Season 1, Episode 4 Transcript
This episode of the ISAVE That Podcast is made possible by support from SecurAcath. The revolutionary SecurAcath subcutaneous catheter securement device will make your job easier and save money by reducing catheter complications. Learn more at www.securacath.com. SecurAcath: For the life of the line.
From the Association for Vascular Access, this is the ISAVE That Podcast.
Eric: Episode 4 of the ISAVE That Podcast – I’m Eric Seger, AVA Director of Communications and JAVA Editor-In-Chief. Joined by the one and only Director of Clinical Education, Judy Thompson out in San Diego. How are you, Judy?
Judy: Good morning, Eric! I’m good. How about you?
Eric: Great! Getting ready to go to yet another day of jury duty. Fulfilling my civic duty for the past two weeks. Going and sitting in jury pool room and waiting to see if any Franklin County Municipal Court cases go to trial. There haven’t been any yet, but I’ve gotta do my taxpaying duty, I suppose.
Judy: Good man. So, you have not even been called in?
Eric: No. No one has. It’s been almost two weeks.
Eric: We’ve all just kind of been waiting. There has been a variance of between 100-130 cases heard every single day and then you’re basically on standby in case any goes to trial. And then as I understand it, if one does go to trial, we can get screened and if you’re selected, actually be on a jury. But it has not happened yet! Me and a bunch of Franklin County residents are just sitting and waiting for the cows to come home, I suppose.
Judy: Well, we’re proud of you. Thanks for doing your civic duty. So, what’s going on in your life other than jury duty, señor?
Eric: Other than jury duty? Still working, getting a lot of great content ready to share with our members both in JAVA, the fall issue of JAVA is due out in the beginning of September, just before the AVA Scientific Meeting in Columbus, so I’m working with our publisher to get that stuff in line and get the pages ready to go. That’s a slow process but it’s moving along.
And then also, I’m working on our next issue of our electronic newsletter, which comes out in the middle of next month, in August, Intravascular Quarterly. Been busy doing that stuff, then podcasting, advertising for conference, moving right along. I can’t believe that July is basically over already. This summer is just flying by.
Judy: It is. You’re right. It’s nerve wracking and stunning. Remember when you were a kid and the years seem to crawl by and now that you’re an adult it flies by? What the heck?
Eric: Yeah, I was actually talking to my wife about that the other day. It’s like, the only time of the year that I thought went fast was the summer because we weren’t in school and I had time to do what I wanted but then during school and all that stuff, the year just crawled by. But now, we’re almost done with the seventh month of the year and fall is just around the corner and conference is too. It’s crazy.
Judy: I’ve been super busy too. It sounds like you’ve had at jury duty, sitting and playing cards with all your other Franklin County folks. But I know that’s not true, I’m sure you’re working from jury duty as well, but I’ve been working on the guidelines a lot. Still, surprisingly. The content is really strong but now we need the videography to go with it. And this is going to be really videography-heavy, and I’m really excited about that but it takes a ton of time to put that together and edit. I can’t wait to get a few of these procedures down pat because they have to be short snippets as well with the way that folks learn these days. I can’t wait to share that with you and share that with all the folks out there in Vascular Access. As well as patients.
Eric: It’s going to be such a valuable teaching tool. I don’t even think I fully understand the gravity of it and I won’t until I see it, but I’m excited to see it because it’s going to be really extensive and going to be a must-have.
Judy: Thanks, I appreciate it. I’m excited. In fact, I was talking to a patient that called in with a question a couple days ago and she was conference last year and heard about the guidelines we’re writing. She called to see where they were and sadly I told her they’re not quite ready yet she goes, ‘I can’t wait because I want to take these in when my daughter goes in for treatment and tell them that this is what AVA says the treatment should be like.’ Not the treatment, per se, but the care, on her daughter’s line.
Judy: It brought it right back home. Yes, we’re writing for clinicians and we’re writing because this is what we do for this association. But when it comes down to it, it’s for the care of the patient. And I really haven’t thought about it to the extent of the patient having it on their phone and say, ‘No, AVA says this is evidence-based and this is how you’re supposed to do a procedure.’ So, it took it to a different level.
Eric: That’s what it’s all about. That’s really great.
