Randomised controlled trials (RCTs) are the “gold standard” for evaluating effectiveness of interventions, as they provide the most reliable evidence with minimal bias compared to other study designs. However, if the number and quality of RCTs are poor, studies may give inconsistent results and small effect sizes, creating difficulties in generalising the findings to a broader population. This scoping review investigated the current evidence for the insertion and management of peripheral vascular devices, including intravenous, midline, and arterial catheters. We searched Pubmed, Cochrane Central Register of Controlled Trials, and CINAHL between 1 January 2005 and 30 June 2015. The final review included 128 RCTs (94 peripheral intravenous catheters, 2 midline catheters, and 32 arterial catheters). Catheter insertion strategies and analgesia methods have been comprehensively studied, particularly for peripheral intravenous catheters, but more RCTs are needed to address post-insertion care and maintenance, including dressings and securement, flushing practices and infection prevention strategies such as skin preparation and hub decontamination. This peripheral vascular catheter scoping review will enable clinicians and researchers to identify the gaps in evidence and prioritise areas needing further research.
Keywords: Scoping review, peripheral vascular device, peripheral intravenous catheter, peripheral arterial catheter, midline catheter, randomised controlled trial.

Purpose: Intravenous (IV) access is the most commonly performed procedure in the emergency department (ED). Patients with difficult venous access require multiple needlesticks (MNS) for successful IV cannulation and may experience increased pain with many attempts.
Objective: To determine the association between number of IV attempts and overall pain experienced by the patient from IV placement.
Methods: Cross-sectional observational study on consecutive patients undergoing IV placement with a 20-gauge IV in the upper extremity in an urban academic hospital. Exclusion criteria included refusal to participate or fully complete all survey questions. The total number of IV attempts and patient pain scores marked on a standardized visual analog scale was recorded. Mean pain scores of two groups, single needlestick (SNS) and MNS, were compared using Student’s t-test.
Results: A total of 760 patients were approached, of whom 31 were excluded, leaving 729 patients in the analysis; 556 with SNS (76%) and 173 with MNS (24%). The mean pain score (95% CI) was 51 mm (46-55 mm) for the MNS group and 25 mm (23-28 mm) for the SNS group, p<0.001. Compared to patients who underwent one IV attempt, patients with two and three attempts had an average 19 mm and 33 mm increase in pain scores, respectively, with the highest average pain associated with five attempts. A total of 58% of MNS patients rated IV placement as the most painful experience while in the ED.
Conclusions: Patients experience increased pain in association with multiple IV attempts.
Key words: Difficult venous access, Pain, Peripheral intravenous catheter, Procedure

Over 400 paediatric anaesthetic and surgical central venous access devices (CVADs) were inserted in Sydney Children’s Hospital (SCH) operating theatres in 2014. During 2014, an average of 14–20 inpatients could be found daily with a CVAD in a non-haematology/oncology/intensive-care environment. Prior to April 2013, there was no organised means of collecting these statistics, or specific services responsible for the maintenance, education and quality assurance relating to paediatric CVADs inserted and managed at SCH. Developed as a response to the growing number of CVADs present at SCH, and the anecdotal increase in complications relating to CVADs, the vascular access clinical nurse specialist (grade 2) position was commenced in mid-2013. Prior to the service formation, department expectations of CVAD insertion and surveillance varied from speciality to speciality, doctor to nurse, and staff to patient/family, regardless of hospital policy and procedure; compounding the problem was a lack of centralised database documentation of all paediatric CVAD insertions, which presented issues regarding options following line complication. The service was considered vital for the improvement of cohesion and inter-speciality efficacy regarding paediatric CVADs, as well as an intermediary between all specialities for the optimal care of paediatric patients with a CVAD. During the first 18 months of the vascular access nurses’ role in SCH, the service has primarily focused on three main areas: clinical support, education, and quality assurance; the combination of which has already established effective improvement in clinical practice and patient outcomes relating to insertion and management of paediatric CVADs.
Keywords: Paediatric, CVAD, PICC, clinical support, nurse-led.

Introduction: Permanent central venous catheter use is associated with significant complications that often require their timely removal. An uncommon complication is resistant removal of the catheter due to adherence of the catheter to the vessel wall. This occasionally mandates invasive interventions for removal. The aim of this study is to describe the occurrence of this “stuck catheter” phenomenon and its consequences.
Methods: A retrospective review of all the removed tunneled hemodialysis catheters from July 2005 to December 2014 at a single academic-based hemodialysis center to determine the incidence of stuck catheters. Data were retrieved from a prospectively maintained computerized vascular access database and verified manually against patient charts.
Results: In our retrospective review of tunneled hemodialysis catheters spanning close to a decade, we found that 19 (0.92%) of catheters were retained, requiring endovascular intervention or open sternotomy. Of these, three could not be removed, with one patient succumbing to catheter-related infection. Longer catheter vintage appeared to be associated with ‘stuck catheter’.
Conclusions: Retention of tunneled central venous catheters is a rare but important complication of prolonged tunneled catheter use that nephrologists should be aware of. Endoluminal balloon dilatation procedures are the initial approach, but surgical intervention may be necessary.
Keywords: Embedded, Hemodialysis, Retention, Tunneled catheters