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Authors

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

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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

  • Reduced number of skin breaking and painful procedures (16,17)
  • Reduced occurrence of complications e.g. infections (18)

Long-term benefits

  • Reduced late consequences of early exposure to antibiotics (consensus)
  • Reduced risk of long-term consequences of painful procedures for infants and parents (19)

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 sheet
       
2. Parents are encouraged and guided to comfort the infant if feasible by healthcare professionals. (20) (see TEG Care procedures) B (High quality) Patient information sheet
       
For healthcare professionals    
3. 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
       
4. The necessity for ongoing vascular access is identified. B (High quality) Guideline
       
5. The procedure is approached in a developmentally supportive manner using (none)-pharmacological pain relieving treatment. (10,22–26) (see TEG Infant-and family-centred developmental care) A (Moderate quality)
B (Moderate quality)
Guideline
       
6. Training on the insertion of VADs is attended by all responsible healthcare professionals. B (High quality) Training documentation
       
For neonatal unit    
7. A unit guideline on the aseptic insertion and maintenance of VADs is available and regularly updated. B (High quality) Guideline
       
For hospital    
8. Training on the aseptic insertion of VADs is ensured. B (High quality) Training documentation
       
9. Equipment to administer and monitor infusion therapy is suitable for a neonatal population. B (High quality) Audit report
       
For health service    
10. A national guideline on the aseptic insertion and maintenance of VADs is available and regularly updated. B (High quality) Guideline
       

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.
 

Sources

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  2. Millam DA. Managing complications of i.v. therapy (continuing education credit). Nursing (Lond). 1988 Mar;18(3):34–43.
  3. Carbajal R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA. 2008 Jul 2;300(1):60–70.
  4. Pettit J. Assessment of the infant with a peripheral intravenous device. Adv Neonatal Care Off J Natl Assoc Neonatal Nurses. 2003 Oct;3(5):230–40.
  5. Franck LS, Hummel D, Connell K, Quinn D, Montgomery J. The safety and efficacy of peripheral intravenous catheters in ill neonates. Neonatal Netw NN. 2001 Aug;20(5):33–8.
  6. Batton DG, Maisels MJ, Appelbaum P. Use of peripheral intravenous cannulas in premature infants: a controlled study. Pediatrics. 1982 Sep;70(3):487–90.
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  8. Stanley MD, Meister E, Fuschuber K. Infiltration during intravenous therapy in neonates: comparison of Teflon and Vialon catheters. South Med J. 1992 Sep;85(9):883–6.
  9. Sheehan AM, Palange K, Rasor JS, Moran MA. Significantly improved peripheral intravenous catheter performance in neonates: insertion ease, dwell time, complication rate, and costs. J Perinatol Off J Calif Perinat Assoc. 1992 Dec;12(4):369–76.
  10. Johnston C, Campbell-Yeo M, Disher T, Benoit B, Fernandes A, Streiner D, et al. Skin-to-skin care for procedural pain in neonates. Cochrane Neonatal Group, editor. Cochrane Database Syst Rev [Internet]. 2017 Feb 16 [cited 2018 May 8]; Available from: http://doi.wiley.com/10.1002/14651858.CD008435.pub3
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  17. Ainsworth SB, McGuire W. Peripherally Inserted Central Catheters vs Peripheral Cannulas for Delivering Parenteral Nutrition in Neonates. JAMA. 2016 Jun 21;315(23):2612–3.
  18. Barría RM, Lorca P, Muñoz S. Randomized controlled trial of vascular access in newborns in the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs JOGNN. 2007 Oct;36(5):450–6.
  19. Grunau RE. Neonatal pain in very preterm infants: long-term effects on brain, neurodevelopment and pain reactivity. Rambam Maimonides Med J. 2013;4(4):e0025.
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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.

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