Eric: What a great story. That’s fantastic. I know there’s going to be other ones like that too that come about once the guidelines are finished. They’re just going to be so many people overwhelming thanking you guys for all the great work you’ve done because it is going to be a must-have and that’s what we do, we’re here to serve the patients. It’s going to be another thing that we can put at the forefront of doing that.
Judy: I agree. I agree. And then this week it’s getting ready to head off on vacation week, so I will be gone for 2 weeks.
Eric: Wow. Where are you headed?
Judy: I’m going to Alaska. The Last Frontier. I hope I see a bear, but not really close.
Eric: Are you cruising up there? What is your itinerary? Before diving into too much about it. I ask because my parents went on an Alaskan cruise for one of their anniversaries when I was a little kid and they said it was amazing.
Judy: Little bit of both. Going to go up there and do some hiking and biking for about 4 days and then I’ll be on a cruise for a week. Exciting time! I can’t wait. I can’t wait to shoot some pictures and hopefully stay clear of the bears when I’m hiking and biking. That’s my No. 1 goal.
Eric: Definitely. Well, your No. 1 goal should be to not worry about work because you’ve put in a lot of hours, so it is going to be a nice break for you, and a well-deserved one, for sure.
Judy: Thank you, thank you.
Eric: Enjoy it, it sounds amazing!
Judy: I appreciate it. Thanks! I will. I will.
Eric: No problem. Well, I think we have some really great interviews lined up for this episode. We’re going to chat with Dr. Jack LeDonne. He is the AVA General Session Herbst Award for this year in September. He’s going to chat a little bit about his session and AVA in general, how he got to know about AVA and got involved and then we’re going to touch a little bit on the recent collaboration from AVA and NHIA to provide a member benefit for NHIA members who are interested in joining AVA to save some money. Then we’ve got some other interviews that Ramzy conducted while in Copenhagen. Ramzy is not with us right now chatting because he is actually on vacation in Mexico with his family. I’m sure he is enjoying himself down there and getting away from things a little bit. But he’ll be back on the next episode and everyone else, I hope you can stay tuned for all of those and plenty more to come. Stay tuned!
Judy: Thanks guys!
The SecurAcath subcutaneous engineered stabilization device is a revolutionary new method for catheter securement that does not require adhesives or sutures. The unique design of the SecurAcath secures right at the insertion site and lasts for the life of the line. The SecurAcath can drastically decrease catheter migration and dislodgement, decrease catheter replacement costs, prevent medical-related adhesive skin injury, or MARSI, reduce catheter complications and lower the total cost of patient care. SecurAcath: for the life of the line. For more information, visit www.securacath.com. That’s s e c u r a c a t h.
Ramzy: And we are joined today by 2018 Suzanne Herbst Award winner Dr. Jack LeDonne. Jack, how are you doing, sir?
Jack: Good enough, Ramzy.
Judy: Good morning, Jack! This is Judy.
Jack: Good morning, Judy.
Judy: Jack we also have Eric Seger, he is our Director of Communications and our Editor-In-Chief of JAVA. And you just heard Ramzy Nasrallah, who is our CEO.
Eric: Doing great, great to talk to you Jack.
Ramzy: I have no complaints. I always love talking to Jack. I’m excited for him to win and be presented with the award at AVA in Columbus coming up in September. And, always, I’m excited to watch him present because he is one of the most lively, informative and engaging presenters that I see throughout the Vascular Access world. And, I get to travel to all of it so I can speak with some authority.
Jack: I appreciate that, Ramzy.
Judy: That is without a doubt true. We love you at AVA, Jack. You are a huge draw for us. Whether we agree with you, disagree, you’re always fun. So, thank you so much.
Judy: Never! I mean, some people do but not me. I don’t know who those people are, but.
Jack: I was just going to say Ramzy was at the beginning … we piloted the CVC insertion course and it was a bit of a dog and pony that day, I’ll never forget it. He was there witnessing it.
Ramzy: That was 2008. This is the decade celebration of that pilot.
Jack: It’s turned into something. But that day we realized we were under-matched with dealing with the enemy.
Judy: But it has made amazing strides and a huge impact in practice. But Jack, your involvement in AVA and Vascular Access has made a huge impact to our specialty. What drew you to AVA?
