Education & Competency
What are the educational and competency requirements for clinicians, patients and carers in order to manage peripheral intravenous cannulas and central venous access devices for paediatric and adult patients with cancer?
Section 1: Patency, occlusion prevention and management
Version 2: January 2024
COLLABORATION & ENDORSEMENT
Collaboration between key professional bodies and standardisation of evidence-based clinical practice is key to reducing the risk vascular access related complications and premature removal.
These guidelines have been endorsed by the following organisations:
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These guidelines answer eight common questions from clinical practice:
AUTHORS
Kerrie Curtis, Nurse Consultant, B(Nurs), M(Nurs-Cancer/Palliative Care), PhD(Candidate)
Nicole Gavin, RN, PhD, Cancer Care Nurse Researcher, PhD, B(Sci-Hon), M (AdvPr-HCR)
Fiona Fuller, Registered Nurse, B(Nurs), GCert(Cancer Care), Cert(Prostate Cancer)
Carolyn Meredith, Regional Nurse Educator, B(Nurs), GCert(Cancer, Haematology Nursing), GCert (HlthProdEd)
CONTRIBUTORS
Kate Schmetzer, Clinical Nurse Educator, B(Nurs), M(Ed), GDip(AdvClinNurs)
Jane Kelly, Clinical Nurse Consultant, B(Nurs), GCert(CancerCare)
Susan Richardson, Clinical Nurse Consultant, B(Nurs), M(NursSci-Oncology), GCert(ClinEd)
Carmel O’Kane, Nurse Practitioner, M(Nurs), GDip(Project Mgt), GDip(Mgt), GCert. (Infectious Diseases)
Elena Tarasenko, Clinical Nurse Specialist, M(AdvPracNurs)
Trudie Lawson, Registered Nurse, M(ClinEd), GCert(Cancer Care), B(Nurs)
Geoff Hill, Specialist Medical Librarian
SEARCH STRATEGY
The database search was run on 15 March 2019 which resulted in 5300 articles. The records were screened and reported using PRISMA; duplicates removed, and titles and abstracts screened for relevancy by one author (KC). This resulted in the final 110 articles. Data extraction was completed, and recommendations were made to guide clinical practice.
The search strategy established in 2019 and revised in 2023 was with the assistance of an expert medical librarian. Search terms included vascular access devices, occlusion prevention and occlusion intervention. The patient cohort was limited to patients with cancer because an initial search of all patient cohorts resulted in more than 57,000 hits: an unrealistic volume to review.
Inclusion
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Study design: most types of studies including randomised controlled trials, systematic reviews and meta analyses, cohort, observational studies, educational literature.
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Patient cohort*: patients with haematological and solid tumour malignancies.
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Age: adult and paediatric patients.
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Vascular access devices: peripheral intravenous cannulas (PIVC) and central venous access devices (CVADs)
Exclusion
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Study design: Case studies, editorials.
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Patient cohort: nonâmalignant conditions
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Age: neonates and infants
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Vascular access devices: haemodialysis catheters, arterial, midline and intraosseus devices
Exception: include records of all patient cohorts receiving home parenteral nutrition (HPN) in order to capture all available studies (relatively few). Supportive therapies for patients with cancer can include parenteral nutrition and HPN studies commonly included a combination of patients with short bowel syndrome and/or cancer.
#Exception: systematic reviews including all patient cohorts, as these studies provide high-quality evidence which may be absent for patients with cancer alone.
A range of study designs were included based on a scoping review which identified relatively few or absent good quality studies to inform CVAD maintenance practices compared to insertion practices (1).
2024 UPDATE
In collaboration with a specialist medical librarian (GH) and the VAD&IT SPN, the Chair of the Patency Subcommittee (CM) revised the literature search including:
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Widening the search terms to include (1) all CVADs and PIVCs and (2) patients with cancer to facilitate the capture of all patency related records, including potential new topics.
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Removal of PubMed and Cochrane databases from the searches as Medline comprehensively lists these records. Current databases include Medline, Embase and CINAHL Complete.
Records from 2019 to 2021 have been screened and data extracted. The Patency Subcommittee (CM, JK, KS, TL, SR) receive monthly alerts of records published in the previous month that fit the search criteria. Records are screened (CM, TL, KC) and data is extracted into Covidence from relevant records that align with the 8 clinical questions. The committee is currently analysing the extracted data and the questions will be updated this year.
References
1. Takashima, M., Ray-Barruel, G., Ullman, A., Keogh, S., & Rickard, C. M. (2017). Randomized controlled trials in central vascular access devices: A scoping review. PLoS ONE [Electronic Resource], 12(3), e0174164. doi:https://dx.doi.org/10.1371/journal.pone.0174164
