Sheila Inwood is a vascular access specialist who was among one of the first nurses to place central catheters in the UK and the first to surgically place an implantable port. She has worked with industry, academia and clinicians to improve the care of patients that need vascular access in her NHS hospital. Ms. Inwood has served as Keynote Speaker at a number of international meetings including WoCoVa and the Association of Vascular Access.
Ms. Inwood has completed the ICMJE disclosure form and has indicated no current conflicts of interest. She has served as the Director of International Medical Affairs and Clinical Affairs for CareFusion and has been a CVC faculty member for Teleflex Inc. in the past.
VC: Tell us a bit about yourself, where you work, what you do and how you came to be where you are?
SI: I work in an 800-bed general hospital. My background in nursing is in the critical care, cardiothoracic area. I established the first IV nutrition nurse post at the hospital in 1987. The primary objective of the position was to enable IV nutrition to be administered around the general hospital, not just in ICU. A huge amount of my time was spent finding someone / anyone to insert a cuffed tunnelled central catheter. This was the only way intravenous nutrition was given (such a long time ago!)
Needless to say the variety of expertise, and knowledge that I encountered during those years as a nutrition nurse was extremely broad. There was no standardised method, level of expertise or equipment for inserting catheters. The supposed level of expertise was firmly in the hands of the anaesthesia department. Failing their support, it was very common to have patients waiting for a catheter to be surgically inserted by a surgeon.
Hand in hand with a visionary anaesthetist, we established a comprehensive vascular access service (VAS) in 1993 providing this to all areas of the hospital. I should clarify when I say that ours was a service that could insert all types of vascular catheters: Traditional, cuffed tunnelled, acute CVC, PICC, dialysis. It truly brought vascular access to the patient in a way that didn't happen before.
VC: I sense the passion in your response, but tell me why you chose the field of vascular access nursing as a career choice? What is it that excites you the most about this work?
SI: I found I could really make a difference. Part of the service delivery was that catheters were placed at the bedside -- when the patient required it. Rather than the patient being moved around the hospital to suit the location of the inserter, the service was delivered to the patient wherever they might be which I found very powerful
I also think vascular access may seem quite simple and straightforward to some, but it has a breadth and depth that never seems to end. It may appear at first glance to be a repetitive process but the one variable that constantly changes are the patients that require your service and expertise. Add to this changes in the accompanying technology (the female version of boys with their toys) and expertise that only grows with time.
VC: What are some of the biggest problems you face on a daily basis as a vascular access specialist?
SI: One problem is that everything thinks they are an “expert” when it comes to vascular access, from peripheral to central lines. I believe this is because in many settings no one particular group “owns” this field. Subsequently, I often get referrals for a PICC, not a vascular access assessment or evaluation to determine what a patient may need. My way of dealing with this problem is to always accept the referral, but explain that I will review the patient and make a decision as to what would be the most appropriate access for their needs. This is a long-term education / culture change process that never ends. I would add that this philosophy only functions if a vascular access specialist such as myself can offer all the choices of vascular access. Meaning if I assess a patient and determine they require a CVC and not a PICC, I need to be able to place it for the patient and the referring provider. If you hold the title of vascular access specialist, you need to have the experience and skill set that justify the title across all devices.
VC: So given this issue, what do you think are the biggest challenges facing the field of vascular access access today and how do we move the field forward?
SI: I think one of the biggest challenges is on our end. For instance, I am not 100% certain that PICC teams are vascular access specialists. Rather, they need to understand their limitations and push to be able to place all types of devices - so that the patient gets what is best for them, not what is available.
Another challenge and area for innovation is a manufacturer’s / industry’s ability to keep up with the appropriate / safest products, technology. There is a real illusion that industry works hand in hand with practitioners; in my opinion, this is not always true. Rather, practice, technology is driven (sadly) by marketing. There needs to be a lot more collaborative cooperation particularly at the R&D stage. Industry needs to work in sync with clinicians so that the needs identified by us can be met by emerging technology.
VC: If there were one vascular access policy change you could make, what may it be and why?
SI: That's easy. All patients should be referred to a vascular access specialist, who is an expert and competent in all areas of vascular access. Just as a patient that may need surgery is referred for a surgical consult, vascular access should be a speciality in its own right. Last I checked we didn’t ask the surgeon to come down to the ER and do an appendectomy now, did we?