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Randomized controlled trials in central vascular access devices: A scoping review.
Mari Takashima1, Gillian Ray-Barruel1, Amanda Ullman1
1Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.
Plos One
|March 22, 2017
Summary
This scoping review highlights the need for more high-quality randomized trials on central venous access device management, particularly for dressing, securement, and patency. Standardizing outcome definitions and increasing multidisciplinary involvement are crucial for advancing evidence in this field.
Area of Science:
- Medical Interventions
- Clinical Research Methodology
- Evidence Synthesis
Background:
- Central venous access devices (CVADs) are crucial but associated with high complication rates.
- Randomized controlled trials (RCTs) assess CVAD interventions, yet evidence gaps persist.
- Scoping reviews identify research priorities by mapping existing evidence.
Purpose of the Study:
- To conduct a scoping review of RCTs evaluating interventions for CVAD outcomes.
- To identify evidence gaps and deficiencies in CVAD management research.
- To inform future research priorities for improving CVAD effectiveness and safety.
Main Methods:
- Systematic search of RCTs published between January 2006 and December 2015.
- Included trials focused on peripherally inserted central catheters, non-tunneled, tunneled, and totally implanted venous access catheters.
- Data extraction by two independent researchers using standardized forms and MeSH terms.
Main Results:
- 178 RCTs were included, with the majority focusing on non-tunneled devices (44%) and adult participants (68%).
- Insertion-related issues (38%) and post-insertion patency (20%) were the most studied themes, with fewer trials on infection prevention (8%) and dressing/securement (7%).
- 46 different study outcomes were reported, with infection outcomes being most common (37%), but definitions were divergent.
Conclusions:
- High-quality RCTs are needed in CVAD management, especially for dressing, securement, and patency.
- Multidisciplinary team involvement and consumer engagement can promote better research.
- Significant gaps exist in pediatric and neonatal populations, particularly for tunneled devices, and outcome definitions require unification.
