Vascular access

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Authors

Van Rens R, Helder, O, Tissières P, Mader S, Thiele N, Borghesi A

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Target group

Infants and parents


User group

Healthcare professionals, neonatal units, hospitals, and health services


Statement of standard

Vascular access is achieved in a competent, skillful and safe manner.


Rationale

Intravenous (IV) cannulation is among the most common and widespread medical procedures performed on critically ill infants in the NICU. (1) Treatment frequently depends on the use of peripheral or central vascular access devices (VADs) to administer fluids, nutrients, and medication. (2–4) There are several types of VADs, which are inserted into either a vein or an artery. Factors such as body weight, fluid characteristics, availability of venous access sites, and anticipated length of access needed are taken into account when siting a VAD. The frequency of complications, including infiltration/extravasation, leaking, occlusion, thrombosis, and infections, has remained relatively constant over the past 30 years. (5–15)


Benefits

Short-term benefits

Long-term benefits


Components of the standard

Component

Grading of evidence

Indicator of meeting the standard

For parents and family

  1. Parents are informed by healthcare professionals about the need and procedure for achieving vascular access.

B (High quality)

Patient information sheet1

  1. Parents are encouraged and guided to comfort the infant if feasible by healthcare professionals. (20) (see Care procedures)

B (High quality)

Patient information sheet1

For healthcare professionals

  1. A unit guideline on the aseptic insertion and maintenance of vascular access devices (VADs) is adhered to by all healthcare professionals. (21)

A (High quality)
B (High quality)

Guideline

  1. The necessity for ongoing vascular access is identified.

B (High quality)

Guideline

  1. The procedure is approached in a developmentally supportive manner using (none)-pharmacological pain relieving treatment. (10,22–26) (see Infant- and family-centred developmental care)

A (Moderate quality)
B (Moderate quality)

Guideline

  1. Training on the insertion of VADs is attended by all responsible healthcare professionals.

B (High quality)

Training documentation

For neonatal unit

  1. A unit guideline on the aseptic insertion and maintenance of VADs is available and regularly updated.

B (High quality)

Guideline

For hospital

  1. Training on the aseptic insertion of VADs is ensured.

B (High quality)

Training documentation

  1. Equipment to administer and monitor infusion therapy is suitable for a neonatal population.

B (High quality)

Audit report2

For health service

  1. A national guideline on the aseptic insertion and maintenance of VADs is available and regularly updated.

B (High quality)

Guideline

1The indicator “patient information sheet” is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.

2The indicator “audit report” can also be defined as a benchmarking report.


Where to go

Further development

Grading of evidence

For parents and family

N/A

For healthcare professionals

N/A

For neonatal unit and hospital

  • Optimise the use of specially trained vascular access professionals.

A (Low quality)
B (Moderate quality)

For health service

  • Develop a European Vascular Access Certification programme for all healthcare professionals in the field.

B (Moderate quality)


Getting started

Initial steps

For parents and family

  • Parents are verbally informed by healthcare professionals about the need and procedure for achieving vascular access.
  • If present, parents are invited to support their infant before, during and after the insertion of vascular access devices (VADs).

For healthcare professionals

  • Attend training on the aseptic insertion and maintenance of VADs.

For neonatal unit

  • Develop and implement a unit guideline on the aseptic insertion and maintenance of VADs.
  • Provide a flow chart that guarantees most appropriate Vascular Access Device to meet each infant’s current and anticipated needs. (23)
  • Provide a vascular visualisation devise for vascular assessment and insertion support if required.
  • Conduct data collection and compliance monitoring.
  • Develop information material for parents on the need and procedure for achieving vascular access. (10,24,25)

For hospital

  • Support healthcare professionals to participate in training on peripheral and central venous/arterial access.
  • Provide a vascular visualisation device for vascular assessment and insertion support if required.

For health service

  • Develop and implement a national guideline on the aseptic insertion and maintenance of VADs including indication for insertion, type of device, access visualisation, and management of access and complications.

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November 2018 / 1st edition / next revision: 2023


Recommended citation

EFCNI, Van Rens R, Helder, O et al., European Standards of Care for Newborn Health: Vascular access. 2018.