How to Order Services with Vascular Access Plus

STEP 1:

Once you have received an order for IV therapy and insertion of a vascular access device, you will need to obtain and complete an order for PICC line placement from the ordering provider. If your facility does not have a standard PICC order, download and complete our order set below.

Standard PICC Order Set

If you need a peripheral IV, midline catheter, or troubleshooting help with a vascular access device already in place please go to Step 3.

STEP 2:

Once you have obtained and completed either your facility’s or VA+ Standard PICC Order Set, you will need to obtain patient consent for PICC line placement. If your facility does not have a PICC consent form, please download and complete the VA+ consent form below.

PICC Consent Form

If you need a peripheral IV, midline catheter, or troubleshooting help with a vascular access device already in place you do not need to obtain consent, and can proceed to Step 3.

STEP 3:

Once you have obtained a PICC order and consent for PICC placement, fax these documents to VA+ at (402) 505-5247. Once you have faxed this information, call Vascular Access Plus at 1-855-742-2827 (855-PICC-VAP) to request service. Please leave your name, the facility you are calling from, your call back number, and what device or troubleshooting help is needed.

In the event that you are unable to reach VA+ staff via our 24 hour on call line, please call 402-450-4264.

How do I order a PICC line or midline if I...

How do I order a PICC line or midline if I work in an acute care hospital?

Step 1. Call our 24 hour on call number at 855-742-2827 and be ready to answer the following pre-assessment questions.

  1. What IV medications are ordered for your patient?
  2. How frequently are IV medications ordered and when is the next dose due?
  3. Does your patient have any relevant issues in regards to vascular access, e.g. difficult to obtain access, hx of frequent infiltrations, need additional sites for access, unable to maintain access, etc.
  4. Does your patient have dx of Chronic Renal Failure Stage 3 or greater?
  5. Does your patient have any access restrictions, e.g. hx mastectomy, one arm available, contractures, pacemaker, port, etc.?
  6. Does your patient meet screening criteria for SARS-Cov-2 (COVID-19) isolation precautions?

Step 3. If your patient needs a PICC line, obtain order from provider and have provider obtain consent from the patient. If your patient needs a midline catheter or ultrasound guided peripheral IV, no consent is required.

Step 4. If your patient has Stage 3 chronic kidney failure or greater, an order will be required from a nephrologist prior to placement, for any vascular access procedure.

Step 5. Once order and consent have been obtained, call the Vascular Access Specialist at 855-742-2827 for estimated time of arrival for procedure.

Step 6. Once you have obtained an arrival time from Vascular Access Plus RN, ensure that no other procedures are scheduled for your patient at that time, make sure your patient has had the opportunity to get up to the bathroom prior to Vascular Access Specialist arrival, and make sure patient is in bed and prepared for procedure at agreed upon time.

How do I order a PICC line or midline if I work in a skilled nursing or long term care facility?

Step 1. Call our 24 hour on call RN at 855-742-2827 and be ready with the following pre-assessment information.

  1. What IV medications are ordered on your patient?
  2. What is the frequency of IV medications, when is the next dose due?
  3. Does your patient have any of the following issues r/t vascular access, e.g. infiltration, additional access sites needed, unable to maintain access, difficult stick, etc.
  4. Does your patient have confirmed Chronic Renal Failure Stage 3 or greater?
  5. Does your patient have any restrictions, e.g. hx mastectomy, one arm no viable, contractures, implanted pacemaker, port, etc.?
  6. Does your patient meet screening criteria for SARS-Cov-2 (COVID-19) isolation precautions?

Step 3. Once you have received an order for IV therapy and vascular access device placement, you need to obtain an order for PICC placement from provider. If your facility does not have a standard PICC order, use our order set below. You will also need to obtain a written provider order if your patient has Chronic Renal Failure Stage 3 or greater and needs a midline or PIV.

Standard PICC Order Set

Step 4. Once PICC order obtained, you will need to get patient consent for PICC line placement. If your facility does not have a standard PICC consent, you can download and use the VA+ consent form below. You do not need to obtain consent for a peripheral IV, midline catheter, or troubleshooting help with a vascular access device already in place.

PICC Consent Form

Step 5. Fax your completed Order and Consent forms to Vascular Access Plus at (402) 505-5247.

