Vascular Access Teams: Evidence Base and Return on Investment

Dedicated vascular access teams (VATs) — also called IV teams, infusion therapy teams, or PICC teams — have operated in US hospitals for decades, but their evidence base has strengthened considerably over the past 20 years. The argument for dedicated vascular access specialists is not merely about procedural skill; it is an outcomes argument. Facilities with dedicated VATs demonstrate measurable improvements in first-attempt success rates, catheter-related complication rates, CLABSI rates, inappropriate catheter use, and the associated downstream costs. For hospital administrators and nursing leadership evaluating whether to invest in or maintain a VAT program, this evidence is the foundation of the financial and safety case.

Parent guide: Vascular Access Team Models: Complete Reference

What Is a Vascular Access Team?

A vascular access team is a dedicated group of clinicians with specialized training in vascular access procedures, device selection, care and maintenance, and complication management. VAT composition varies by institution:

Common VAT models:

PICC-only team: Inserts PICCs and provides post-insertion troubleshooting; does not manage peripheral IV or other device types
Full-scope VAT: Inserts peripheral IVs, midlines, PICCs; manages all CVAD types; consults on device selection; provides education; leads quality improvement
Vascular Access Specialist (VAS) embedded model: Specialists co-located within specific units (ICU, oncology, NICU) rather than centralized
IV therapy team: Historical model focused on peripheral IV maintenance and medication administration; now largely replaced by device-focused VATs at most large institutions

VAT staff credentials: VA-BC (Vascular Access Board Certified) through CBVN/AVAR is the specialty credential; CRNI (Certified Registered Nurse Infusion) through INCC/INS is the broader infusion therapy credential. Most VAT members are RNs, often with advanced certifications in ultrasound-guided access.

Evidence: CLABSI Reduction

Primary Evidence

Brunelle (2003): An early single-center study demonstrated that implementing a dedicated IV team reduced CLABSI rates by 75% compared to pre-VAT rates. The mechanism was improved insertion technique compliance and maintenance protocol adherence.

Abi-Said et al. (1999): Among the first to demonstrate that provider experience (number of CVC insertions performed) was significantly associated with catheter-related infection rates — providing the foundational evidence for concentrating insertion procedures in experienced practitioners.

Harnage (2012): A large, multi-site study at Baptist Health System demonstrated that adopting a PICC team with standardized insertion protocols and ultrasound guidance reduced PICC-related CLABSI rates by 76% over 3 years. Cost savings from infection reduction were calculated at $4.7 million per year across the health system.

Moureau et al. (2002, 2010): Multi-site data from facilities with centralized PICC insertion teams demonstrated PICC-related CLABSI rates of <1.0 per 1,000 catheter-days, substantially below national benchmarks for facilities without dedicated teams.

Mechanism of CLABSI Reduction

VATs reduce CLABSI through several distinct mechanisms:

Improved technique compliance: VAT specialists insert devices more frequently than generalist nurses or physicians, maintaining higher competency and more consistent bundle compliance
Appropriate device selection: VATs reduce inappropriate catheter use (unnecessary CVADs, PICCs used when peripheral IV would suffice), eliminating CLABSI risk from catheters that should not have been placed
Maintenance protocol adherence: At institutions where VATs manage ongoing CVAD maintenance (dressing changes, flushing, hub decontamination), protocol compliance rates are consistently higher than unit-based nursing
Earlier complication recognition: Daily VAT assessment rounds identify early signs of CRBSI (exit site inflammation, fever, local signs) before bloodstream infection is established

Evidence: First-Attempt Success Rates

Peripheral IV First-Attempt Success

Generalist nurse first-attempt peripheral IV success: Typically 60–75% across published literature; lower in patients with difficult vascular access (DIVA).

VAT specialist first-attempt peripheral IV success: 85–95% in multiple single-center studies. This reflects higher procedural volume, advanced techniques (ultrasound guidance, extended-length catheters), and patient selection awareness.

Difficult vascular access (DIVA) patients: In patients with DIVA scores ≥4 (predicting difficult access), generalist first-attempt success falls to 40–50%. VAT specialists with ultrasound guidance achieve 80–90% first-attempt success in the same population.

Clinical and Financial Impact of First-Attempt Success

Each failed PIV attempt:

Extends procedure time by 5–15 minutes
Creates additional patient pain and anxiety
Damages additional vein segments
May precipitate hospital-acquired venous injury (phlebitis, hematoma, arterial injury)
Triggers escalation to higher-acuity access (midline, PICC) when peripheral access could have succeeded with better technique

Indirect costs of failed PIV attempts have been estimated at $200–$600 per failed attempt when accounting for supply costs, nursing time, patient satisfaction impact, and device escalation costs.

Evidence: Appropriate Catheter Utilization

One of the most significant but least-discussed benefits of VATs is reducing inappropriate catheter use — specifically, the placement of CVADs (especially PICCs) when a lower-acuity device (peripheral IV, midline) would be clinically appropriate.

The PICC Over-Use Problem

PICC lines have become the default central access device at many US hospitals, including many inserted without appropriate indication. Inappropriate PICCs expose patients to:

PICC-associated DVT (1–5% symptomatic, 10–38% subclinical)
CLABSI risk (1.0–2.0 per 1,000 catheter-days)
Venous damage that may eliminate future AVF creation sites
Cost: PICC placement is a procedural cost ($200–$800) plus daily maintenance costs

Michigan Appropriateness Guide for Intravenous Catheters (MAGIC, 2015): The MAGIC criteria established evidence-based appropriateness ratings for PICC insertion. When VATs apply MAGIC criteria, PICC insertion rates decline 20–40% at facilities that implement structured appropriateness review.

