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. 2018 Mar 20;3(3):CD011429.
doi: 10.1002/14651858.CD011429.pub2.

Vascular access specialist teams for device insertion and prevention of failure

Peter J Carr  1 , Niall S Higgins, Marie L Cooke, Gabor Mihala, Claire M Rickard
Affiliations

Vascular access specialist teams for device insertion and prevention of failure

Peter J Carr et al. Cochrane Database Syst Rev. .

Abstract

Background: Most people admitted to hospitals worldwide require a vascular access device (VAD). Hundreds of millions of VADs are inserted annually in the USA with reports of over a billion peripheral intravenous catheters used annually worldwide. Numerous reports suggest that a team approach for the assessment, insertion, and maintenance of VADs improves clinical outcomes, the patient experience, and healthcare processes.

Objectives: To compare the use of the vascular access specialist team (VAST) for VAD insertion and care to a generalist model approach for hospital or community participants requiring a VAD in terms of insertion success, device failure, and cost-effectiveness.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1); Ovid MEDLINE (1950 to 7 February 2018); Ovid Embase (1980 to 7 February 2018); EBSCO CINAHL (1982 to 7 February 2018); Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities (1990 to 7 February 2018); and Google Scholar. We searched the following trial registries: Australian and New Zealand Clinical Trials Register (www.anzctr.org.au); ClinicalTrials.gov (www.clinicaltrials.gov); Current Controlled Trials (www.controlled-trials.com/mrct); HKU Clinical Trials Registry (www.hkclinicaltrials.com); Clinical Trials Registry - India (ctri.nic.in/Clinicaltrials/login.php); UK Clinical Trials Gateway (www.controlled-trials.com/ukctr/); and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (www.who.int/trialsearch). We searched all databases on 7 February 2018.

Selection criteria: We planned to include randomized controlled trials (RCTs) that evaluated the effectiveness of VAST or specialist inserters for their impact on clinical outcomes.

Data collection and analysis: We used standard methodological procedures recommended by Cochrane and used Covidence software to assist with file management.

Main results: We retrieved 2398 citations: 30 studies were eligible for further examination of their full text, and we found one registered clinical trial in progress. No studies could be included in the analysis or review. We assigned one study as awaiting classification, as it has not been accepted for publication.

Authors' conclusions: This systematic review failed to locate relevant published RCTs to support or refute the assertion that vascular access specialist teams are superior to the generalist model. A vascular access specialist team has advanced knowledge with regard to insertion techniques, clinical care, and management of vascular access devices, whereas a generalist model comprises nurses, doctors, or other designated healthcare professionals in the healthcare facility who may have less advanced insertion techniques and who care for vascular access devices amongst other competing clinical tasks. However, this conclusion may change once the one study awaiting classification and one ongoing study are published. There is a need for good-quality RCTs to evaluate the efficacy of a vascular access specialist team approach for vascular access device insertion and care for the prevention of failure.

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Conflict of interest statement

Peter J Carr received a grant from CareFusion (facilitated by his institution at the time) to attend a scientific meeting on vascular access in the USA in 2012. He received speakers bureau payment from CareFusion in 2013 and BD in 2014 for lectures on the subject of vascular access. His PhD research was supported by a BD contribution to the AVATAR group based at Griffith University. No funding was allocated for the review, with no influence over the design of this review. All of the aforementioned have not biased or influenced this review.

Niall S Higgins has no conflicts of interest to declare.

Marie L Cooke is an academic researcher. Griffith University (not Prof Cooke) has received an unrestricted educational grant from Baxter to support the development of educational materials on peripheral intravenous catheter insertion, maintenance, and removal. Prof Cooke has not undertaken any research specifically into IV teams (the topic of this review).

Gabor Mihala has no conflicts of interest to declare.

Claire M Rickard is an academic researcher and speaker in the field of vascular access. Griffith University (not Prof Rickard) has received payments from manufacturers of intravenous (IV) catheters and related equipment for educational lectures or expert opinion on products (3M, Bard, B.Braun, BD, CareFusion, Mayo, ResQDevices, Smiths Medical) and for one consultancy research project on the topic of a simulated time‐in‐motion study on flushing of IV catheters (BD) (Keogh 2014). Griffith University (not Prof Rickard) has also received unrestricted, grant‐in‐aid donations from manufacturers of IV catheters and related equipment (3M, Adhezion, Angiodynamics, Bard, Baxter, BD, Centurion, CareFusion, Cook, Entrotech, FloMedical, Medtronic, Smiths Medical, and Teleflex) to 1) support Prof Rickard's independent research (manufacturers have no involvement in study design, execution, data handling, publication preparation, or approval), and 2) to support travel costs for research staff and students to present their independent research at conferences. Prof Rickard is a PhD supervisor and co‐investigator on the registered trial (ACTRN12616001675415), investigating vascular access specialist team (the topic of this review), for which there is no commercial funding and with an ultrasound machine loaned by Bard (manufacturer has no involvement in study design, execution, data handling, publication preparation, or approval). Prof Rickard has published government‐funded research that identified IV team/expert vascular access specialist team insertion as one of many factors statistically linked to fewer IV catheter complications (Wallis 2014).

Figures

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1
Study search flowchart.
See this image and copyright information in PMC

Comment in

References

References to studies excluded from this review

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