Clinical Nurse Specialist, OPAT & Vascular Access Service
The Homerton University Hospital NHS FT
Sickle cell disease (SCD) is a hugely debilitating disease resulting in a range of acute and chronic complications. Sadly, as patients with this disease age, the effects of prolonged haemolytic anaemia often lead to more severe comorbidities. As a result of such complications, SCD patients are routinely hospitalised, requiring frequent venous access for treatments such as blood exchange transfusions. This, over time, causes damage to their vessel health resulting in many SCD patients being classed as having difficult intravenous access (DIVA).
In DIVA patients the use of peripheral cannulas often results in unacceptably high failure rates and multiple, painful, insertion attempts. This can result in the need to insert femoral lines into SCD DIVA patients to ensure they receive their planned, essential, treatment. However, femoral line insertion has its own challenges. These include increased complication risks for patients, such as infection, and also an increase in staffing and equipment requirements. Once the femoral vein develops scar tissue this procedure becomes more complex and can require theatre admission to insert the line, which can at best require more time and staffing and at worst delay critical treatment.
Homerton Hospital have developed a new pathway of care to overcome this issues.