Vessel health and preservation, device selection and difficult intravenous access: CNSA vascular access devices evidence based clinical practice guidelines.

Abstract

Introduction: Vascular access devices (VADs), both peripheral intravenous cannulas (PIVCs) and central venous access devices (CVADs) are fundamental in the diagnosis, assessment and treatment of patients with cancer. Standardised, evidence-based management is essential to minimise complications and premature removal. Vessel health and preservation, a relatively new topic in the literature, is about appropriate device selection for the individual patient and their prescribed therapy, and identification and appropriate management of difficult intravenous access. Objectives/Aims: To summarise the current literature and detail graded, evidenced-based recommendations to guide clinical management of CVADs with the aim of preserving vein health for current and future use. Methods: The CNSA VAD Specialist Practice Network used a systematic review methodology to establish clinically relevant PICO questions, perform an extensive database search, extract a priori data into Covidence and analyse data from the eligible studies. Findings from the data analysis were summarised into clinically-focused recommendations for practice, graded using the Infusion Nurses Society grading scale. Results/Outcomes: A final 378 records were included from the 7936 records screened and 692 eligible records. Most studies were from Europe (n=132), followed by the USA (n=116), Australia (n=24) and China (n=20). The number of studies in this an emerging subject is steadily increasing with notable increases around the times of two key publications by Moureau and colleagues in 2012 and Hallam and colleagues in 2016. Recommendations detailing these three subjects were established and published on the CNSA website. Conclusion: This systematic review provides a summary of current evidence and valuable evidence-based, graded recommendations to inform clinical practice.