Vascular access devices (VADs) play a crucial role in the emergency department (ED) by facilitating timely treatments and diagnostic tests for patients (Ma et al, 2014). A variety of VADs are available to serve different purposes (such as monitoring or receiving treatment) and durations (short, medium and long term). For instance, peripheral intravenous catheters (PIVCs) are the most commonly used VADs and are designed for the short-term administration of intravenous fluids or medications (Australian Commission on Safety and Quality in Health Care, 2021). Midline catheters offer a middle ground between PIVCs and central venous catheters (CVCs), being longer catheters inserted in peripheral veins of upper limbs, terminating at peripheral veins around the axilla level, and often used in patients with difficult intravenous access (Gorski et al, 2021). Additionally, arterial lines play an important role in providing continuous blood pressure monitoring for patients requiring close cardiac monitoring (Armstrong et al, 2023). CVCs are primarily used in the ED for administering intravenous medications contraindicated for peripheral administration, delivering bolus fluids, or providing live venous monitoring for critically unwell patients (Theodoro et al, 2014). Intraosseous catheters (IOs) serve as a reliable last-resort method for urgently obtaining access during resuscitation (Dornhofer and Kellar, 2023).
Despite the widespread use of these VADs in ED settings there are common risks and complications associated with their insertion and management, including infection, occlusion, infiltration and phlebitis (Theodoro et al, 2015; Meyer et al, 2020). These complications frequently result in negative patient experiences, suboptimal patient care, and increased organisational costs (Morgan et al, 2022). To enhance the safety and quality of VAD use, numerous randomised controlled trials (RCTs) have been conducted to assess the effectiveness of interventions.
RCTs are widely considered to provide the most reliable evidence compared with other study designs, being the gold standard method for evaluating the effectiveness of interventions (Hariton and Locasio, 2018). However, RCTs with small sample sizes, unclear hypotheses, poor design and inadequate reporting often offer limited value and are challenging to generalise to a broader perspective of other EDs (Nichol et al, 2010). Conducting RCTs is often time-consuming and costly, demanding substantial resources and time (Djurisic et al, 2017). Therefore, it is imperative for researchers to undertake meaningful research that aligns with clinical needs and addresses identified research priorities, minimising research waste and unnecessary duplication. Currently, there is a lack of synthesised evidence summarising RCTs investigating VADs in ED settings. This scoping review will identify gaps in the literature, providing clinicians and researchers an understanding of the current focus of VAD research and helping identify priority areas for further exploration and research.
Aim
The aim of the scoping review is to explore and synthesise the findings of RCTs related to VADs in ED settings over the past decade.
Methods
Review framework
The researchers will conduct the scoping review using Arksey and O'Malley's framework, following their five recommended steps: identifying review questions, identifying relevant studies, selecting studies for inclusion, sorting, collating and analysing data and summarising and reporting results (Arksey and O'Malley, 2005).
Identifying review questions
The review questions are:
Identifying relevant studies
The authors conducted a preliminary search using the search strategies developed with the assistance of an experienced university health science librarian. These defined search strategies will be used to search the Cochrane Central Register of Controlled Trials, Pubmed, CINAHL, and Embase databases (Tables 1, 2,3 and 4).
