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Brief Summary

GUIDELINE TITLE

Assessment and device selection for vascular access.

BIBLIOGRAPHIC SOURCE(S)

  • Registered Nurses Association of Ontario (RNAO). Assessment and device selection for vascular access. Toronto (ON): Registered Nurses Association of Ontario (RNAO); 2004 May. 67 p. [59 references]

GUIDELINE STATUS

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

BRIEF SUMMARY CONTENT

 RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary. The recommendations that follow are based on the previous version of the guideline.

The levels of evidence supporting the recommendations (Ia, Ib, IIa, IIb, III, IV) are defined at the end of the "Major Recommendations" field.

  Recommendation Level of Evidence

Practice Recommendations

 Assessment and Device Selection

1. All clients requiring vascular access, regardless of duration of therapy, require the use of a structured approach such as an algorithm to facilitate a comprehensive client assessment and the development of a vascular access care plan prior to the initiation of therapy.

 IIb

2. To determine the most appropriate type of vascular access device, the nurse needs to consider the following factors:

  • Prescribed therapy – Level Ib
  • Duration of therapy – Level Ib
  • Physical assessment – Level IV
  • Client health history – Level IV
  • Support system/resources – Level IV
  • Device availability – Level IV
  • Client preference – Level IV
  
Client Education

3. Nurses will discuss the options for vascular access devices with the client and family caregivers. Device selection is a collaborative process between the nurse, client, physician and other members of the health care team; however, the nurse has a role to educate and advocate for clients in relation to the selection of appropriate devices.

 IV
Documentation

4. Nurses will document comprehensive information regarding assessment of infusion therapy and device recommendations. This documentation should include, as a minimum:

  • Assessment completed and the written plan of care developed; and
  • Client and family caregiver education.
 IV

Education Recommendation

5. The principles and practice of infusion therapy should be included in the basic education of nurses in their core curriculum, be available as continuing education, be provided in orientation to new organizations, and be made available through continuing professional development opportunities.

 IV

Organization and Policy Recommendations

6. Health care organizations should have access to infusion therapy nursing expertise to support optimal vascular access outcomes.

 III

7. Health care organizations must have quality improvement systems in place to monitor client outcomes. This should include an interdisciplinary process that will monitor quality indicators related to vascular access and infusion therapy, the provision of timely feedback for improved client outcomes, and systems for reporting and capturing data to support practice improvements.

 IV

8. In order to support continuity of client care within and between organizations, all clients with a vascular access device and/or their caregivers need to have available comprehensive information about the device, which should include, as a minimum:

  • Details of therapy
  • Type of vascular access device, including number of lumens
  • Date of insertion
  • Tip location, for all central vascular access devices
  • Delivery system in use
  • Client education plan
  • Client specific instructions
  • Details of any complications experienced
  • Appropriate resources, as required
 IV

9. Nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. Organizations may wish to develop a plan for implementation that includes:

  • An assessment of organizational readiness and barriers to education
  • Involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process
  • Dedication of a qualified individual to provide the support needed for the education and implementation process
  • Ongoing opportunities for discussion and education to reinforce the importance of best practices
  • Opportunities for reflection on personal and organizational experience in implementing guidelines
 IV

Definitions:

Level of Evidence

Ia - Evidence obtained from meta-analysis or systematic review of randomized controlled trials

Ib - Evidence obtained from at least one randomized controlled trial

IIa - Evidence obtained from at least one well-designed controlled study without randomization

IIb - Evidence obtained from at least one other type of well-designed quasi-experimental study, without randomization

III - Evidence obtained from well-designed nonexperimental descriptive studies, such as comparative studies, correlation studies, and case studies

IV - Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities

CLINICAL ALGORITHM(S)

An algorithm is provided in the original guideline document for assessment and device selection.

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EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence is provided for each recommendation (see "Major recommendations").

