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Vascular access specialist teams for device insertion and prevention of failure

This is not the most recent version

Appendices

Appendix 1. MEDLINE (Ovid SP) search strategy

1 ((Catheterization, Central Venous/ or Catheterization, Peripheral/ or Catheters, Indwelling/ or Catheterization/ or Catheterization, Swan‐Ganz/) and (team* or clinician* or specialist*).ti,ab.) or ((clinician* or specialist*) adj5 (inserter* or mainte* or vascular access*)).mp. or ((vascular access or intravenous therap* or IV) adj5 team*).mp.
2 ((randomized controlled trial or controlled clinical trial).pt. or randomized.ab. or placebo.ab. or drug therapy.fs. or randomly.ab. or trial.ab. or groups.ab.) not (animals not (humans and animals)).sh.
3 1 and 2

Appendix 2. Data extraction tool

Data extraction sheet

Review title or ID

Study ID(surname of first author and year first full report of study was published e.g. Smith 2001)

Report IDs of other reports of this study(e.g. duplicate publications, follow‐up studies)

Notes:

1. General information

Date form completed(dd/mm/yyyy)

Name/ID of person extracting data

Report title

(title of paper/ abstract/ report that data are extracted from)

Report ID

(ID for this paper/ abstract/ report)

Reference details

Report author contact details

Publication type

(e.g. full report/abstract/letter)

Study funding sources

(including role of funders)

Possible conflicts of interest

(for study authors)

Notes:

2. Study eligibility

Study characteristics

Eligibility criteria

(Insert eligibility criteria for each characteristic as defined in the protocol)

Yes

No

Unclear

Location in text

(pg & ¶/fig/table)

Type of study

Randomized controlled trial

Participants

Adult/paediatric recipients of VAD

Hospital/community setting

Types of intervention

VAD insertion by a VAST

Designation of VAST

(infusion therapist, IV team, VA team, other specialist inserting VADs)

Types of comparison

VAD insertion by medical doctor

VAD insertion by nurse

VAD insertion by physician assistant

VAD insertion by technician

Types of outcome measures

Primary outcomes

First‐time insertion success

Cost

Complication or adverse events and time of

  • phlebitis

  • extravasation

  • infiltration

  • catheter‐related or catheter‐associated bloodstream infection

  • pneumothorax

  • arterial puncture

  • thrombosis

Secondary outcomes

Device failure and time of as a result of

  • phlebitis

  • extravasation

  • infiltration

  • catheter‐related or catheter‐associated bloodstream infection

  • thrombosis

  • dislodgement

Patient satisfaction

Staff satisfaction

Length of hospital stay

INCLUDE

EXCLUDE

Reason for exclusion

Notes:

: paragraph; fig: figure; IV: intravenous; pg: page; VA: vascular access; VAD: vascular access device; VAST: vascular access specialist team.

DO NOT PROCEED IF STUDY EXCLUDED FROM REVIEW

3. Population and setting

Description

Include comparative information for each group (i.e. intervention and controls) if available

Location in text

(pg & ¶/fig/table)

Population description

(from which study participants are drawn)

Setting

(including location and social context)

Inclusion criteria

Exclusion criteria

Method/s of recruitment of participants

Informed consent obtained

Yes No Unclear

Notes:

: paragraph; fig: figure; pg: page.

4. Methods

Descriptions as stated in report/paper

Location in text

(pg & ¶/fig/table)

Aim of study

Design(e.g. parallel, cross‐over, cluster)

Unit of allocation

(by individuals, cluster/ groups or body parts)

Start date

End date

Total study duration

Ethical approval obtained for study

Yes No Unclear

Notes:

: paragraph; fig: figure; pg: page.

5. Risk of bias assessment

Domain

Risk of bias

Support for judgement

Location in text

(pg & ¶/fig/table)

Low risk

High risk

Unclear

Random sequence generation

(selection bias)

Allocation concealment

(selection bias)

Blinding of participants and personnel

(performance bias)

Outcome group:

First time insertion success

Cost

Complications/adverse events from VAD

Device failure

Blinding of outcome assessment

(detection bias)

Outcome group:

First‐time insertion success

Cost

Complications/adverse events from VAD

Device failure

Incomplete outcome data

(attrition bias)

First‐time insertion success

Cost

Complications/adverse events from VAD

Device failure

Selective outcome reporting?

(reporting bias)

Other bias

Notes:

: paragraph; fig: figure; pg: page; VAD: vascular access device.

6. Participants

Provide overall data and, if available, comparative data for each intervention or comparison group.

Description as stated in report/paper

Location in text

(pg & ¶/fig/table)

Total no. randomized

(or total population at start of study for NRCTs)

Clusters

(if applicable, number, type, number of people per cluster)

Baseline imbalances

Withdrawals and exclusions

(if not provided below by outcome)

Age

Sex

Race/ethnicity

Severity of illness

Community/ inpatient

Critical care area

Co‐morbidities

Other treatment received(additional to study intervention)

Other relevant socio‐demographics

Subgroups measured

Subgroups reported

Notes:

: paragraph; fig: figure; NRCT: non‐randomized controlled trial; pg: page.

7. Intervention groups

Copy and paste table for each intervention and comparison group

Intervention group 1

Description as stated in report/paper

Location in text

(pg & ¶/fig/table)

Intervention

(e.g. VAD inserted by member of VAST)

VAD(i.e. type of VAD)

Description(e.g. clinical practice such as advanced technology ultrasound used)

Number randomized to group(specify whether number of people, VADs or clusters)

Training and education of VAST clinician

Timing(e.g. 5 day service, on call or 24/7)

Delivery(e.g. role and responsibility of VAST, autonomous/independent clinicians)

Providers and model

(e.g. profession, nurse led/ medical model)

Co‐interventions
(e.g. VAST patients all have chlorhexidine impregnated discs, and generic do not)

Economic variables
(i.e. intervention cost, changes in other costs as result of intervention)

Resource requirements to replicate intervention

(e.g. staff numbers, equipment)

Notes:

: paragraph; fig: figure; pg: page; VAD: vascular access device; VAST: vascular access specialist team.

