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Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review
Rebecca S Paterson1,2, Vineet Chopra3,4,5, Erin Brown1,2
1Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.
Insights
This review synthesizes evidence on pediatric vascular access devices (VADs), finding support for single-lumen and ultrasound-guided VADs. However, limited evidence exists for specific populations, impacting evidence-based practice.
Area of Science:
- Pediatric critical care medicine
- Vascular access device technology
- Evidence-based healthcare
Background:
- Vascular access devices (VADs) are crucial for administering treatments to pediatric patients.
- Optimal selection and insertion of VADs are essential for patient safety and treatment efficacy.
- A critical review of existing evidence is needed to guide clinical practice.
Purpose of the Study:
- To critically review the available evidence regarding the selection and insertion of pediatric vascular access devices (VADs).
- To identify areas with strong evidence and those lacking robust data for VAD use in children.
- To inform clinical decision-making for VADs in diverse pediatric populations.
Main Methods:
- A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, and Cochrane Library.
- Included studies encompassed clinical practice guidelines, systematic reviews, cohort studies, and randomized controlled trials (RCTs) in patients aged 0-18 years.
- Data extraction focused on VAD type, patient population, insertion techniques, complications, and device reliability.
Main Results:
- Evidence supports the use of single-lumen devices and ultrasound-guided insertion techniques in general pediatric populations.
- Significant gaps in evidence were identified for neonates, cardiac patients, those with difficult venous access, midline catheters, and specific technologies like near-infrared devices.
- A lack of high-quality evidence, particularly RCTs, was noted across many areas.
Conclusions:
- Current evidence adequately supports VAD selection and insertion for general pediatric cases and specific techniques.
- The lack of robust evidence for certain pediatric subgroups necessitates cautious clinical decision-making.
- This synthesis highlights the need for further research to establish evidence-based recommendations for VADs in all pediatric patients.
Objective:
To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs).
Data Sources:
Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases.
Study Selection:
Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included.
Data Extraction:
Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications.
Results:
VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-to-vein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope.
Limitations:
Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations.
Conclusions:
This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients.
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