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IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

  • Registered Nurses Association of Ontario (RNAO). Assessment and device selection for vascular access. Toronto (ON): Registered Nurses Association of Ontario (RNAO); 2004 May. 67 p. [59 references]

ADAPTATION

The panel, following the appraisal process, identified the following guidelines, and related updates, to adapt and modify recommendations:

DATE RELEASED

2004 May

GUIDELINE DEVELOPER(S)

Registered Nurses Association of Ontario - Professional Association

SOURCE(S) OF FUNDING

Funding was provided by the Ontario Ministry of Health and Long Term Care.

GUIDELINE COMMITTEE

Not stated

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Guideline Development Panel Members

Julia Johnston, RN, BScN, MN, CINA(c)
Team Leader
Nurse Clinician
Infusion Therapy
Mount Sinai Hospital
Toronto, Ontario

Sharon Armes, RN, CINA(c)
Vascular Access Clinician for Canada
Bard Canada Inc.
Mississauga, Ontario

Elaine Barringer, RN
Staff Nurse – Emergency Department
Ontario Nurses Association Representative
Peterborough Regional Health Centre
Peterborough, Ontario

Patti Dickieson, RN, BScN
Manager
Education, Research, Special Projects
Victorian Order of Nurses – Sudbury Branch
Sudbury, Ontario

Lina D’Onofrio, RN, MN
Clinical Nurse Specialist
Transfusion Services
University Health Network
Toronto, Ontario

Cyndi Giff, RN
Clinical Practice Consultant
ParaMed Home Health Care
Carleton Place, Ontario

Wilma Koopman, RN, MScN
Nurse Practitioner/Clinical Nurse Specialist
Neuromuscular Services – Ambulatory Care
London Health Sciences Centre
London, Ontario

Eileen Koza, RN
Infusion Therapy Consultant/Trainer
Independent Practice
Waterloo, Ontario

Karen Laforet, RN, BA, CINA(c)
Professional & Technical Services for IV
Site Care Management and Wound Care
3M Canada
London, Ontario

Heather McConnell, RN, BScN, MA(Ed)
RNAO Project Staff- Facilitator
Project Manager, Nursing Best Practice Guidelines Project
Registered Nurses Association of Ontario
Toronto, Ontario

Anne McKenzie, RPN
RPNAO Representative
Community Nurse
Carepartners
Fergus, Ontario

Susanne Nelson, RN, BScN, MN(c), CINA(c)
Nurse Coordinator – Vascular Access
University Health Network
Toronto, Ontario

Sharon Rodkin, RN, CINA(c)
Clinical Consultant Medication Delivery
Baxter Corporation
Mississauga, Ontario

Lisa Valentine, RN, BScN, MN
Practice Consultant
College of Nurses of Ontario
Toronto, Ontario

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Declarations of interest and confidentiality were made by all members of the guideline development panel. Further details are available from the Registered Nurses Association of Ontario (RNAO).

GUIDELINE STATUS

Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary.

GUIDELINE AVAILABILITY

Electronic copies of the addended guideline: Available in Portable Document Format (PDF) from the Registered Nurses Association of Ontario (RNAO) Web site.

Print copies: Available from the Registered Nurses Association of Ontario (RNAO), Nursing Best Practice Guidelines Project, 158 Pearl Street, Toronto, Ontario M5H 1L3.

AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

Print copies: Available from the Registered Nurses Association of Ontario (RNAO), Nursing Best Practice Guidelines Project, 158 Pearl Street, Toronto, Ontario M5H 1L3.

PATIENT RESOURCES

None available

NGC STATUS

This NGC summary was completed by ECRI on November 2, 2004. The information was verified by the guideline developer on November 23, 2004.

COPYRIGHT STATEMENT

This document is in the public domain and may be used and reprinted without special permission, except for those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders. The Registered Nurses Association of Ontario (RNAO) will appreciate citation as to source. The suggested format for citation is indicated below:

Registered Nurses Association of Ontario (2004). Assessment and device selection for vascular access. Toronto, Canada: Registered Nurses Association of Ontario.

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DISCLAIMER

NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .

NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding guideline content are directed to contact the guideline developer.
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