Chopra et al. (2015): A pre-post study at a large academic center demonstrated that implementing a VAT-led PICC appropriateness program reduced PICC insertions by 35% without increasing adverse events — patients who would have received inappropriate PICCs received appropriately selected peripheral devices instead.

Evidence: Catheter Dwell and Complication Reduction

PICC dwell time reduction: VATs that systematically review CVAD necessity (daily necessity review as part of CLABSI maintenance bundle) reduce catheter dwell time. Every unnecessary catheter-day eliminated reduces the cumulative CLABSI risk.

Phlebitis reduction: Studies at institutions with IV teams managing peripheral IV placement and rotation demonstrate peripheral phlebitis rates of 3–5% — within or below INS benchmarks. Facilities without IV teams typically report rates of 10–20% in practice-level assessments.

Infiltration and extravasation rates: VAT-managed peripheral access programs have lower infiltration rates due to appropriate site selection, catheter gauge selection, and earlier recognition of early-infiltration signs during assessment rounds.

Return on Investment: Financial Analysis

CLABSI Cost Offset

CLABSI is the primary financial driver of VAT ROI. A single CLABSI event costs:

Direct healthcare costs: $46,000–$68,000 per event (2011 Pronovost estimate; adjusted for inflation, current estimates $55,000–$90,000)
Hospital revenue impact: CLABSI is a non-reimbursable hospital-acquired condition under Medicare — the hospital bears the full cost of CLABSI treatment
Regulatory penalty risk: HAI rates are publicly reported (CMS, The Leapfrog Group); poor rates affect payer negotiations and hospital reputation

Breakeven calculation example:

Hospital with 50-bed ICU
Pre-VAT CLABSI rate: 3.0 per 1,000 catheter-days
Post-VAT CLABSI rate: 0.5 per 1,000 catheter-days (achievable per multiple studies)
Average ICU census-days × catheter utilization ratio × 365 = catheter-days per year
Reduction × 2.5 per 1,000 × annual catheter-days = CLABSIs prevented
CLABSIs prevented × $60,000 per event = annual cost savings from CLABSI alone

For most medium-to-large hospitals (>200 beds), CLABSI prevention alone generates $500,000–$2,000,000 per year in avoided costs — more than sufficient to fund a comprehensive VAT program.

Additional VAT ROI Components

ROI Component	Mechanism	Estimated Savings
CLABSI prevention	Fewer infections, lower treatment costs	$500K–$2M/year (varies by baseline)
Reduced inappropriate PICC use	20–35% reduction in unnecessary PICCs	$150K–$500K/year (insertion + dwell costs)
Peripheral IV escalation avoidance	VAT PIV success prevents escalation to PICC	$50K–$200K/year
Decreased complication management	Fewer phlebitis/infiltration events requiring treatment	Difficult to quantify; significant
Supply standardization	VAT purchasing standardization reduces per-unit costs	10–20% supply cost reduction
Reduced nursing burden	Unit nurses spend less time on failed PIV attempts	Estimated 15–30 min/patient-day

Published ROI Data

Alexandrou et al. (2015): A systematic review of IV team outcomes demonstrated that specialized IV nursing teams consistently reduced complication rates across multiple device types, with positive financial impact documented in every study that included financial analysis.

Soifer et al. (1998): One of the earliest formal VAT ROI analyses, demonstrating that the cost of implementing an IV therapy team was recovered within the first year through CLABSI reduction alone.

Building the Business Case for VAT Investment

For clinical leaders presenting the VAT business case to administration:

Essential Data to Gather

Current CLABSI rate and SIR (Standardized Infection Ratio from NHSN reporting)
Annual central-line days (from NHSN data or EHR extraction)
PICC insertion volume and payer mix — how many PICCs are currently inserted per year? By whom?
Current PIV first-attempt success data (if available; many facilities lack this data)
Current PICC appropriateness rate — what percentage of PICCs meet MAGIC criteria?
Nursing time spent on IV access — unit nurse time audit (often 30–60 minutes per shift per difficult-access patient)

Framing the ROI Presentation

Lead with CLABSI data: this is the most compelling financial argument
Include the human cost: CLABSI attributable mortality is 12–25%
Address the non-reimbursement issue: CLABSIs are Medicare HACs — every prevention is direct financial protection
Present the staffing model: VAT programs cost $300K–$700K/year in staffing for a typical medium hospital; breakeven is typically achieved in year 1–2 through CLABSI savings alone

Related guides:

References

Brunelle D. (2003). Impact of a dedicated infusion therapy team on the reduction of catheter-related nosocomial infections. J Infus Nurs, 26(6):362–366.
Harnage SA. (2012). Seven years of evidence-based practice: implementing a PICC team. J Assoc Vasc Access, 17(2):82–89.
Chopra V, et al. (2015). The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Ann Intern Med, 163(6 Suppl):S1–S40.
Alexandrou E, et al. (2015). International prevalence of the use of peripheral intravenous catheters. J Hosp Med, 10(8):530–533.
Pronovost PJ, et al. (2011). Estimating the cost of healthcare-associated infections: pitfalls and furthering the debate. Infect Control Hosp Epidemiol, 32(2):180–182.
Moureau NL, et al. (2002). Complications associated with venous access devices. J Infus Nurs, 25(5):318–323.