Service Delivery Models and Operational Scope Policy

1. Policy Statement

It is the policy of this organization that vascular access and infusion therapy services shall be delivered through a team of clinicians dedicated exclusively to this specialty, operating under a consultative model that provides holistic, evidence-based care across both inpatient and outpatient settings. The service shall extend beyond task-based device insertion to encompass expert clinical consultation, vessel health and preservation, daily line necessity review, staff education, quality oversight, and technology-enabled interprofessional communication.

2. Purpose

This policy exists to:

• Define the organizational service delivery model for vascular access, ensuring that the program is designed around comprehensive clinical consultation rather than a narrow “insertionist” function.
• Establish the core service components required for a modern, evidence-based vascular access program.
• Define operational coverage requirements to ensure consistent clinical outcomes across all hours and all days of the week.
• Mandate the use of Vessel Health and Preservation (VHP) frameworks to ensure that the right device is selected for the right patient at the right time.
• Require integration of electronic medical record (EMR) tools to facilitate interprofessional communication, line necessity tracking, and compliance monitoring.

3. Scope

This policy applies to:

• All members of the Vascular Access Specialist Team (VAST) and infusion therapy clinical staff.
• All clinical units and departments that request, receive, or support vascular access services.
• All care settings, including inpatient acute care, intensive care, emergency departments, perioperative areas, ambulatory infusion centers, home health, and skilled nursing facilities operating under organizational agreements.
• All referring clinicians (physicians, APRNs, PAs, RNs) who order or consult for vascular access services.

4. Policy Requirements

4.1 Team Structure and Holistic Care Model

4.1.1 The organization shall maintain a dedicated Vascular Access Specialist Team (VAST) composed of clinicians whose primary assignment is the delivery of vascular access and infusion therapy services. Team members shall not be routinely reassigned to non-vascular-access duties (e.g., general floor nursing assignments) except during declared institutional emergencies.

4.1.2 The VAST shall operate under a holistic care model in which the specialist’s role encompasses the full continuum of vascular access management: pre-insertion assessment and device selection, procedural insertion, post-insertion surveillance and maintenance, complication recognition and management, patient education, line necessity evaluation, and device removal.

4.1.3 Team members shall meet the minimum qualifications defined in the organization’s Vascular Access Specialist job description, including current licensure, documented competency in all procedures within the team’s scope, and pursuit of or current maintenance of board certification (CRNI® or VA-BC™).

4.2 Core Service Components

4.2.1 The VAST shall provide the following core clinical services:

Device Placement. Expert insertion of peripheral intravenous catheters (PIVCs), ultrasound-guided PIVCs, midline catheters, peripherally inserted central catheters (PICCs), and other CVADs as defined by organizational credentialing and the team’s approved scope of procedures.

Difficult Intravenous Access (DIVA) Consultation. Specialized support for patients with limited venous access, utilizing advanced technologies including ultrasound guidance, near-infrared vein visualization, and alternative site assessment. The VAST shall be the designated escalation resource for all DIVA encounters as defined in the organization’s DIVA Escalation Protocol.

Vessel Health and Preservation (VHP). The VAST shall utilize a validated Vessel Health and Preservation framework to guide device selection, ensuring that each patient receives the least invasive, most clinically appropriate device for the prescribed therapy. VHP assessments shall consider: the prescribed infusate characteristics (pH, osmolarity, vesicant/irritant properties), anticipated duration of therapy, patient’s vascular health and access history, patient’s clinical condition and mobility, and the patient’s informed preference.

Clinical Rounding. VAST members shall perform daily clinical rounds on all patients with indwelling CVADs and shall perform scheduled surveillance rounds on patients with peripheral devices. Rounding activities shall include: site assessment, dressing and securement evaluation, line necessity review, staff adherence to maintenance protocols, and identification of devices eligible for downsizing or removal.

Consultation Services. The VAST shall be available for consultation to all clinical staff regarding device selection, complex infusion management, complication troubleshooting, and patient-specific vascular access planning.¹ Consultation requests and findings shall be documented in the patient’s health record.

4.3 Operational Coverage

4.3.1 The organization shall define the operational coverage hours for the VAST based on patient volume, acuity, and institutional need. The minimum coverage model shall ensure availability during all peak clinical activity hours (defined as the hours during which the majority of new vascular access orders are placed and new admissions occur).

