It is important that all persons engaged in delivering invasive upper extremity therapy to patients have a competent understanding and discipline in their approach to these interventions. One convenient way to think of this process is by adhering to the ” Five A’s” each time that an upper extremity intervention is planned. The “Five A’s” are as follows:

ASSESS whether or not invasive intervention is truly necessary and whether the patient has any contradictions to such interventions and that the site, time, medication or intervention, dose and patient are all appropriate  for the planned intervention.  This is a good time to also assess by asking  the Five Rights if the intervention involves  a drug or medication or infusion or a modified version of the Five Rights if the intervention is an IV or PICC line:.  The modified Five Rights can be thought of as follows:

• Right person,
• Right time
• Right place
• Right intervention
• Right patient education and expectations of and signed and agreed to consent to the intervention.

ASK  patients where they prefer to have access or invasive interventions attempted AND if the patient has any area where interventions should not be attempted or where they have experienced problems in the past.

AFFIRM that the underlying anatomy and patients condition and the surrounding environment will support the delivery of such intervention and that the person attempting the intervention has all the necessary tools, skills and safety systems in place to assure success.

ATTEMPT only once with a repeat intervention  mandatory time out if the first attempt is not successful. Following a failed attempt, the following should occur:

ASSURE that following the intervention that the intervention went as planned and report and study as a system when it did not. Monitor the site of the intervention to assure that no complications occur.

Adherence to the “Five A’s” each time ann intervention is planned involving an arm, coupled with the use of checklists and other tools assures that care is delivered in a safe and effective manner consistent with the tenant of minimizing potential harm to the patient and assuring maximal opportunity for a successful and complication free intervention.