Step 6. Once Steps 1-5 are complete, call Vascular Access Plus at 855-742-2827 to confirm with RN and schedule date and time of procedure.

How do I order a PICC line or midline if I work in a rural or critical access hospital?

Step 1. Call our 24 hour on call number at 855-742-2827 and be ready to answer the following pre-assessment questions.

  1. What IV medications are ordered for your patient?
  2. How frequently are IV medications ordered and when is the next dose due?
  3. Does your patient have any relevant issues in regards to vascular access, e.g. difficult to obtain access, hx of frequent infiltrations, need additional sites for access, unable to maintain access, etc.
  4. Does your patient have dx of Chronic Renal Failure Stage 3 or greater?
  5. Does your patient have any access restrictions, e.g. hx mastectomy, one arm available, contractures, pacemaker, port, etc.?
  6. Does your patient meet screening criteria for SARS-Cov-2 (COVID-19) isolation precautions?

Step 3. Once you have received an order for IV therapy and vascular access device placement, you need to obtain an order for PICC placement from the ordering provider. If your facility does not have a standard PICC order, download our order set and complete it. You will also need to obtain provider order if your patient has Chronic Renal Failure Stage 3 or greater and needs a midline or PIV placed.

Standard PICC Order Set

Step 4. Once you have obtained the PICC Order Set, you will need to obtain patient consent for PICC line placement. If your facility does not have a PICC consent, you can download and use the VA+ consent form below. You do not need to obtain consent for a peripheral IV, midline catheter, or troubleshooting help with a vascular access device already in place.

PICC Consent Form

Step 5. Fax your completed PICC, Midline or PIV Order and completed PICC Consent form to Vascular Access Plus at (402) 505-5247.

Step 6. Once all the above steps are completed, call our Vascular Access Specialist at 855-742-2827 to confirm and schedule date and time of procedure.

How do I order a PICC line or midline if I work in an assisted living facility?

Step 1. Call our 24 hour on call number at 855-742-2827 and be prepared to answer the following pre-assessment questions.

  1. What are the names of the IV medications ordered for your patient?
  2. Identify the current issues is your patient experiencing in regards to vascular access, e.g. frequent infiltrations, difficult to obtain access, unable to maintain access, need additional access sites, etc.
  3. Does your patient have Chronic Renal Failure Stage 3 or greater?
  4. Does your patient have any restrictions regarding access, e.g. history of mastectomy, only one arm available, pacemaker, implanted port, etc.?
  5. Does your patient meet screening criteria for SARS-Cov-2 (COVID-19) isolation precautions?

Step 3. Once you have received an order for IV therapy and insertion of a vascular access device, you will need to obtain and complete an order for PICC line placement from the ordering provider. If your facility does not have a standard PICC order, download and complete our order set below. You will also need to complete this order for any midline or PIV placement on patients with Chronic Renal Failure Stage 3 or greater.

Standard PICC Order Set

Step 4. Once you have obtained the PICC Order Set, you will need to obtain patient consent for PICC line placement. If your facility does not have a PICC consent form, please download and complete the VA+ consent form below. If you need a peripheral IV, midline catheter, or troubleshooting help with a vascular access device already in place you do not need to obtain patient consent.

PICC Consent Form

Step 5. Fax your completed PICC, Midline or PIV Order and completed PICC Consent form to Vascular Access Plus at (402) 505-5247.

Step 6. Once all the above steps are completed, call our Vascular Access Specialist at 855-742-2827 to confirm and schedule date and time of procedure.

How do I order a PICC line or midline if I work in a physician’s office or outpatient clinic?

Step 1. Call our 24 hour on call number at 855-742-2827 and be prepared to answer the following pre-assessment questions.

  1. What are the names of the IV medications ordered for your patient?
  2. Identify the current issues is your patient experiencing in regards to vascular access, e.g. frequent infiltrations, difficult to obtain access, unable to maintain access, need additional access sites, etc.
  3. Does your patient have Chronic Renal Failure Stage 3 or greater?
  4. Does your patient have any restrictions regarding access, e.g. history of mastectomy, only one arm available, pacemaker, implanted port, etc.?
  5. Does your patient meet screening criteria for SARS-Cov-2 (COVID-19) isolation precautions?