| ((“Vascular Access Devices”[Mesh] OR “Catheterization, Peripheral”[Mesh] OR “Central Venous Catheters”[Mesh] OR “Catheterization, Central Venous”[Mesh] OR “PIV”[tiab] OR “PIVs”[tiab] OR “IVC”[tiab] OR “IVCs”[tiab] OR “IVD”[tiab] OR “IVDs”[tiab] OR “PIVC”[tiab] OR “PIVCs”[tiab] OR “CVAD”[tiab] OR “CVADs”[tiab] OR “CVC”[tiab] OR “CVCs”[tiab]) |
| OR ((“hemodynamics”[Mesh] OR “haemodynamic”[tiab] OR “haemodynamics”[tiab] OR “hemodynamic”[tiab] OR “hemodynamics”[tiab]) AND (“monitoring”[tiab]) AND (“peripheral”[tiab] OR “peripherally”[tiab])) |
| OR (((((“peripheral”[tiab] OR “peripherally”[tiab]) AND (“Arteries”[Mesh] OR “arteries”[tiab] OR “arterial”[tiab] OR “intravenous”[tiab] OR “central”[tiab])) OR “midline”[tiab] OR “midlines”[tiab] OR “IV”[tiab] OR “intravenous”[tiab] OR “central venous”[tiab] OR “intraosseous”[tiab] OR ((“vascular”[tiab] OR “venous”[tiab]) AND “access”[tiab]))) AND (“Catheters”[Mesh] OR “Equipment and Supplies”[Mesh] OR “catheter”[tiab] OR “catheters”[tiab] OR “catheterisation”[tiab] OR “catheterization”[tiab] OR “cannulation”[tiab] OR “line”[tiab] OR “lines”[tiab] OR “equipment”[tiab] OR “supplies”[tiab] OR “device”[tiab] OR “devices”[tiab]))) |
| AND (“Emergency Service, Hospital”[Mesh] OR “emergency”[all] OR “ER”[tiab] OR “ED”[tiab] OR “trauma centre”[tiab] OR “trauma center”[tiab] OR “trauma centres”[tiab] OR “trauma centers”[tiab] OR “Trauma Unit”[tiab] OR “Trauma Units”[tiab] OR “accident and emergency”[tiab] OR “a&e”[tiab] OR “a & e”[tiab] OR “critical care”[tiab]) |
| AND (“Controlled Clinical Trials as Topic”[Mesh] OR “Controlled Clinical Trial” [Publication Type] OR “Systematic Reviews as Topic”[Mesh OR “Systematic Review” [Publication Type] OR “Meta-Analysis as Topic”[Mesh] OR “Meta-Analysis” [Publication Type] OR “controlled trial”[tiab] OR “controlled trials”[tiab] OR “randomized”[tiab] OR “randomised”[tiab] OR “randomly”[tiab] OR “random”[tiab] OR “trial”[tiab] OR “systematic review”[ti] OR “systematic reviews”[ti] OR “systematic literature review”[ti] OR “systematic scoping review”[ti] OR “systematic narrative review”[ti] OR “systematic evidence review”[ti] OR “systematic qualitative review”[ti] OR “systematic quantitative review”[ti] OR “systematic critical review”[ti] OR “systematic mixed studies review”[ti] OR “systematic mapping review”[ti] OR “Cochrane review”[ti] OR “Cochrane reviews”[ti] OR “systematic search and review”[ti] OR “systematic integrative review”[ti] OR “systematically”[tiab] OR “meta analysis”[ti] OR “meta analyses”[ti] OR “metanalysis”[ti] OR “metanalyses”[ti] OR “meta review”[ti] OR “meta reviews”[ti] OR “metareview”[ti] OR “metareviews”[ti] OR “umbrella review”[ti] OR “umbrella reviews”[ti]) |
| NOT (animals [mh] NOT humans [mh]) |
| AND 2012:2023[dp] |
| ((MH “Vascular Access Devices+” OR MH “Catheterization, Peripheral+” OR MH “Central Venous Catheters+” OR MH “Catheterization, Central Venous+” OR TI(“PIV” OR “PIVs” OR “IVC” OR “IVCs” OR “IVD” OR “IVDs” OR “PIVC” OR “PIVCs” OR “PICC” OR “CVAD” OR “CVADs” OR “CVC” OR “CVCs”) OR AB(“PIV” OR “PIVs” OR “IVC” OR “IVCs” OR “IVD” OR “IVDs” OR “PIVC” OR “PIVCs” OR “CVAD” OR “CVADs” OR “CVC” OR “CVCs”)) |
| OR ((MH “Hemodynamics+” OR (TI “haemodynamic” OR AB “hemodynamic”) OR (TI “haemodynamics” OR AB “hemodynamics”) OR (TI “hemodynamic” OR AB “hemodynamic”) OR (TI “hemodynamics” OR AB “hemodynamics”) AND (TI “monitoring” OR AB “monitoring”) AND ((TI “peripheral” OR AB “peripheral”) OR (TI “peripherally” OR AB “peripherally”)))) |
