Other Titles
Rapid Presentation Round
Abstract
Temporary, non-tunneled central venous catheters (CVCs) are commonly used for vascular access in patients with vesicant infusion needs or difficult intravenous access (DIVA). However, CVCs are associated with primary bloodstream infections (BSIs), contributing to significant morbidity, mortality, and financial burdens. At our institution, central line-associated bloodstream infection (CLABSI) rates and central utilization ratios have steadily increased since 2023, rising from 0.43 to 0.75 and 0.17 to 0.21, respectively, despite system-wide infection prevention initiatives. Recognizing the limitations of current approaches, particularly for DIVA patients, midlines emerged as an alternative to both CVCs and ultrasound-guided peripheral IVs (USG-PIVs).
In response, a multimodal training program was designed to establish cognitive and psychomotor competencies among advanced practice providers (APPs) for midline placement. Guided by the Nursing Professional Development (NPD) Practice Model, the program aimed to reduce unnecessary CVC use while enhancing vascular access options for DIVA patients. Beginning in November 2023, stakeholders were identified, and Phase 1 training commenced with MICU APPs (n=13) collaborating with midline experts and the Interventional Radiology team. Phase 2, initiated in March 2024, trained 2-3 APP superusers per service line (n=9), addressing gaps identified in Phase 1 and expanding the cohort of trained providers. To date, 14 additional APPs have completed the program.
The Plan-Do-Check-Act (PDCA) cycle was instrumental in identifying and addressing performance gaps, sustaining competency, and guiding policy development. Since the program’s inception, ICU midline use has increased (n>25 monthly), with a corresponding decline in CVC use (n<20 monthly). These outcomes highlight the potential of midlines to mitigate BSIs and provide adequate vascular access for DIVA patients.
This initiative demonstrates the critical role of staff professional development in addressing clinical challenges through evidence-supported training and competency development. The successful implementation of a midline program underscores the importance of a structured multimodal approach and ongoing evaluation. For the nursing profession, this work exemplifies how collaborative, interdisciplinary training can improve patient outcomes, reduce infection risks, and expand the scope of APP practice in acute care.
Notes
References:
1. Beville, A. S. M., Heipel, D., Vanhoozer, G., & Bailey, P. (2021). Reducing Central Line-Associated Bloodstream Infections (CLABSIs) by Reducing Central Line Days. Current Infectious Disease Reports, 23(12), 23–23. https://doi.org/10.1007/s11908-021-00767-w
2. Berkhout, M., Smit, K., & Versendaal, J. (2024). Decision discovery using clinical decision support system decision log data for supporting the nurse decision-making process. BMC medical informatics and decision making, 24(1), 100. https://doi.org/10.1186/s12911-024-02486-3
3. Blanco P. (2019). Ultrasound-guided peripheral venous cannulation in critically ill patients: a practical guideline. The ultrasound journal, 11(1), 27. https://doi.org/10.1186/s13089-019-0144-5
4. Branch, R. (2010). Instructional design: The ADDIE approach. Springer, New York. https://doi.org/10.1007/978-0-387-09506-6
5. Brescia, F., Pittiruti, M., Spencer, T. R., & Dawson, R. B. (2024). The SIP protocol update: Eight strategies, incorporating Rapid Peripheral Vein Assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion. The journal of vascular access, 25(1), 5–13. https://doi.org/10.1177/11297298221099838
6. Buetti, N., Marschall, J., Drees, M., Fakih, M. G., Hadaway, L., Maragakis, L. L., Monsees, E., Novosad, S., O’Grady, N. P., Rupp, M. E., Wolf, J., Yokoe, D., & Mermel, L. A. (2022). Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infection Control and Hospital Epidemiology, 43(5), 553–569. https://doi.org/10.1017/ice.2022.87
7. Felgen, J. (2007). I2E2: Leading Lasting Change. Creative Health Care Management. ISBN# 9781886624696
8. Gorgone, M., O'Connor, T. P., & Maximous, S. I. (2022). How I Teach: Ultrasound-guided Peripheral Venous Access. ATS scholar, 3(4), 598–609. https://doi.org/10.34197/ats-scholar.2022-0029HT