4.3.2 Extended Coverage Goal. The organization recognizes that data supports 24-hour, 7-day-a-week specialist coverage as the model associated with the most consistent clinical outcomes. The VAGC shall develop a phased plan to achieve this coverage level if it is not already in place, with annual assessment of progress and barriers.

4.3.3 After-Hours Coverage. When the VAST is not physically present (e.g., overnight or weekends in facilities without 24/7 coverage), the organization shall maintain a defined after-hours coverage plan that includes: identification of credentialed backup clinicians, a documented escalation pathway, and telephone consultation availability with a VAST member.

4.3.4 Response Time Standards. The VAST shall establish and maintain response time standards for consultation requests, categorized by urgency: emergent (within 30 minutes), urgent (within 2 hours), and routine (within 4 hours or next business day for non-emergent requests received outside coverage hours).

4.4 Consultative Approach and Shared Decision-Making

4.4.1 Vascular access specialists shall function as clinical consultants, not solely as proceduralists. This means that VAST members shall engage in shared decision-making with the ordering provider and the bedside nursing team regarding the appropriateness of the requested device, the timing of insertion and removal, and the identification of alternative approaches when the requested device may not be the optimal choice.

4.4.2 When a VAST clinician determines that a requested device is not clinically appropriate (e.g., a PICC is ordered when a midline would suffice, or a CVAD is requested when adequate peripheral access exists), the specialist shall communicate this assessment to the ordering provider, propose an evidence-based alternative, and document the consultation and outcome in the health record. The final device selection decision rests with the ordering provider in collaboration with the specialist, unless patient safety would be compromised.

4.4.3 The VAST shall not insert a vascular access device solely because it was ordered without first performing an independent clinical assessment of the patient and the device’s appropriateness.

4.5 Technology Integration

4.5.1 The organization shall provide EMR tools that support vascular access management, including: electronic order sets for vascular access device insertion and removal that include required documentation fields, line necessity checklists integrated into the daily assessment workflow for all CVADs, automated alerts for overdue dressing changes, site assessments, and device dwell time milestones, and a VAST consultation order that facilitates interprofessional communication and tracking.

4.5.2 The VAST shall collaborate with Health Information Technology (HIT) to ensure that EMR documentation templates capture all required data elements defined in the organization’s Documentation Policy and enable extraction of data for quality improvement and surveillance purposes.

4.5.3 The VAST shall maintain and utilize a centralized device tracking system or registry that enables real-time visibility of all indwelling vascular access devices within the organization, including device type, insertion date, dwell time, location, and status.

5. Compliance

5.1 Monitoring. Compliance shall be monitored through tracking of VAST response times against defined standards, daily line necessity review completion rates, VHP assessment documentation rates, monthly review of VAST clinical rounding logs and consultation volume, and patient and staff satisfaction surveys related to vascular access services.

5.2 Key Performance Indicators.

• VAST consultation response time compliance (target: ≥90% within defined standards).
• Daily CVAD line necessity review completion rate (target: 100%).
• VHP framework utilization rate for new device placements (target: ≥95%).
• First-attempt insertion success rate (target: ≥85%).
• Unnecessary CVAD placement rate (target: year-over-year reduction).

5.3 Enforcement. Failure to maintain required coverage levels, perform daily rounding, or complete line necessity reviews shall be escalated to the VAST Manager and the VAGC for corrective action.

6. Exceptions

6.1 Temporary reductions in VAST coverage (e.g., due to staffing shortages, natural disaster, or pandemic surge) shall be documented, communicated to all clinical units, and accompanied by an interim coverage plan approved by the CNO. The VAGC shall develop a restoration timeline.

6.2 Requests to modify core service components require VAGC approval with a documented rationale and impact assessment.

7. Related Documents

• SOP-VA-050: Vascular Access Consultation Request and Response Procedure
• SOP-VA-051: Vessel Health and Preservation (VHP) Assessment Procedure
• SOP-VA-052: Daily CVAD Clinical Rounding Procedure
• SOP-VA-053: DIVA Escalation Protocol
• POL-004: Strategic Planning and Implementation of Vascular Access Services
• POL-003: Evidence-Based Selection and Clinical Monitoring Standards
• POL-006: Interprofessional Safety and Care Transitions
• VAST After-Hours Coverage Plan
• EMR Vascular Access Order Set and Documentation Template Specifications

8. Revision History

References