Jack: Basically, at work, I received a copy of the JAVA and it was a different name back then. NAVAN or, had a different name. I received this journal in the mail. I’m flipping through it and saying, ‘Boy, this sounds an awful lot like what I do.’ Then instead of putting it down and never seeing it again, I joined up. It was just somehow someone sent me that journal in the mail. I don’t even know how. I had never heard of it before but that was in 2005 when I got that.
Eric: Sounds like some fabulous marketing.
Jack: Oh, absolutely. Genius! Pure genius. I sign up and then I saw a thing that you could submit to present at the conference and I’m going, ‘Wow, look at this!’ So, I submitted an abstract, presented at the conference in Indianapolis in 2006 and then a lady named Darcy called me up to talk about my presentation. So that’s how I got involved with AVA.
Ramzy: That was my first AVA. And that’s the same one I met Darcy Doellman at too. Wow! We’re basically the same guy, Jack.
Jack: No question. No question. We both don’t know much math.
Judy: Small world. So, like Ramzy said earlier, you are being awarded with AVA’s highest award. Congratulations! The Suzanne Herbst Award. So well-deserved.
Jack: Thank you.
Judy: Along with this award, you’re given the stage, so tell us a little bit about your presentation.
Ramzy: I think he’s stage shy. He’s going to be nervous before he presents.
Jack: True and true. I figured now I have to do an acceptance speech so my idea was to have Suzanne Herbst, if she was going to be there, talk about the beginning of AVA and I’m thinking I have 20 minutes and who is going to listen to this, but anyway, I’m not going to do that. I’m just going to do a regular acceptance speech.
I had submitted a different topic for the conference and when I received this, I decided that I would change the topic because it’s going to be a general session. I want to talk about quality improvement in Vascular Access, trying to put together the different fragmented things that come up in the literature and the education that we all talk about. In other words, people come up with things like ‘Hey, here’s my new needleless connector. This is the bomb this is the answer.’ Hey, great! I’m sure it’s a great product. It’s a big world. There’s a lot too this thing, so I try to break it down to different phases of the life cycle so in other words instead of focusing on the patient, I’m focusing on the device and just doing the best in each phase of the life cycle of a Central Venous Access Device. That’s the basis of the presentation.
When we were in Copenhagen, the Keynote was a great talk given by a Dr. Didier Pittet from Switzerland. He gave a great talk and basically what it came down to is if you want to prevent infection, do everything right. I’m saying, ‘Yeah, that’s what have to do and hey that needleless connector, that’s a part of it, I’m sure.’
But there’s a lot of things that we have to do right to prevent infections. I think infection is a special complication. It adds implications not only for us and our patients but for the generations going forward. I think dealing with infections, there’s a place to taking a longer very, a generational view, an existential view. So, I’m going to try and do all that.
Judy: That is awesome, and I know your presentations are always chalk full of videos and I’m excited to see what you put together for this. You’re a master at presenting and I’m excited to listen.
Ramzy: It’s hard to get bored at a Jack talk and I like what you said about Didier at WoCoVA, where he was actually criticizing bundles –
Jack: I got that. That’s going to be, I just started taking that down last night. That’s going to be in there.
Ramzy: He’s right to a degree. When people get too over-reliant on bundles, they think the bundle does the work, but you just said it – there are components within the bundle, and you have to do everything right.
Jack: When I talk about insertion and that there are 16 choices, I’m thinking that’s not much of a fun thing for a bundle. People tell me it’s too much. And I’m thinking, ‘Sure, it’s too much but on the other hand, you have those decisions whether you like it or not.’ You can use an ultrasound or not use an ultrasound, not cut the skin. If you choose to cut the skin, you made a choice. You’re going to have these choices like it or not and I don’t choose to boil it down to a bundle of 3-5 objects and I’m glad to hear Didier … I like it when these big people and I are saying kind of the same thing. It gives me validation. I like that.
As far as videos for this thing, I’m looking, I don’t have that many. It’s going to be my focus the next couple weeks to make it lively. I’ve always found: If I try to do a regular talk with graphs and statistics, the people in the audience are on Facebook. If I show video, they watch the video.
Eric: Video is becoming king in all aspects of content sharing.
Ramzy: Dr. Jack was way ahead of that. He’s been plugging videos in for a while.
