Care and Maintenance to Reduce Vascular Access Complications

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Care and Maintenance to Reduce Vascular Access ComplicationsInterpretation of EvidenceLevels of EvidenceIaIbEvidence obtained from meta-analysis or systematic review of randomized controlled trials.Evidence obtained from at least one randomized controlled trial.IIa Evidence obtained from at least one well-designed controlled study without randomization.IIb Evidence obtained from at least one other type of well-designed quasi-experimental studywithout randomization.IIIIVEvidence obtained from well-designed non-experimental descriptive studies, such ascomparative studies, correlation studies and case studies.Evidence obtained from expert committee reports or opinions and/or clinical experiences ofrespected authorities.12
Nursing Best Practice GuidelineResponsibility for DevelopmentThe Registered Nurses’ Association of Ontario (RNAO), with funding from the Governmentof Ontario, has embarked on a multi-year project of nursing best practice guideline development, pilotimplementation, evaluation and dissemination. In this sixth cycle of the projectprogram, one of the areasof emphasis is on vascular access care and management to reduce complications for the client. Thisguideline was developed by a panel of nurses convened by the RNAO, conducting its work independent ofany bias or influence from the Ontario Government of Ontario.Purpose & ScopeBest practice guidelines (BPG) are systematically developed statements to assist practitioners’and clients’ decisions about appropriate health care (Field & Lohr, 1990). This best practice guideline focuseson assisting all nurses in diverse practice settings, both institutional and community, who provide care toclients requiring vascular access. This guideline incorporates best practices related to the care andmaintenance of vascular access devices applicable to all adult clients requiring this kind of care. It shouldbe noted that the main focus of this guideline is the care and maintenance of central venous access devices(CVAD); however, where care and maintenance strategies can be used for both CVAD and peripheralvenous access devices (PVAD), this has been articulated in the specific recommendations. This guidelinedoes not include recommendations related to the care of clients requiring infusion therapy through thefollowing devices: arterial lines, hemodialysis catheters, pulmonary artery lines, pheresis lines, epiduralcatheters, pressure monitoring devices, umbilical vein, femoral catheters, and/or intraosseous lines.Nurses working with other types of vascular access devices will require further practice direction fromguidelines in their unique area of practice.As part of the health care team, nurses caring for clients with indwelling vascular access devices have animportant role in providing safe infusion therapy. This guideline focuses its recommendations on: PracticeRecommendations that assist the nurse to provide appropriate care for the client, including site selection,site care, and catheter care; Education Recommendations for supporting the knowledge, skills, andjudgment required for nurses; and Organization and Policy Recommendations addressing the importanceof a supportive practice environment as an enabling factor for providing high quality nursing care, whichincludes ongoing evaluation of guideline implementation.The purpose of this guideline is to provide evidence-based support for nurses related to the care andmaintenance of vascular access devices, client education and safety. Specific clinical questions to beaddressed include:■■How can the risk of complications be minimized through appropriate care and maintenance ofvascular access devices?What strategies should be used for client and staff education to address the care and maintenance ofvascular access devices?It is acknowledged that the individual competencies of nurses varies between nurses and across categoriesof nursing professionals (RPNs and RNs) and are based on knowledge, skills, attitudes, critical analysis and13
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Care and Maintenance to Reduce Vascular Access Complications

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