Step 2. You will also need to be prepared to provide our on call Vascular Access Specialist with the name and phone number of your facility’s administrator, DON and/or ordering provider, so we can arrange for a one time service agreement.

Step 3. Once you have received an order for IV therapy and insertion of a vascular access device, you will need to obtain and complete an order for PICC line placement from the ordering provider. If your facility does not have a standard PICC order, download and complete our order set below. You will also need to complete this order for any midline or PIV placement on patients with Chronic Renal Failure Stage 3 or greater.

Standard PICC Order Set

Step 4. Once you have obtained the PICC Order Set, you will need to obtain patient consent for PICC line placement. If your facility does not have a PICC consent form, please download and complete the VA+ consent form below. If you need a peripheral IV, midline catheter, or troubleshooting help with a vascular access device already in place you do not need to obtain patient consent.

PICC Consent Form

Step 5. Fax your completed PICC, Midline or PIV Order and completed PICC Consent form to Vascular Access Plus at (402) 505-5247.

Step 6. Once all the above steps are completed, call our Vascular Access Specialist at 855-742-2827 to confirm one time service has been approved, and to schedule date and time of procedure.

Step 7. Email VA+ administration at hr@vascularaccessplus.com with facility contact information about procedure invoicing, including billing contact person’s name and phone number.

How do I order a PICC line or midline if I work in a patient’s home?

Vascular Access Plus has been providing in home infusion and vascular access services, in conjunction with pharmacies and home health agencies, since 2008. If you work in home infusion, are a home infusion patient or are a family member of someone receiving home infusion and vascular access services, we would love to help ensure you are getting the best care delivery possible.

Step 1. Contact our VA+ nursing on call line at 855-742-2827 to speak with one of our RNs on call.

Step 2. Email our home infusion department directly with information about your patient needs, your contracted pharmacy or medication delivery service and your contact information. Email: infusiondept@vascularaccessplus.com

While we may not be able to fulfill all requests for services in the home, we are happy to assist in care delivery management to ensure your vascular access and infusion needs are met.

How do I order a PICC line or midline if my facility doesn’t have a contract with Vascular Access Plus?

Our primary goal is to help you and your patients with vascular access needs. We are happy to provide one time service agreements for vascular access needs in Nebraska, Iowa, Kansas and South Dakota prn.

Step 1. Call our 24 hour on call number at 855-742-2827 and be prepared to answer the following pre-assessment questions.

  1. What are the names of the IV medications ordered for your patient?
  2. Identify the current issues is your patient experiencing in regards to vascular access, e.g. frequent infiltrations, difficult to obtain access, unable to maintain access, need additional access sites, etc.
  3. Does your patient have Chronic Renal Failure Stage 3 or greater?
  4. Does your patient have any restrictions regarding access, e.g. history of mastectomy, only one arm available, pacemaker, implanted port, etc.?
  5. Does your patient meet screening criteria for SARS-Cov-2 (COVID-19) isolation precautions?

Step 2. You will also need to be prepared to provide our on call Vascular Access Specialist with the name and phone number of your facility’s administrator, DON and/or ordering provider, so we can arrange for a one time service agreement.

Step 3. Once you have received an order for IV therapy and insertion of a vascular access device, you will need to obtain and complete an order for PICC line placement from the ordering provider. If your facility does not have a standard PICC order, download and complete our order set below. You will also need to complete this order for any midline or PIV placement on patients with Chronic Renal Failure Stage 3 or greater.

Standard PICC Order Set

Step 4. Once you have obtained the PICC Order Set, you will need to obtain patient consent for PICC line placement. If your facility does not have a PICC consent form, please download and complete the VA+ consent form below. If you need a peripheral IV, midline catheter, or troubleshooting help with a vascular access device already in place you do not need to obtain patient consent.

PICC Consent Form

Step 5. Fax your completed PICC, Midline or PIV Order and completed PICC Consent form to Vascular Access Plus at (402) 505-5247.

Step 6. Once all the above steps are completed, call our Vascular Access Specialist at 855-742-2827 to confirm one time service has been approved, and to schedule date and time of procedure.

Step 7. Email VA+ administration at hr@vascularaccessplus.com with facility contact information about procedure invoicing, including billing contact person’s name and phone number.

Vascular Access Plus 24 hour on-call line: 855-742-2827