9. Sandrucci, S., & Mussa, B. (2014). Peripherally Inserted Central Venous Catheters (2014th ed.). Springer Milan. https://doi.org/10.1007/978-88-470-5665-7
10. Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do- study-act method to improve quality in healthcare. BMJ quality & safety, 23(4), 290–298. https://doi.org/10.1136/bmjqs-2013-001862
11. U.S. Centers for Disease Control and Prevention (CDC). (2024). Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central Line-Associated Bloodstream Infection). National Healthcare Safety Network. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf
12. Wright, D. (2021) The Ultimate Guide to Competency Assessment in Healthcare (4th ed.).Creative Health Care Management. ISBN# 9781886624184
Sigma Membership
Alpha Tau
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Competence, Interprofessional and Interdisciplinary, Teaching and Learning Strategies, Nursing Education, Advances in Education, Central Venous Catheters, Midline Catheters
Recommended Citation
Aguilar, Al-Zada and Maute, Sarah D., "Advanced Practice Provider (APP) Midline Training Initiative" (2025). Biennial Convention (CONV). 130.
https://www.sigmarepository.org/convention/2025/presentations_2025/130
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-12-01
Advanced Practice Provider (APP) Midline Training Initiative
Indianapolis, Indiana, USA
Temporary, non-tunneled central venous catheters (CVCs) are commonly used for vascular access in patients with vesicant infusion needs or difficult intravenous access (DIVA). However, CVCs are associated with primary bloodstream infections (BSIs), contributing to significant morbidity, mortality, and financial burdens. At our institution, central line-associated bloodstream infection (CLABSI) rates and central utilization ratios have steadily increased since 2023, rising from 0.43 to 0.75 and 0.17 to 0.21, respectively, despite system-wide infection prevention initiatives. Recognizing the limitations of current approaches, particularly for DIVA patients, midlines emerged as an alternative to both CVCs and ultrasound-guided peripheral IVs (USG-PIVs).
In response, a multimodal training program was designed to establish cognitive and psychomotor competencies among advanced practice providers (APPs) for midline placement. Guided by the Nursing Professional Development (NPD) Practice Model, the program aimed to reduce unnecessary CVC use while enhancing vascular access options for DIVA patients. Beginning in November 2023, stakeholders were identified, and Phase 1 training commenced with MICU APPs (n=13) collaborating with midline experts and the Interventional Radiology team. Phase 2, initiated in March 2024, trained 2-3 APP superusers per service line (n=9), addressing gaps identified in Phase 1 and expanding the cohort of trained providers. To date, 14 additional APPs have completed the program.
The Plan-Do-Check-Act (PDCA) cycle was instrumental in identifying and addressing performance gaps, sustaining competency, and guiding policy development. Since the program’s inception, ICU midline use has increased (n>25 monthly), with a corresponding decline in CVC use (n<20 >monthly). These outcomes highlight the potential of midlines to mitigate BSIs and provide adequate vascular access for DIVA patients.
This initiative demonstrates the critical role of staff professional development in addressing clinical challenges through evidence-supported training and competency development. The successful implementation of a midline program underscores the importance of a structured multimodal approach and ongoing evaluation. For the nursing profession, this work exemplifies how collaborative, interdisciplinary training can improve patient outcomes, reduce infection risks, and expand the scope of APP practice in acute care.
Description
Guided by the Nursing Professional Development (NPD) model, a multimodal training program enhanced vascular access care by equipping advanced practice providers (APPs) with expertise in midline placement. Developed to address difficult intravenous access (DIVA) challenges, this program used the Plan-Do-Check-Act (PDCA) cycle, driving an increase in ICU midline use, a decrease in unnecessary central venous catheters (CVCs), and showcasing nursing’s pivotal role in improving patient outcomes.