| AND (MH “Arteries+” OR (TI(“arteries” OR “arterial” OR “intravenous” OR “central”) OR AB(“arteries” OR “arterial” OR “intravenous” OR “central”)))) OR (TI(“midline” OR “midlines” OR “IV” OR “intravenous” OR “central venous” OR “intraosseous”) OR AB(“midline” OR “midlines” OR “IV” OR “intravenous” OR “central venous” OR “intraosseous”)) OR (TI(“vascular” OR “venous”) OR AB(“vascular” OR “venous”)) AND (TI “access” OR AB “access”))) AND (MH “Catheters+” OR MH “Equipment and Supplies+” OR TI(“catheter” OR “catheters” OR “catheterisation” OR “catheterization” OR “cannulation” OR “line” OR “lines” OR “equipment” OR “supplies” OR “device” OR “devices”) OR AB(“catheter” OR “catheters” OR “catheterisation” OR “catheterization” OR “cannulation” OR “line” OR “lines” OR “equipment” OR “supplies” OR “device” OR “devices”)))) |
| AND (MH “Emergency Service+” OR “emergency” OR TI(“ER” OR “ED” OR “trauma centre” OR “trauma center” OR “trauma centres” OR “trauma centers” OR “Trauma Unit” OR “Trauma Units” OR “accident and emergency” OR “a&e” OR “a & e” OR “critical care”) OR AB(“ER” OR “ED” OR “trauma centre” OR “trauma center” OR “trauma centres” OR “trauma centers” OR “Trauma Unit” OR “Trauma Units” OR “accident and emergency” OR “a&e” OR “a & e” OR “critical care”)) |
| AND (MH “Clinical Trials+” OR MH “Systematic Review” OR MH “Meta Analysis” OR TI(“controlled trial” OR “controlled trials” OR “randomized” OR “randomised” OR “randomly” OR “random” OR “trial” OR “systematic review” OR “systematic reviews” OR “systematic literature review” OR “systematic scoping review” OR “systematic narrative review” OR “systematic evidence review” OR “systematic qualitative review” OR “systematic quantitative review” OR “systematic critical review” OR “systematic mixed studies review” OR “systematic mapping review” OR “Cochrane review” OR “Cochrane reviews” OR “systematic search and review” OR “systematic integrative review” OR “systematically” OR “meta analysis” OR “meta analyses” OR “metanalysis” OR “metanalyses” OR “meta review” OR “meta reviews” OR “metareview” OR “metareviews” OR “umbrella review” OR “umbrella reviews”) OR AB(“controlled trial” OR “controlled trials” OR “randomized” OR “randomised” OR “randomly” OR “random” OR “trial”)) |
| NOT ((MH “Animals+” OR MH “Animal Studies” OR TI animal model*) NOT MH “Human”) |
| AND PY 2012-2023 |
| ((‘vascular access device’/exp OR ‘catheterization’/exp OR ‘central venous catheter’/exp OR ‘central venous catheterization’/exp OR “PIV”:ti,ab OR “PIVs”:ti,ab OR “IVC”:ti,ab OR “IVCs”:ti,ab OR “IVD”:ti,ab OR “IVDs”:ti,ab OR “PIVC”:ti,ab OR “PIVCs”:ti,ab OR “CVAD”:ti,ab OR “CVADs”:ti,ab OR “CVC”:ti,ab OR “CVCs”:ti,ab) |
| OR ((‘hemodynamics’/exp OR “haemodynamic”:ti,ab OR “haemodynamics”:ti,ab OR “hemodynamic”:ti,ab OR “hemodynamics”:ti,ab) AND (“monitoring”:ti,ab) AND (“peripheral”:ti,ab OR “peripherally”:ti,ab)) |
|
OR (((((“peripheral”:ti,ab OR “peripherally”:ti,ab) AND (‘artery’/exp OR “arteries”:ti,ab OR “arterial”:ti,ab OR “intravenous”:ti,ab OR “central”:ti,ab)) OR “midline”:ti,ab OR “midlines”:ti,ab OR “IV”:ti,ab OR “intravenous”:ti,ab OR “central venous”:ti,ab OR “intraosseous”:ti,ab OR ((“vascular”:ti,ab OR “venous”:ti,ab) AND “access”:ti,ab))) |
| AND (‘hospital emergency service’/exp OR “emergency” OR “ER”:ti,ab OR “ED”:ti,ab OR “trauma centre”:ti,ab OR “trauma center”:ti,ab OR “trauma centres”:ti,ab OR “trauma centers”:ti,ab OR “Trauma Unit”:ti,ab OR “Trauma Units”:ti,ab OR “accident and emergency”:ti,ab OR “a&e”:ti,ab OR “a & e”:ti,ab OR “critical care”:ti,ab) |
