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Clark E, Giambra BK, Hingl J, Doellman D, Tofani B, Johnson N. Reducing risk of harm from extravasation: a 3-tiered evidence-based list of pediatric peripheral intravenous infusates. J Infus Nurs. 2013; 36:37-45

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An international survey of pediatric and neonatal clinicians' vascular access practice: PediSIG assessment of vascular access, education, and support (PAVES) catheter selection

23 July 2020
Association for Vascular Access
02 July 2020
Volume 29 · Issue 14

Abstract

Highlights

There is a wide variance in neonatal and pediatric vascular access workforce models, training, and competency assessments.

Pain control during procedures is critical for children, yet it is not consistently used.

Procedural support has shown improved patient outcomes, yet is not standardly used for every distressful procedure.

Core standards are needed to ensure proper training and support for the pediatric and neonatal vascular access clinicians.

Background:

Despite evidence to support best practice in neonatal and pediatric venipuncture delivery and procedural support, there are inconsistencies in practice. To inform future research, education, and workforce innovation, the Association for Vascular Access Pediatric Special Interest Group (PediSIG) developed and undertook a survey to describe the current vascular access practice for clinicians caring for neonatal and pediatric patients.

Objective:

Describe the current state of workforce models, training, and clinical practices surrounding pediatric and neonatal vascular access.

Design:

Cross-sectional, electronic survey using convenience sampling.

Settings:

International clinicians who provide vascular access (peripheral intravenous catheter insertion, venipuncture for blood sampling) for neonatal and pediatric patients.

Methods:

An electronic survey was developed by the PediSIG. The survey covered workforce models, clinician training and competency, pain relief, procedural support, and device securement. The electronic survey was then distributed to the PediSIG membership and shared among several neonatal/pediatric email lists. Data were analyzed descriptively, with an exploration of association between clinical outcomes, workforce, and training.

Results

There were 242 responses from 5 countries showing a wide variance of practice. Workforce models showed many different team names and responsibilities along with a variance of personnel and staffing hours. Clinician training was described as 4 hours or less by 44% (n = 69) of respondents. Less than half of the responses (47%; n = 99) reported having a formal procedure to escalate a patient to an expert care and not having a set number of max attempts before escalation. Only two-thirds (n = 115) of respondents said they had a standardized protocol for pain control and procedural support, with only 13% (n = 23) and 15% (n = 27), respectively, self-reporting that they always followed the protocol.

Conclusions

The respondents reported a wide variance in neonatal and pediatric vascular access procedures and the resources used to support this practice. Core standards need to be developed to help guide neonatal and pediatric clinicians and their institutions. The standards should encompass recommendations for workforce models, proper training, competency, insertion guidelines, pain control,

Vascular access, such as blood sampling and peripheral intravenous (PIV) catheter insertion, is a common experience for the hospitalized neonate and child that requires procedural skill by the inserter. Despite its frequent occurrence, each patient presents with unique underlying conditions, along with an often-acute need for access. Venipuncture and vascular access are considered basic nursing skills, but can also be complex, time-sensitive, and technically difficult procedures that need to be performed successfully within a limited time.1 Due to limited communication abilities, unpredictable behavior, activity levels, and small vessel sizes, the venipuncture and PIV insertion is even more complex for neonates and children.2

Vascular access is a painful procedure that can have lifelong implications for neonates and children if not managed properly. Additionally, needle fear associated with PIV and venipuncture procedures is prevalent in children, and may increase with age if not managed.3 Knowing the distress vascular access can cause, it is important to emphasize care and comfort during vascular access device procedures to support the neonate and child and family during a necessary but frequently painful experience. The American Society for Pain Management Nursing position statement4 highlights this necessity, stating that health care professionals have a responsibility to collaborate, advocate, and intervene to provide optimal comfort management before, during, and after procedures for patients of all ages.

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Neonate
Pediatric venipuncture
Peripheral venous catheterization
Evidence-based practice
PICC line catheterization
procedural pain
vascular access