Registered Nurses' Association of Ontario

Systematic Assessment Prior to Inserting a Vascular Access Device

Completing a systematic assessment of persons prior to having a VAD inserted is good clinical practice and a pre-requisite for providing other clinical interventions. The following components can be used to guide the systematic assessment:

  1. Vascular assessment
    1. intended frequency and duration of therapy;
    2. prescribed therapy ;
    3. history of vascular access, including previous history of vascular access complications;
    4. comorbidities;
    5. age and developmental stage;
    6. anatomy;
    7. activity level;
    8. skin integrity;
    9. patient’s preference and lifestyle; and
    10. available resources for VAD care and maintenance.
  2. Psychosocial assessment
    1. age and developmental stage;
    2. mental health status;
    3. presence of needle phobia;
    4. presence of family or caregiver support;
    5. cognition; and
    6. need for pain management strategies.
  3. Device selection and vesicant medications
    1. Determine if the planned therapy poses an infusate risk or if the medication is a vesicant.
    2. It is important to select the least invasive device for the duration and type of treatment, and one that promotes vessel preservation.
  4. Site selection
    1. To select the site for VAD insertion, assess the person’s vascular structure and integrity at and above the insertion site.
    2. The following sites should be avoided for vascular access:
      1. area of flexion [except where this is not possible in trauma or emergency cases];
      1. chest wall, digits or breast;
      2. lower legs, except in a non-walking child;
      3. insertion area that is painful on palpation;
      4. vein that is obviously compromised;
      5. extremity with a planned or actual arteriovenous fistula/graft site; and
      6. extremity affected by lymphedema, paralysis, extravasation, acute infection, tissue injury or acute trauma.

To view Practice Notes from the Expert Panel click here.

Clinical Management
Assessment and Device Selection for Vascular Access
Point of Care Resources