Judy: Yeah, he led the pack on this one. Jack, one of your key presentations that you often do is on defining where insertion starts, and care and maintenance begins. And I think that huge. That’s really taken to a lot of people’s heart. I know it’s been replicated because I’ve seen it. I’ve seen that in a couple of presentations. For people that haven’t seen it, just touch base really quick on the jest of insertion vs. the care and maintenance and really the percentages of what we’re in.
Jack: I’ll tell you what the origin was. It was a famous surgical textbook, which I can’t remember the name of, by a British surgeon named Oliver Cope. It’s about the acute abdomen. I remember there was one line in there that stuck out: If you know when something started, that’s good information. In other words, someone comes to you with abdominal pain and they say it started last night, that means nothing. If they say it started two years ago, that means something different. Just knowing when something starts, or something stops is good information and it compartmentalizes what we know about it and what we can do about it.
So, to your question, you hear a lot of terms thrown around and one of them is care and maintenance. All we do is really say the term care and maintenance. We don’t really go into it nearly enough. I stop to think: What is the phase of care and maintenance? So, it’s really once the devices is in and the dressing is on, by definition the patient is in the care and maintenance phase. And that phase lasts from the time you put on the initial dressing until you remove the device. And when you start looking at how these things dwell, the insertion phase, say 60 minutes – people tell you it takes 2 minutes, 5 minutes or 10 minutes but we all know it’s 60 minutes out of your life.
So, the insertion phase is 60 minutes and then the dwell of these things is 6 days, 15 days, 20 days or longer. The care and maintenance phase, or the dwell, is 99%+ of the life of the catheter. So, once you realize what phase you’re in, you kind of hone in and improve that phase or determine if an infection is occurring in a particular phase, you can deal with that.
There’s another thing for me: It’s the relationship between the insertion and the care and maintenance. In other words, the inserter, in the 2 minutes or 60 minutes that he’s responsible for the device, has to hand it over to the RN in a proper configuration so she can provide ideal care and maintenance. If we don’t do that, we didn’t do our job.
Another thing: So, you asked, when do you consider that an infection is due to insertion and when do you consider that it shifts over to care and maintenance? People generally say in the 4-5 day range. That, after 4-5 days, generally and this is an informal poll around the country and around the world, people will say that after 5 days it’s no longer the insertion that caused it. But only if was put in properly and the dressing stays on. You put it in a funny configuration because of the insertion, that may be because of the infection way longer than 5 days. If the dressing can’t stay on, it’s not doing its job, namely separating the patient from the toxic environment of the ICU or the skilled nursing facility, or whatever. You have to understand the relationship between a proper insertion and ideal care and maintenance. In order to prevent an infection, we have to do everything right.
Judy: Jack, that’s such a great point. I’ve seen you talk many times and that really, the 4-5 day period, I’ve used that length of time myself but I never really brought it back to, ‘Hey, if you put it up by the earlobe, it still belongs to the inserter because they put it in a horrible spot.
Jack: Yes! And that’s the point for the ‘idiots’ that put these lines in any which way and the infection comes on Day 5 and, ‘Oh, not me then. It’s not me.’ This is another thing: People are scared of pneumothorax and other insertional complications. Pneumothorax – Liz from England told me this, when we were in Denmark – she said, ‘Jack: I’m scared to do the axillary approach because if I puncture somebody’s lung, everybody’s going to know who did it.’ That’s the problem with infection: Everybody denies that it’s them. For pneumothorax, there’s no denial, no denial about it. If you stuck a needle into somebody’s lung, there’s no denial.
But I think we have to get people to be more scared of causing an infection than they are of puncturing somebody’s lung. It’s misguided, misplaced. I did a comparison of this last year. The two complications do not compare. Infection has a 12-25% mortality (rate), extreme morbidity, very expensive. The only thing is that pneumothorax is pinned to an individual person.
Judy: That’s true. It screams ownership on that one.
Ramzy: You see Dr. Jack in Columbus in September, if you haven’t registered already you should. He is the 2018 Suzanne Herbst Award winner, Dr. Jack LeDonne. Jack, thank you for joining us today on the podcast.
Jack: Thank you very much.
Eric: Thank you, Jack.
Judy: Thank you, Jack. Take care. See you in September.
Jack: Bye bye, kids.
