Implementation of a vascular access team to support perioperative nursing care – a lean and evidence-based management approach

Introduction
This study presents the implementation of a vascular access team (VAT) as an innovative organizational model for nursing practice in an intensive care unit, with a particular emphasis on its role in supporting perioperative care for surgical patients. The authors evaluated the potential of integrating Lean management and evidence-based management (EBM) principles to improve care quality, enhance nurse autonomy, and optimize human resource utilization in complex clinical settings.

Material and methods
The analyzed model includes the implementation of an interdisciplinary VAT at a university hospital. The team, composed primarily of anesthesiology nurses trained in midline catheter insertion, provided vascular access in scheduled, urgent, and emergency scenarios, including support for patients in surgical departments. The study assessed the team’s structure, clinical pathways, documentation protocols, and operational impact across units. A case study design with qualitative elements was employed. The implementation followed four stages: needs assessment, team organization, pilot testing, and full deployment. Lean tools (e.g., process mapping, standardization) and EBM frameworks (RAPEVA, INS, MAGIC) guided clinical practice standardization and ensured procedural quality.

Results
The pilot phase demonstrated reduced cannulation failure rates, fewer physician interventions in difficult access cases, and improved patient comfort. Notably, the VAT model facilitated timely and efficient vascular access in surgical patients, reducing delays in operative care and postoperative complications. Standardized protocols enhanced workflow transparency, documentation quality, and interdisciplinary communication.

Conclusions
A vascular access team may serve as an effective strategy to strengthen care quality, support perioperative workflows, and develop advanced nursing competencies in both intensive and surgical care settings. Its implementation reflects the principles of Lean and EBM and may contribute to improved patient outcomes, staff satisfaction, and organizational performance.