Care and Maintenance to Reduce Vascular Access Complications

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Care and Maintenance to Reduce Vascular Access Complicationsdecision making which are enhanced over time by experience and education. It is expected that individualnurses will perform only those aspects of care and maintenance for vascular access devices for which theyhave received appropriate education and have experience. It is expected that nurses will seek appropriateconsultation in instances where the client’s care needs surpass the nurse’s ability to act independently. Itis acknowledged that effective healthcare depends on a coordinated health care team approachincorporating ongoing communication between health professionals and clients, ever mindful of thepersonal choices and unique needs of each individual client.Development ProcessIn June of 2004, a panel of nurses with expertise in vascular access from institutional, community,educational and industry settings (including vendor companies) was convened under the auspices of theRNAO. At the outset, the panel established the scope of the guideline through a process of discussion andconsensus. It was decided to focus on the care and maintenance of vascular access in order to reducecomplications for the client.A set of nine published guidelines related to vascular access care and maintenance were identified througha structured search, the details of which are described in Appendix A. These guidelines were reviewedaccording to a set of screening criteria, established through panel consensus, which resulted in theelimination of two guidelines. The screening criteria used were:■Guideline was in English;■ Guideline was dated no earlier than 2000;■■■Guideline was strictly about the topic area;Guideline was evidence-based; andGuideline was available and accessible for retrieval.Seven guidelines were critically appraised with the intent of identifying existing guidelines that werecurrent, developed with rigour, evidenced-based and which addressed the scope identified by the panel forthis best practice guideline. A quality appraisal was conducted on these seven clinical practice guidelines usingthe Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument (AGREE Collaboration, 2001).This process yielded a decision to work primarily with five existing guidelines including:14
Nursing Best Practice Guideline1. Centers for Disease Control and Prevention (CDC) (2002). Guidelines for the prevention ofintravascular catheter-related infections. Morbidity and Mortality Weekly Report (MMWR) 51(No. RR-10), 1-29.2a. Department of Health (DH) (2001a). Guidelines for preventing infections associated with theinsertion and maintenance of central venous catheters: Introduction. Journal of Hospital Infection 47,S13-S19.2b. Department of Health (DH) (2001b). Guidelines for preventing infections associated with theinsertion and maintenance of central venous catheters. Journal of Hospital Infection 47, S47-S67.3a. Evidence-Based Practice in Infection Control (EPIC) (2001a). The EPIC project: Developing nationalevidence-based guidelines for preventing hospital-acquired infections. National evidence-basedguidelines for preventing hospital-acquired infections associated with the use of central venouscatheters. Technical report part A. Available: http://www.epic.tvu.ac.uk/epicphase/epic1.html3b. Evidence-Based Practice in Infection Control (EPIC) (2001b). The EPIC project: Developing nationalevidence-based guidelines for preventing hospital-acquired infections. National evidence-basedguidelines for preventing hospital-acquired infections associated with the use of central venouscatheters. Technical report part B. Available: http://www.epic.tvu.ac.uk/epicphase/epic1.html4. Intravenous Nurses Society (INS) (2000). Infusion nursing: Standards of practice. Journal ofIntravenous Nursing, 23, S1-S88.5. Royal College of Nursing (RCN) (2003). Standards for infusion therapy. London: Author.The panel members divided into subgroups to undergo specific activities using the short-listed guidelines,other literature and additional resources for the purpose of drafting recommendations. This processyielded a draft set of recommendations. The panel members as a whole reviewed the recommendations,discussed gaps, available evidence and came to consensus on a draft guideline.This draft was submitted to a set of external stakeholders for review and feedback. An acknowledgement ofthese reviewers is provided at the front of this document. Stakeholders represented various health caredisciplines, clients and families, as well as professional associations. External stakeholders were providedwith specific questions for comment, as well as the opportunity to give overall feedback and generalimpressions. The results were compiled and reviewed by the development panel. Discussion andconsensus resulted in revisions to the draft document prior to publication.15
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