Section 2: Vessel Health and Preservation

A systematic review methodology was utilized to identify, search and analyse current literature. Refer here for more details.

Clinical questions

Clinical questions using the population, intervention, comparator, outcome (PICO) format informed the search strategy:

1. What is vessel health and preservation?

P: all patient cohorts

I: vein health

C: venous depletion

O: strategy (algorithm, decision pathway) for vessel preservation

2. How does the clinical team decide what the most appropriate vascular access device is for the individual patient and the prescribed therapies with the aim of preserving vessel health?

P: all patient cohorts

I: vascular access device selection process

C: difficult intravenous access

O: preservation of vessel health

3. How is the patient included, informed, and actively involved in the decision-making process for the most appropriate vascular access device for them & their prescribed therapies to preserve their vessel health?

P: all patient cohorts

I: informed patient involved in device selection or experience of VADs

C: patient impact when not involved

O: decision by the healthcare team including the patient

In collaboration with a medical librarian, a search was established for each question.

Inclusion

• Study designs: interventional and observational studies - randomised controlled trials, cohort, expert delphi or consensus if VHP or device selection related, algorithm or tool for device selection
• Age group: adults, adolescent and paediatric patients
• Patient cohort: all patient population (not just oncology)
• Vascular access devices: peripheral intravenous cannulas (PIVC), peripherally inserted central catheters (PICC), centrally inserted central catheters (CICC), tunnelled cuffed-CICCs (tc-CICC), totally implantable venous access devices (TIVADs), apheresis-CICCs (A-CICC) and tunnelled cuffed A-CICC (tc-A-CICC)
• Topic: 1. VAD selection and assistive technology for first time success including for difficult intravenous access 2. Patient experience, inclusion, informed decision and education

Exclusion

• Study designs: case studies, conference abstracts, education literature, letter to editor, study protocols, guidelines
• Age groups: neonates, infants
• Vascular access devices: Haemodialysis-CICCs, arterial, midline and intraosseus devices
• Topic: Study outcomes are VAD complications only and not prolonged outcome of VHP. Assumption based on a large body of evidence is that ultrasound guided PIVC and CVAD insertion has positive outcomes, so studies where the outcome is related to US use to prevent VAD complications or comparison of US versus traditional insertion was excluded.

Literature search

The search was run in July 2022 in Medline, Embase and CINAHL (Figure 1)

Figure 1

Summary of evidence

Characteristics of studies

Of the final 378 studies, the majority were from Europe (n=132), followed by the USA (n=116), Australia (n=24), China (n=20), multinational (n=14), Turkey (n=12), Canada and India (n=10 each), Japan (n=9), Korea (n=7), Brazil and South Korea (n=4), Iran and Pakistan (n=2) and Argentina, Austria, Brunei, Egypt, Indonesia, Israel, Malaysia, Saudi Arabia, Singapore, South Africa and Tunisia (n=1 each). Study designs included randomised controlled trials (n=XX), observational studies (n=XX), surveys / questionnaires (n=XX) and expert opinion/Delphi studies (n=XX). Interestingly as this is an emerging subject, the number of studies is steadily increasing, and a notable increase around the times of two key publications by Moureau and colleagues (2012) and Hallam and colleagues (2016). (Figure 2)

Figure 2