The benefit of a vascular access specialist placing a peripheral intravenous catheter: a narrative review of the literature
Nicole Marsh, Emily Larsen, Joan Webster, Marie Cooke, Claire M. Rickard
Abstract
Background Peripheral intravenous catheters (PIVCs) are a quick, effective means to gain access to a patient’s vasculature for the delivery of intravenous treatment. Although a frequently performed procedure, the skill and training for clinical staff to successfully place these catheters is often underestimated, with up to 50% of insertions requiring multiple attempts prior to successful placement. Methods A narrative review of studies describing the benefit of vascular access specialists (VAS) inserting PIVCs was undertaken. A detailed literature search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and EMBASE, on 30 November 2018. The methodological rigour of included studies was assessed as per the Mixed Methods Appraisal Tool (MMAT). Results The search generated 708 records. Once titles, abstracts and reference lists were screened, 10 studies were included in this review. Six studies compared a VAS team with insertion by other health professionals; four examined outcome improvements within their own VAS team. Outcomes considered included: PIVC failure; phlebitis; PIVC-related infection; and first-time insertion success. All included studies described positive VAS team outcomes; however, methods and results reporting varied greatly in outcome assessment and quality. Overall, the quality assessment of included studies (using the MMAT) was low, with 68% of criteria items scoring ‘not reported’ or unclear. Conclusion Use of a VAS for PIVC insertion to reduce PIVC failure and improve first-time insertion success is currently inadequately supported by high quality evidence. Well conducted randomised control trials (RCTs) to compare VAS with the generalist PIVC insertion model are required.