| AND (‘controlled clinical trial (topic)’/exp OR ‘controlled clinical trial’/exp OR ‘systematic review (topic)’/exp OR ‘systematic review’/exp OR ‘meta analysis (topic)’/exp OR ‘meta analysis’/exp OR “controlled trial”:ti,ab OR “controlled trials”:ti,ab OR “randomized”:ti,ab OR “randomised”:ti,ab OR “randomly”:ti,ab OR “random”:ti,ab OR “trial”:ti,ab OR “systematic review”:ti OR “systematic reviews”:ti OR “systematic literature review”:ti OR “systematic scoping review”:ti OR “systematic narrative review”:ti OR “systematic evidence review”:ti OR “systematic qualitative review”:ti OR “systematic quantitative review”:ti OR “systematic critical review”:ti OR “systematic mixed studies review”:ti OR “systematic mapping review”:ti OR “Cochrane review”:ti OR “Cochrane reviews”:ti OR “systematic search and review”:ti OR “systematic integrative review”:ti OR “systematically”:ti,ab OR “meta analysis”:ti OR “meta analyses”:ti OR “metanalysis”:t OR “metanalyses”:ti OR “meta review”:ti OR “meta reviews”:ti OR “metareview”:ti OR “metareviews”:ti OR “umbrella review”:ti OR “umbrella reviews”:ti) |
| NOT (‘animal experiment’/de NOT (‘human experiment’/de OR ‘human’/de)) |
| AND [2012-2023]/py |
| AND ([article]/lim OR [article in press]/lim OR [review]/lim) |
| ID | Search |
|---|---|
| #1 | MeSH descriptor: [Vascular Access Devices] explode all trees |
| #2 | MeSH descriptor: [Catheterization, Peripheral] explode all trees |
| #3 | MeSH descriptor: [Central Venous Catheters] explode all trees |
| #4 | MeSH descriptor: [Catheterization, Central Venous] explode all trees |
| #5 | (“PIV” OR “PIVs” OR “IVC” OR “IVCs” OR “IVD” OR “IVDs” OR “PIVC” OR “PIVCs” OR “CVAD” OR “CVADs” OR “CVC” OR “CVCs”):ti,ab,kw |
| #6 | #1 OR #2 OR #3 OR #4 OR #5 |
| #7 | MeSH descriptor: [Hemodynamics] explode all trees |
| #8 | (“haemodynamic” OR “haemodynamics” OR “hemodynamic” OR “hemodynamics”):ti,ab,kw |
| #9 | #7 OR #8 |
| #10 | ("monitoring"):ti,ab,kw |
| #11 | (“peripheral” OR “peripherally”):ti,ab,kw |
| #12 | #9 AND #10 AND #11 |
| #13 | (“peripheral” OR “peripherally”):ti,ab,kw |
| #14 | MeSH descriptor: [Arteries] explode all trees |
| #15 | (“arteries” OR “arterial” OR “intravenous” OR “central”):ti,ab,kw |
| #16 | #14 OR #15 |
| #17 | #13 AND #16 |
| #18 | (“midline” OR “midlines” OR “IV” OR “intravenous” OR “central venous” OR “intraosseous”):ti,ab,kw |
| #19 | (“vascular” OR “venous”):ti,ab,kw |
| #20 | ("access"):ti,ab,kw |
| #21 | #19 AND #20 |
| #22 | #17 OR #18 OR #21 |
| #23 | MeSH descriptor: [Catheters] explode all trees |
| #24 | MeSH descriptor: [Equipment and Supplies] explode all trees |
| #25 | (“catheter” OR “catheters” OR “catheterisation” OR “catheterization” OR “cannulation” OR “line” OR “lines” OR “equipment” OR “supplies” OR “device” OR “devices”):ti,ab,kw |
| #26 | #23 OR #24 OR #25 |
| #27 | #22 AND #26 |
| #28 | #6 OR #12 OR #27 |
| #29 | MeSH descriptor: [Emergency Service, Hospital] explode all trees |
| #30 | (“emergency”) |
| #31 | (“ER” OR “ED” OR “trauma centre” OR “trauma center” OR “trauma centres” OR “trauma centers” OR “Trauma Unit” OR “Trauma Units” OR “accident and emergency” OR “a&e” OR “a & e” OR “critical care”):ti,ab,kw |
| #32 | #29 OR #30 OR #31 |
| #33 | #28 AND #32 with Cochrane Library publication date from Jan 2012 to present |
