Purpose and scope
The purpose of this best practice guideline (BPG) is to provide nurses (nurse practitioners, registered nurses, registered practical nurses and nursing students) and other members of the interprofessional team with evidence-based recommendations and resources related to the insertion, assessment and maintenance of vascular access devices (VADs) in the infant (0–1 year), pediatric (1–18 years) and adult populations (18 years and older).
This guideline is applicable to all practice settings where care is provided for persons with VADs such as, but not limited to:
- primary care
- rehabilitation
- long-term care
- acute care, and
- community care.
Caution note: As with all procedures, health providers must be aware of scope of practice and follow regulatory body guidelines. Health providers should only be caring for or inserting VADs for which they have the necessary knowledge, skill and judgement. Health providers should also follow organizational policies and procedures related to VAD insertion and maintenance. This BPG addresses recommendations requiring advanced skill.
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Who's using this?
Registered Nurses’ Association of Ontario (RNAO). Vascular access. 2nd ed. Toronto (ON): RNAO; 2021.
Recommendations
Good practice statement: The expert panel recommends health providers complete a systematic assessment of the person prior to inserting a vascular access device.
Recommendation 1.1: The expert panel recommends that health providers provide comprehensive health teaching to persons and their families/caregivers about their vascular access device.
Recommendation 2.1: The expert panel recommends health-service organizations implement practical education on the insertion and/or management of vascular access devices for health providers.
Recommendation 3.1: The expert panel suggests that acute care health-service organizations implement vascular access specialists or vascular access specialist teams to support the insertion and management of vascular access devices.
Recommendation 4.1: The expert panel suggests health providers perform venipuncture when drawing blood samples to maintain specimen integrity.
Recommendation 5.1: The expert panel recommends that acute care health-service organizations implement a multi-component peripheral vascular access device care protocol. This protocol includes a minimum of a daily review by health providers, in collaboration with persons and their families.
Recommendation 6.1: The expert panel recommends that health providers use ultrasound-guided technique for the insertion of peripheral arterial catheters.
Recommendation 6.2: The expert panel suggests that health providers use ultrasound-guided technique for the insertion of peripheral vascular access devices in persons with difficult intravenous access.
Recommendation 7.1: The expert panel recommends that health providers offer adults nonpharmacological and pharmacological pain management strategies during the insertion of a vascular access device.
Recommendation 7.2: The expert panel recommends that health providers offer non-pharmacological and pharmacological pain management strategies during the insertion of a vascular access device to infants and children, tailored to their age and developmental stage.
