Abstract
BackgroundRandomized controlled trials evaluate the effectiveness of interventions for central venous access devices, however, high complication rates remain. Scoping reviews map the available evidence and demonstrate evidence deficiencies to focus ongoing research priorities.MethodA scoping review (January 2006–December 2015) of randomized controlled trials evaluating the effectiveness of interventions to improve central venous access device outcomes; including peripherally inserted central catheters, non-tunneled, tunneled and totally implanted venous access catheters. MeSH terms were used to undertake a systematic search with data extracted by two independent researchers, using a standardized data extraction form.ResultsIn total, 178 trials were included (78 non-tunneled [44%]; 40 peripherally inserted central catheters [22%]; 20 totally implanted [11%]; 12 tunneled [6%]; 6 non-specified [3%]; and 22 combined device trials [12%]). There were 119 trials (68%) involving adult participants only, with 18 (9%) pediatric and 20 (11%) neonatal trials. Insertion-related themes existed in 38% of trials (67 RCTs), 35 RCTs (20%) related to post-insertion patency, with fewer trials on infection prevention (15 RCTs, 8%), education (14RCTs, 8%), and dressing and securement (12 RCTs, 7%). There were 46 different study outcomes reported, with the most common being infection outcomes (161 outcomes; 37%), with divergent definitions used for catheter-related bloodstream and other infections.ConclusionMore high quality randomized trials across central venous access device management are necessary, especially in dressing and securement and patency. These can be encouraged by having more studies with multidisciplinary team involvement and consumer engagement. Additionally, there were extensive gaps within population sub-groups, particularly in tunneled devices, and in pediatrics and neonates. Finally, outcome definitions need to be unified for results to be meaningful and comparable across studies.
Highlights
Central venous access devices (CVADs) provide access to the greater vascular system to administer therapy contraindicated to be given peripherally, for longer term treatment, and for venous monitoring and blood sampling [1]
Insertion-related themes existed in 38% of trials (67 randomized controlled trials (RCTs)), 35 RCTs (20%) related to post-insertion patency, with fewer trials on infection prevention (15 RCTs, 8%), education (14RCTs, 8%), and dressing and securement (12 RCTs, 7%)
The non-specified category was created to classify studies that did not specify the type of CVAD
Summary
Central venous access devices (CVADs) provide access to the greater vascular system to administer therapy contraindicated to be given peripherally, for longer term treatment, and for venous monitoring and blood sampling [1]. Patients requiring CVADs are heterogeneous, with varying ages, acute and chronic illnesses, across hospitals and in community care. There are many different CVAD types inserted for different treatment requirements; for example, long or short term duration, and continuous or intermittent therapy. Despite the prevalence of CVADs in acute and chronic care, serious insertion and management complications associated with CVADs continue to be prevalent [5–10]. Developing, testing and implementing effective interventions to prevent CVAD-associated harm are important considerations for healthcare researchers, clinicians, and patients. In order to improve the quality and safety of CVADs, many randomized controlled trials (RCTs) have been conducted to evaluate the effectiveness of healthcare interventions. Randomized controlled trials evaluate the effectiveness of interventions for central venous access devices, high complication rates remain.
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