Registered Nurses’ Association of Ontario (RNAO) best practice guideline on the assessment and management of vascular access devices

Abstract

Introduction: Vascular access is the most common invasive procedure performed in health care. This fundamental procedure must be performed in a safe and effective manner. Vascular access devices (VADs) are often the source of infections and other complications, yet there is a lack of clear guidance on VADs for health providers across different settings. A Best Practice Guideline (BPG) was developed by the Registered Nurses’ Association of Ontario (RNAO) to provide evidence-based recommendations on the assessment and management of VADs. Methods: RNAO BPGs are based on systematic reviews of the literature following the GRADE approach. Experts on the topic of vascular access were selected to form a panel. Systematic reviews were conducted on six research areas: education, vascular access specialists, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. A search for relevant research studies published in English limited to January 2013 was applied to eight databases. All studies were independently assessed for eligibility and risk of bias by two reviewers based on predetermined inclusion and exclusion criteria. The GRADE approach was used to determine certainty of the evidence. Results: Over 65,000 articles were screened related to the six priority research questions. Of these, 876 full-text publications were examined for relevance, with 174 articles designated to inform nine recommendations in the BPG on the subject areas of: comprehensive health teaching, practical education for health providers, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. In June 2021, the RNAO published the BPG on vascular access, which included the recommendations and other supporting resources. Conclusion: The vascular access BPG provides high quality guidance and updated recommendations, and can serve as a primary resource for health providers assessing and managing VADs.

Nurses' evidence‐based knowledge and self‐efficacy in venous access device insertion and management: Development and validation of a questionnaire

“…Compared with previous tools developed for single venous access devices (Osti et al, 2019;Raña-Rocha et al, 2020;Roslien & Alcock, 2009;Sharour, 2018;Xu et al, 2020) and lacking satisfactory psychometric testing (Buchanan et al, 2023;Raynak et al, 2020),…”

“…central venous catheters, nurses, peripheral catheterization, psychometric properties, questionnaire, vascular access devices focusing on routine management procedures, such as the difficult intravenous access scale (Van Loon et al, 2019) or to assess competences related to specific VAD-related complications such as bloodstream infection (Cicolini et al, 2014;Esposito et al, 2017;Labeau et al, 2008). Additionally, they often only assess either knowledge or self-efficacy, are based on outdated scientific evidence compared to the latest guideline recommendations and lack complete and satisfactory psychometric testing (Buchanan et al, 2023;Raynak et al, 2020). Among measures of nurses' self-efficacy, a simple and clear 10-item tool was developed by Roslien and Alcock (2009) based on Bandura et al (1999).…”

“…Their overall rate in adult patients ranges from 5% to 32% depending on the specific VAD (Badger, 2019; de Vasconcelos Pina et al., 2023; Marsh et al., 2018). Such complications can arise due to inadequate VAD management (Buchanan et al., 2023; Matey & Camp‐Sorrell, 2016). Challenges include suboptimal implementation of evidence‐based practices in clinical settings (Buchanan et al., 2023; Fiorini et al., 2021), and many barriers have been identified including nurses' VAD management (Jeffery & Pickler, 2014; Piredda et al., 2019).…”

Results of a long‐term, prospective study on complications of central venous catheter in pediatric patients with hematologic‐oncologic diseases

“…Our unit implemented written procedures and organized educational programs for nurses and physicians involved in CVC management since 2010. 5 Since then, every nurse has been trained to properly manage the catheters, monitor and record any complication episodes, and record the effectiveness of treatment in collaboration with the medical team. To survey the efficacy of interventions and the maintenance of the competencies over time, a prospective data collection of the type, number, treatment, and outcome of CVC was established.…”

An Explanatory Model of Vascular Access Care Quality: Results of a Cross-Sectional Observational Study

“…These include implementing a multi-component or multimodal care protocol, often referred to as a “care bundle”. A care bundle is a group of evidence-based interventions that can ensure the provision of a standardised care method, and in addition, several studies have already shown that its application can reduce complications [ 6 , 7 , 8 ].…”