Difficult Venous Access: Addressing This Barrier To Care In Hepatitis Treatment Clinics

Author: Sheils S, Mason S, Gullick G

Theme: Models of Care Year: 2018

Difficult Venous Access (DVA) is a common problem reported by patients attending our
hepatitis clinics. Our Drug Health Service reported 59% of clients having DVA, and
recognised this as significant barrier to hepatitis care with 66% reluctant to have blood taken
and 36% feeling bad or discriminated against because of DVA.
Description of model of care/intervention:
Hepatitis nurses who were skilled venepuncturists, were trained in External Jugular Vein
access (EJV). A simple protocol was developed, training implemented, and EJV offered as
standard care for patients with DVA. Recent evaluation of EJV included a 3-month clinical
audit, patient surveys and qualitative interviews with 10 patients engaging with EJV to better
understand its acceptability.
Clinical audit revealed a 100% successful venepuncture rate (n=24), with EJV taking an
average of 5-minutes with one operator versus 15-minutes with two operators for peripheral
venipuncture, with minimal adverse events. 100% (n=19) patients reported high or very high
satisfaction levels with EJV. Analysis of semi-structured interviews (n=10), guided by
Sekhon et al’s (2017) Theoretical Framework of Acceptability, showed a very high level of
patient acceptability, with EJV described as a simple, easy, pain-free solution to their
longstanding DVA. This was in contrast to their previous distressing and painful
venepuncture experiences where poor continuity of care and multiple unsuccessful attempts
left them feeling disempowered, disrespected and frustrated. Patients therefore advocated
for widespread application of the EJV model of care.
Conclusion and next steps:
EJV is successful in our hepatology setting. It is common practice in our hospital-based
hepatitis clinics and has recently expanded into suitable community clinics. To complement
our EJV service, from April 2018 our hepatitis nurses will offer Ultrasound (US)-guided
venepuncture. Training has been completed, and implementation of a small, portable US
device for use in a range of community-based clinical settings is underway.
Disclosure of Interest Statement: See example below:
Presenters have received a research scholarship for transcription of interviews and
conference travel from the Australasian Hepatology Association, via a Abbvie funded
research grant

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