they have any questions about a potential candidate for PICC placement in the mid-thigh, they could give you a call on that. It seems like another way that clinicians such as yourself can continue to put forth the best effort to, to benefit patients. That's really great. Well, Connie, I really appreciate you taking the time this morning to chat with me a little bit about your case study on the mid-thigh femoral PICC placement. For those of you listening to this podcast, you can check out Connie's published article in a few weeks in the Journal of the Association for Vascular Access, both in your mailbox if you receive the printed copy as well as online via email and on the AVA journal website. Connie, thanks so much for your time this morning and stay warm up there with all the snow happening in Chicago.

Connie: Absolutely. Thank you, Eric. It's been a privilege.