Centerpoint Medical Center
October 14, 2013

by Linda Friedel | Reprinted courtesy of KC Nursing News

A group of Chinese nurses recently observed vascular access care with specialists in area hospitals. The inaugural event was enlightening and collegial, say area nurses.

Margy Galloway, RN, BSN, BA-BC, CRNI, vascular access clinician at Saint Luke’s Hospital and coordinator for the project, said the contingency from China was eager to learn.

“I was real excited to have them there,” said Galloway. “They were excited to do new things. They want to do better things with their patients.”

Galloway, a local and national leader in vascular access care, teamed with Bard Access Systems to develop the one-day program. Bard Access Systems sponsored 28 Chinese nurses to attend the Association of Vascular Access (ACA) conference in Nashville from Sept. 20 to 23 before eight of them stopped over for a day in Kansas City. The contingency of eight nursing leaders divided into groups of two and three to meet with vascular access specialists at Saint Luke’s Hospital, Centerpoint Medical Center and The University of Kansas Hospital on Sept. 25. Vascular access nurse specialists from the host hospitals spent a half day with the Chinese nurses demonstrating PICC lines (peripherally inserted central catheter), answering questions, discussing early assessment and the process of daily work flow. Scott Wang of Bard Access Systems provided interpretation and Rich Lewis, RN, BS, VA-BC, PICC business analyst with Bard, accompanied the nurses.

“There has been a growing trend for vascular access,” said Lewis. “They are building that in China.”

Traditionally nurses in China do not have vascular access except in the oncology population, said Galloway and Lewis. They would like to branch out into other settings, such as in renal, medical surgical and for patients with infections, they said. Vascular access nurses place more lines in the outpatient setting in China, Lewis said.

“We’re more in the ICU in the U.S.,” he said.

Between eight and 15 PICC lines are scheduled in inpatient settings on any given day at Saint Luke’s Hospital, including consultations, Galloway said. There were a dozen scheduled by midmorning the day the Chinese nurses observed processes at Saint Luke’s Hospital. They had an opportunity to see two patients and two PICCS and one with a regular IV. Galloway demonstrated as the visiting nurses observed her working with patients.

“They go home talking about what they learned,” Galloway said. “We’re working toward creating the same standards throughout the world internationally. We’re promoting excellence in vascular access.”

In addition to observing technology and techniques the visiting nurses wanted to know how the local vascular access nurses are staffed, the number of nurses it takes for their teams and how the nurses interface with pharmacists and physicians, Galloway said. Galloway and nurses from the participating hospitals said they were amazed at the size of hospitals in Chinese cities in which the visiting nurses represented. They hailed from Beijing, Anjing, Nanging, Guangzhou and Wuhan where hospitals range in the thousands from 1,500 beds to 8,000, compared to Kansas City area hospitals which count in the hundreds. In many of the Chinese hospitals physicians and anesthetists install PICC lines and jugular lines while nurses provide the care. In others, such as university and teaching hospitals, nurses place their own lines, said Ramona Martin, RN, VAV-BC, CRNI, vascular access specialist and vascular access team leader at Centerpoint Medical Center.

“They are very skilled nurses,” Martin said. “They do exactly what I do in their home country.”

Martin said their visit was a phenomenal experience. She was grateful for the opportunity. The Chinese nurses observed processes and asked numerous questions about the physicians. She was surprised to learn about their flexible practice. The Chinese vascular access nurses said their teams do not require physicians orders to make a change in plans.

“It was interesting,” she said. “In their country, they can choose to do different devices.

They could install, then they would go to the jugular. They didn’t have to have an order from a physician.”

Liu Huili, BSN, through the interpreter, said in her home hospital the nurses set up their own PICC team. They install 2,000 PICCs per year, just for tumors, she said. They primarily work in oncology. The port and CVCs are done by anesthetists, she said.

“The nurses do the consult and make a recommendation that allows them to insert the lines,” Martin said. “Nursing is an evolving practice. They (Chinese nurses) are growing into the decision-making process. Now they’re starting to partner with physicians.”

Tony Wiedel, RN, VA-BC, staff nurse on the IV therapy team at The University of Kansas Hospital, helped to host the small delegation of Chinese nurses at KU Hospital.

“It was an honor to do it,” he said.

They wanted to see line placement and how their processes worked at KU, Martin said. “We do a lot of phenomenal things as far as vascular access,” he said. “In China they place acute care catheters but not a lot of PICCs. It’s generally with cancer patients.”

The Chinese nurses observed line placements and line exchanges, and how the vascular access nurses work with different departments, he said.

“In China everything happens in the hospital,” Martin said. “We showed them uses for outpatient PICCs they hadn’t seen before. It reminds you why you do what you do and love what you do. It was just a great collaboration between the two groups.”

Saint Luke’s Hospital sponsored a dinner party for the Chinese nurses as a culmination of activities. Vascular access specialists from participating hospitals attended in addition to representatives from local agencies involved in vascular access such as the Joint Commission, pharmacists, dieticians, vendors, respiratory therapists, consumers and physicians. Vascular access specialists from Shawnee Mission Medical Center, North Kansas City Hospital, Centerpoint Medical Center and a member of the Chinese delegation presented educational programs.

“We have had nurses from Italy before,” Galloway said. “It’s always very interesting. What is it here they are really looking for?”

Yinghong Moore was one of the few nurses at the dinner event who communicated easily with the visiting nurses. Moore, RN on the pulmonary unit at Saint Luke’s Hospital, is originally from Nugene, China and conversed with the visiting nurses in their native Mandarin, the country’s official language. Moore has been in the United States for 10 years.

“I was so excited to see them come here,” she said.

Moore attended nursing school in Kansas City. She has never practiced nursing in China, but said she marvels at the progress her homeland has made in nursing in the past two decades.

“I was shocked because China caught up so fast,” she said. “They have advanced programs for nurses.”

The nurses she met were all directors with nothing less than a master’s degree, she said. Many of them are involved in research, which resonates with Moore, she said. That surprised her, too.

“When I talked to them they were very relaxed and asked me lots of question,” she said.

“I liked that. I know what they are thinking. They are all very smart nurses, very highly educated.”

Bringing the Chinese vascular access nurses to Kansas City was a labor of love, Galloway said. It was a way to not only demonstrate expertise of the vascular access program at Saint Luke’s, but it was an exchange of ideas, she said. Galloway is a long-time advocate in vascular access and is passionate about advancing the specialty locally, nationally and internationally, she said. She was the first vascular access nurse at Saint Luke’s Hospital, then grew the program. She has been a member of AVA since 1998 and founded the local MO-KAN chapter in 2010. She has taught vascular access techniques to nurses across the country and pioneered in new techniques, including placement of the central line in the jugular vein.

“I enjoy sharing and teaching the line-placement program for nurses, the bedside process,” she said.

Photo by Linda Friedel | The Kansas City Nursing News