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Guides, algorithms and other support tools to improve neonatal and pediatric venous access care: A scoping review
Alina G Burek1,2, Katie Butler3, Tracey Liljestrom1,2
1Children's Wisconsin, Milwaukee, Wisconsin, USA.
Insights
This review found that most pediatric venous access guidelines focus on central line-associated bloodstream infections (CLABSI) and neonates, with gaps in device selection and applicability for other patient groups.
Area of Science:
- Pediatric critical care
- Vascular access devices
- Evidence-based medicine
Background:
- Pediatric venous access is essential but lacks standardized clinical guidelines.
- Existing guides, algorithms, and tools show significant variability in focus and quality.
- Identifying gaps in current venous access management is crucial for improving patient care.
Purpose of the Study:
- To review and analyze existing pediatric venous access guidelines, algorithms, and tools.
- To map the focus of these resources regarding device type and patient population.
- To identify quality gaps and areas for improvement in pediatric venous access care.
Main Methods:
- A scoping review of Ovid MEDLINE and other databases was conducted.
- Studies published after 2013 focusing on pediatric venous access guides/algorithms/tools were included.
- The Appraisal of Guidelines for Research Evaluation (AGREE II) tool assessed study quality.
Main Results:
- 105 studies were reviewed, with a majority focusing on central access (66%) and neonates (50%).
- Central line-associated bloodstream infection (CLABSI) reduction was the primary aim in 56% of studies.
- Half of the reviewed guides were recommended for use, but rigor of development and applicability scored poorly.
Conclusions:
- Current pediatric venous access guidelines predominantly target CLABSI reduction and neonatal populations.
- Significant gaps exist in guidance for device selection, removal, and application across diverse pediatric populations.
- Further development is needed to enhance the quality and applicability of venous access tools for comprehensive pediatric care.
Background/Objective:
Despite the ubiquitous need of venous access in children, care is often highly variable, lacking standardization. Our objective was to review current venous access guides, algorithms, and other tools available for clinical implementation; map out their focus (device type, population); and identify quality gaps.
Methods:
A scoping review with a systematic search of Ovid MEDLINE and other databases was completed on January 24, 2025. All study designs describing the development of venous access guides/algorithms/tools for patients aged <18 years in the emergency department or inpatient units published after 2013 in English were included. Descriptive analysis was used to summarize the results. Quality of studies was assessed using the Appraisal of Guidelines for Research Evaluation (AGREE II) tool.
Results:
Of the 105 studies included, 18% (n = 19) involved peripheral access, 66% (n = 69) involved central access, and 16% (n = 17) involved both. Neonates were the population of focus in half the publications (n = 52), and reduction in central line-associated bloodstream infections (CLABSI) was the primary aim of 56% (n = 59) of publications. Device selection and removal were two components of care with the lowest representation, particularly for peripheral access. Based on AGREE II scoring, 50% (n = 53) of identified guides/algorithms/tools were recommended for use. The lowest scoring quality domains were rigor of development and applicability, with 25% (n = 26) and 28% (n = 29) of studies, respectively, scoring in the lowest quintile.
Conclusions:
Most venous access guides/algorithms/tools focus on CLABSI reduction and neonates, leaving gaps in guidance for other components of the care process and other populations.
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