Studies that meet the inclusion but not exclusion criteria will be included in the scoping review (Table 5). Inclusion criteria are: RCTs that studied PIVCs (including peripheral intravenous catheters, midlines, arterial lines), CVCs and IOs in ED settings; published peer-reviewed journal; full-text articles in English and Chinese as Chinese is the first author's (HX) mother tongue; published in the past 10 years (2012-2023). The researchers have chosen 2012 instead of 2013 with the search taking place in late 2023. Systematic reviews will also be included in the search strategies to help identify potentially relevant RCTs via the reference lists of the systematic reviews. Exclusion criteria are: non-RCT, secondary analysis of RCTs, editorials, review papers, commentary and discussion papers.
| Inclusion criteria |
|---|
|
|
| Exclusion criteria |
|
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Study selection and data extraction
Endnote v20 software will be used during screening. Once duplications are removed, the title and abstracts will be screened by two authors independently. If authors are uncertain about the inclusion of studies by reviewing the title and abstracts, full text will be retrieved and reviewed to assist in decision-making. The rationale for excluded full-text studies will be documented. The full text of all included studies will be reviewed by two authors independently to ensure the qualified studies are included in the final analysis. Any disagreements will be discussed with a third author. A PRISMA-ScR flowchart will be created to record the entire process of data selection and extraction (Tricco et al, 2018).
A purpose-built Excel spreadsheet will be created for data extraction and will include: study authors, year, country, investigator (medical, nursing or mixed), study design (RCT or pilot RCT), population (adult, paediatric, neonatal or mixed), country, type of devices (PIVCs; CVCs; IOs), sites (multi-site, single site), sample size, randomisation method (computergenerated or not), intervention (new design or product, different technique) and comparator, inserter (doctors, nurses, specialist inserter-radiologist, vascular specialist service), outcome measures, main findings and funding body. The team will gather data regarding the funding body to detect industry sponsorship bias because it poses the potential risk of favouring the interests of the financial sponsor in research studies (Stegeman et al, 2023). The quality of evidence (eg, risk of bias assessment) will not be examined due to the nature of the scoping review. Data extracted will be based on published articles. Article authors will be contacted for further information if required.
Data sorting, collating and analysis
Extracted data will be sorted, collated and analysed using descriptive statistics by two authors. Any disagreement will be discussed. A third author may be involved if unable to achieve consensus.
Summarising and reporting results
The ‘Evidence & Gap map’ method, developed by Snilstveit et al (2016), aims to visually outline known and unknown effects of interventions within a thematic area. The team will present descriptive tables with grouped themes of current evidence, employing the Evidence & Gap map method when suitable. These tables will summarise the themed findings of the included studies and identify gaps where the evidence is missing.
Dissemination
To the best of the authors’ knowledge this review represents the inaugural scoping review delving into RCTs focused onVADs conducted in ED settings. The authors intend to disseminate the findings of the review to audiences potentially interested in this topic through peer-reviewed journals, as well as local and international conferences and symposiums. Furthermore, the insights gleaned from the review are poised to shape the future prioritisation of research related to VADs and influence clinical practice in ED settings.