Considering Vascular Procedures in Your ASC? Come to ASCA 2019 to learn what you need to know BY LISA PETRUSKY, RN, CASC

If you are planning to add vascular procedures to your ASC, I recom- mend you attend my ses- sion “Should You Per-

form Vascular Procedures in Your ASC?” at the ASCA 2019 Confer- ence & Expo, May 15–18, in Nash- ville, Tennessee. I will share tips on what to consider before taking on this specialty at your facility. A few points to think through: Actual procedures to be per-

formed. Will you limit what you do to peripheral arterial and venous dis- ease procedures, peripherally inserted central catheters (PICCs) or ports and vein procedures or will you add vas- cular access procedures? Once you determine which procedures you will be performing, consider the population you will serve. Patient population. If adding vas- cular access procedures, these patients carry a diagnosis of end-stage renal disease (ESRD) or chronic kidney disease (CKD), and you must con- sider the American Society of Anes- thesiologists (ASA) physical status (PS) classification of these patients. If you have anesthesia personnel, they must be consulted. Anesthesiologists might consider ESRD patients a PS4. Many ASCs cannot even perform pro- cedures on a patient rated a 4. In the current ASA classifications, PS3 now encompasses “ESRD undergoing reg- ularly scheduled dialysis.” Careful scrutiny and understanding of a dialy- sis patient along with a robust process and procedure for scheduling these patients is extremely important. In addition to physical status clas- sification, your state might not allow you to perform a procedure that “involves a major blood vessel.” If



Lisa Petrusky, RN, CASC, will present “Should You Perform Vascular Procedures in Your ASC?” on Thursday, May 16, from 9:10–10:10 am. Learn more and see the complete schedule on the ASCA 2019 website. annualconference/schedule

performing vascular access proce- dures, this would potentially elimi- nate the majority of these procedures unless a waiver were sought and granted. Consult your regulations and read them carefully for this type of language. Physical space and equipment.

If you have a single-specialty vas- cular practice, the operating room size can be built to class B specifica- tions, unless Class C is required by state regulations or, as we prefer, 400 square feet. If adding peripheral arte- rial disease procedures or contemplat- ing a fixed fluoroscopy unit instead of a portable C-Arm, this might be too small depending on the unit and the

peripheries you choose to enhance your work space. Keep in mind, with vascular procedures one cannot pre- dict the supplies necessary pre-pro- cedure, so having supply cabinets in the operating room is a must. Vascu- lar procedures can be accomplished under moderate sedation negating the requirement for anesthesia person- nel and equipment. A portable vital signs machine with capnography capabilities and a nursing cart replace an anesthesia machine. Registered nurses replace anesthesia. Physicians. Are your doctors going to be employees or contracted? Are they going to be vascular sur- geons, interventional radiologists or interventional nephrologists? With each physician comes admitting/ transfer privileges hurdles. Some states require one or the other, some require both. Our interventional radi- ologists are with us 100 percent of the time. They are our medical direc- tors but not employees; they are con- tracted. We have a tough time obtain- ing interventional radiologists’ admitting privileges. Laboratory. What labs do you need on-site to provide the neces- sary and safe care to your patients? Rapid blood glucose for all dia- betic patients, potassium on ESRD patients, INRs for central lines, ACT for peripheral cases?

I will share more on these topics and touch on some billing and cod- ing at my presentation. Hope to see you at ASCA 2019.

Lisa Petrusky, RN, CASC, is the director of clinical integration at Azura Vascular Care, a subsidiary of Fresenius Medical Care, N.A. in Malvern, Pennsylvania. Write her at

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