Eric: And I’m joined now by Jenn Charron, the Vice President for Clinical Services for the National Home Infusion Association (NHIA) to chat a little bit about a recent collaboration between NHIA and AVA. Hi, Jenn, how are you doing? Happy to have you here!
Jenn: Thank you for having me. I’m really excited to be here.
Eric: For those who maybe don’t know much about NHIA, could you maybe talk a little bit about what your association does and also what you do personally for it and the groundwork for this relationship with AVA came around?
Jenn: Sure, yeah. NHIA is a trade association – it’s a little bit different from the way AVA’s set up. So, essentially, organizations become members, which then includes a membership for all of their employees. Whereas AVA has the individual membership. We represent the home infusion providers, so those are the companies providing the medication and the nursing and the clinical services for the patient but also the businesses that support the home infusion market. That can range anywhere from tech companies all the way up to TPOs. That’s kind of how NHIA is structured.
What I do at NHIA really is focus on education. So, I oversee the conference, webinars, CE activities. But I also work really closely with our business development and our government affairs team to grow our association and then push for legislation related to the advancement of home infusion.
How this all started really was Beth (Gore) came to our conference in 2017. She had talked to Marilyn Tretler about a central line venous access device tool that we had developed as well as one of our education committee members and thought it would be a good idea to make it in a patient education tool. Beth and I chatted about that and then I came to the AVA conference and met Ramzy and talked to Beth again. Then Ramzy came to our office and we spent the day together and really enjoyed the conversation with everybody I had talked to at AVA. Love the energy of the association. So, here we are! That’s how we got here.
Eric: And here we are, that’s right! It sounds like there is plenty similar in the vein of education and obviously, that’s one of AVA’s core values: educating clinicians, saving the lines and protecting patients. Which, NHIA is all about as well. It sounds like it is an essential piece of your patient safety structure and another great organization that we can work with to benefit and put patients first.
I think teaming with AVA moving forward in the continuum of care is going to be incredibly beneficial for both parties in this relationship.
Jenn: Absolutely. I think it’s really great to be working with an association feeling like we’re all on the same team to just push the industry forward. It’s all about elevating our care which then provides a much better experience for patients. So, we’re excited to be working with you all.
Eric: Definitely. And as I understand it and I was involved with working on the press release with you, Ramzy and with Marilyn, who you mentioned before, to announce this collaboration. The collaboration is that the NHIA members that are interested in becoming AVA members will receive a 15% discount on the annual AVA membership fee, which gets them access to all kinds of great content. Whether it be in the Journal of the Association for Vascular Access, Intravascular Quarterly, which is our quarterly e-newsletter, the AVA Learning Center, reduced board certification fees and discounts on registration for the AVA Annual Scientific Meeting. If listeners want more details on that collaboration, you can read the press release at www.avainfo.org/NHIA or head to the NHIA website as well. You can read about it and find out more about this great organization.
It’s clear that this collaboration, in my opinion, can work for those individuals who are extremely talented in performing safe Vascular Access every single day in the home care setting.
Jenn: Yeah, absolutely. I think a lot of times we forget about those that are in the home and a lot of Vascular Access is not just at the hospital. A lot of our patients need these for their entire lives. So, the more that we can focus on ensuring that those patients are getting good, quality, safe care in their home, the better off both the whole healthcare in general will be but also individual patients.
Eric: It’s a no-brainer in my opinion, and I think it’s kind of been a long time coming for organizations like ours to sort of meet in the middle and push for positive Vascular Access advancement and doing it together. My next question: “How receptive has your membership base been since we made the announcement. I know it happened only recently, about a week or so, but about the discount to join AVA – are they excited about teaming up with us to move forward?
Jenn: Yeah, I think we’ve gotten a lot of good, positive feedback, so we’re excited about that. And interestingly enough, I was just kind of browsing through LinkedIn yesterday and one of the comments was, ‘Long time coming!’ And I think that speaks a lot to the fact that associations really, we need to work together for a common good and collaborating is what we need to be doing moving forward.
Eric: Absolutely. It’s clear that this is an extremely positive step in the right direction for Vascular Access in the continuum of care. I wanted to extend a hearty thank you to Jenn – we worked pretty diligently together to finalize the press release and get the finer points of this collaboration for the announcement.