8. Outcomes

We will utilize this table for each primary and secondary outcome.

Outcome 1

Description as stated in report/paper

Location in text

(pg & ¶/fig/table)

Outcome name

Primary 1 (P1)

Secondary 1 (S1)

Time points measured

Time points reported

Outcome definition(with diagnostic criteria if relevant)

Person measuring/reporting

Unit of measurement

(if relevant)

Scales: upper and lower limits(indicate whether high or low score is good)

Is outcome/tool validated?

Yes No Unclear

Imputation of missing data
(e.g. assumptions made for ITT analysis)

Assumed risk estimate

(e.g. baseline or population risk noted in Background)

Power (sample size calculations)

Notes:

: paragraph; fig: figure; ITT: intention to treat; pg: page.

9. Results

Copy and paste the appropriate table for each outcome, including additional tables for each time point and subgroup as required.

9.1 Dichotomous outcome

Description as stated in report/paper

Location in text

(pg & ¶/fig/table)

Comparison

Outcome

Subgroup

Time point
(specify whether from start or end of intervention)

Results

Intervention

Comparison

No. events

No. participants

No. events

No. participants

Number missing participants and reasons

Number participants moved from other group and reasons

Any other results reported

Unit of analysis(by individuals, cluster/groups or body parts)

Statistical methods used and appropriateness of these methods(e.g. adjustment for correlation)

Re‐analysis required?(specify)

Yes No Unclear

Re‐analysis possible?

Yes No Unclear

Re‐analysed results

Notes:

: paragraph; fig: figure; pg: page.

9.2 Continuous outcome (repeat as necessary)

Description as stated in report/paper

Location in text

(pg & ¶/fig/table)

Comparison

Outcome

Subgroup

Time point
(specify whether from start or end of intervention)

Post‐intervention or change from baseline?

Results

(We will specify is our results are catheters or days)

Intervention

Comparison

Mean

SD (or other variance)

No. participants

Mean

SD (or other variance)

No. participants

Number missing participants and reasons

Number participants moved from other group and reasons

Any other results reported

Unit of analysis

(individuals, cluster/ groups or body parts)

Statistical methods used and appropriateness of these methods(e.g. adjustment for correlation)

Re‐analysis required?(specify)

Yes No Unclear

Re‐analysis possible?

Yes No Unclear

Re‐analysed results

Notes:

: paragraph; fig: figure; pg: page; SD: standard deviation.

Other information

Description as stated in report/paper

Location in text

(pg & ¶/fig/table)

Comparison

Outcome

Subgroup

Time point
(specify whether from start or end of intervention)

Results

Intervention result

SD (or other variance)

Control result

SD (or other variance)

Overall results

SE (or other variance)

Number participants

Intervention

Control

Number missing participants and reasons

Number participants moved from other group and reasons

Any other results reported

Unit of analysis(by individuals, cluster/groups or body parts)

Statistical methods used and appropriateness of these methods

Re‐analysis required?(specify)

Yes No Unclear

Re‐analysis possible?

Yes No Unclear

Re‐analysed results

Notes:

: paragraph; fig: figure; pg: page; SD: standard deviation; SE: standard error.

10. Applicability

Have important populations been excluded from the study?(consider high‐risk populations, and possible differences in the intervention effect)

Yes No Unclear

Is the intervention likely to be aimed at disadvantaged groups?(e.g. lower socioeconomic groups)

Yes No Unclear

Does the study directly address the review question?

(any issues of partial or indirect applicability)

Yes No Unclear

Notes:

: paragraph; fig: figure; pg: page.

11. Other information

Description as stated in report/paper

Location in text

(pg & ¶/fig/table)

Key conclusions of study authors

References to other relevant studies

Correspondence required for further study information(from whom, what and when)

Notes:

: paragraph; fig: figure; pg: page.

Appendix 3. Summary of findings and quality of evidence

Insertion of a vascular access device by a VAST

Patients or population: people receiving vascular access device.

Setting: inpatient setting and outpatient/community setting.

Intervention: insertion or care (or both) of a vascular access device by a member of a VAST.

Comparison: clinicians inserting these devices who exist outside of a defined VAST.

Definitions:

CVC: central venous catheter; IO: intraosseous; PICC: peripherally inserted central catheter; VAD: vascular access device; VAST: vascular access specialist team.

Primary outcome

Illustrative comparison risk

Relative effect

Number of participants

Quality of evidence

Comments

First‐time insertion success

Economic cost‐benefit analysis

Phlebitis

Infiltration/extravasation

Catheter‐related bloodstream infection

Iatrogenic event

Pneumothorax/haemothorax

Arterial puncture

Occlusion

Thrombosis

Overall device failure with dwell time

Device failure

Secondary outcomes

Illustrative comparison risk

Relative effect

Number of participants

Quality of evidence

Comments

Anatomical location of VAD inserted

Patient satisfaction

Staff satisfaction

Length of hospital stay

Sensitivity analysis

Effectiveness:

Paediatric

Adult

Specific VAD inserted by VAST

(arterial, peripheral, PICC, CVC, tunnelled, IO, other ‐ will specify)

VAST make up (model and members such as nursing/medical/technicians/physician assistants)

CVC: central venous catheter; IO: intraosseous; PICC: peripherally inserted central catheter; VAD: vascular access device; VAST: vascular access specialist team.