Implementation frameworks, strategies and outcomes in optimizing central venous access device practice in paediatrics: A scoping review

Abstract

AbstractPaediatric patients with complex or acute conditions may require a central venous access device, however, almost one‐third of these devices have associated complications (e.g. infections). Implementation of evidence‐based practices regarding central venous access devices can reduce and potentially prevent complications.AimsThis scoping review aimed to explore recent interventional research in CVAD management through an implementation lens.DesignThis scoping review used the Arksey and O'Malley framework. Studies were included if they were written in English, published in 2012 to July 2023, involved children and were relevant to the study aims. Risk of bias was appraised by the Mixed Methods Appraisal Tool.Data SourcesSearches were undertaken in EMBASE, CINAHL (Ebsco), PubMed, Web of Science and Cochrane Library (CENTRAL).ResultsOf the 1769 studies identified in a systematic search, 46 studies were included. Studies mostly focused on health professionals and central venous access device maintenance and had quantitative pre‐post study designs. Adherence to implementation frameworks was lacking, with many studies employing quality improvement approaches. Implementation strategies were typically multipronged, using health‐professional education, bundles and working groups. Bundle compliance and reductions in central line‐associated bloodstream infections were the most featured outcomes, with most studies primarily focusing on effectiveness outcomes.ConclusionTranslation of evidence‐based practices to the clinical setting is difficult and current adoption of implementation frameworks (apart from ‘quality improvement’) is limited. Implementation strategies are diverse and dependent on the local context, and study outcomes typically focus on the effectiveness of the physical intervention, rather than measuring the implementation effort itself.Implications for PatientsFuture intervention research requires a more uniform and deliberate application of implementation frameworks and strategies.ImpactGreater exploration of relationships between frameworks and strategies and implementation and service outcomes is required to increase understanding of their role in maximizing resources to improve health care.Adhered to best reporting guidelines as per PRISMA‐ScR (Tricco et al., 2018).Patient or Public ContributionNo patient or public contribution.