I would be remiss if I failed to mention Marilyn, who is your Vice President of Communications. I understand that you both wear multiple hats for NHIA to keep things moving in the right direction, as we all do with association life. AVA’s excited to continue to work with you guys moving forward. So, thanks again and I also wanted to thank you for coming on our podcast to chat about it.
Jenn: Absolutely. I’m excited to continue to move this relationship forward. Thanks for having me!
Ramzy: We’re here with Matt Ostroff, he’s on the AVA Design Team, we are in Copenhagen at WoCoVA. Matt, how are you doing, sir?
Matt: I’m doing great. I just got to present on my mid-thigh work, doing femoral catheters up to the IVC. It’s been really exciting here to see the new technology and the new techniques and everybody, how they’re working to mitigate patient issues.
Ramzy: It’s fascinating stuff to come to a place like WoCoVA and see these advancements from the globe. And, you’re going to be presenting also at AVA coming up in September.
Matt: I’ll be presenting on my mid-thigh work as well at AVA and putting the D-TEAM together was really exciting. I think this is going to be a great conference.
Ramzy: It’s going to be awesome. And being on the Design Team, you have insight into the curriculum on what’s being planned, being put together. But one of the things that makes you really emblematic of what AVA stands for is that we’re a multidisciplinary Vascular Access organization. Could you talk a little bit about where you come from? How you got involved with Vascular Access? And, some of the differences you see between where you started and how you’ve evolved as a Vascular Access clinician.
Matt: Sure. Probably the most exciting thing for me was I started on the street – I was a paramedic. We were putting peripheral lines in, external jugular lines in, intubating, we were working on the street under really awful conditions. To take that emergency setting and then apply it to procedures where it’s semi-stable and mostly controlled, you can take that edge you lived on, on the street and be calm when things are difficult, when patient presentations are more complex.
It’s been interesting to take the progression from going on the street to the emergency room, to being a specialist and applying all the different environments I’ve been in to where I am now. I think it’s made me a more well-rounded individual, where I can focus on figuring everything out because I’m used to chaos and focus on what’s in front of me, which is the most important thing, which is our patient.
Ramzy: And the chaos of the street vs. the relative chaos of the ED. We were talking earlier about some of the misconceptions of how the patient is presented in the emergency room. We watched so many shows like ER. You always get the exciting stuff when you’re watching something that has commercial breaks. What is the difference between how we think of the emergency room and the patient there vs. what it’s actually like to be working those shifts?
Matt: Right. I mean, when you tell someone you’re a paramedic they think, ‘Oh, wow! You’re flying around the city with sirens!’ And we do, but about 80% of our cases are stable patients where we’re able to take care of them, take a history, put a very nice, good IV in. Even in the ER, the same thing – the 20% of the trauma that we deal with, or the cardiac arrests, those are lines that should be exchanged because we’re in a rush. We’re in a crazy environment. Everything is going wild and it’s crazy and you don’t have the time to set up. But for 80% of our patients we need to give a little credit to the clinicians out there that they are trying to do a good job. They’re prepping the skin, they’re wearing gloves, they’re trying to put the IVs in a really good location. You’re right: There is a big misconception that everything is dirty. They’re just like cowboys out there doing crazy things.
Ramzy: Every scenario is the worst case scenario.
Matt: Even the ER nurses. My wife always tells me, she says, ‘Nobody goes to work to hurt somebody.’ So, while you might be the specialist that does a full max barrier procedure and then you criticize the nurse in the ER who’s got 17 patients trying their best, we have to realize where everybody is, where they sit, what their environment is before we judge how they practice. And then we can improve their practice.
We have to realize that nobody is intending to do anything wrong. They just need to be educated and that’s what AVA is all about. You come to AVA and you go, ‘Whoa. I could do this. I could do this better. I could improve that. That’ll help my patients.’ And then you bring that back.
Ramzy: Right. Vascular Access is a multidisciplinary specialty and it’s shared from the street to the ER, to the floors. And you’re really emblematic of what we’re trying to represent. He is Matt Ostroff, you can see him and many other key opinion leaders who are doing novel things in Vascular Access in Columbus, coming up in September. Thank you for your time. Let’s go enjoy Copenhagen.
Matt: Thank you.