Vascular access in critically ill patients with COVID-19: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to examine the extent of vascular access research undertaken on the critically ill COVID-19 population. INTRODUCTION: Two fundamental supportive invasive interventions in the critical care environment are mechanical ventilation and intravenous therapy. Ventilation research has dominated the literature since the pandemic began; however, there has been little research on vascular access devices, despite these interventions existing almost codependently. The systematic proning of this cohort of patients increases the risk of dressing infiltration and infection. Vascular access devices, and the coagulopathic manifestations of COVID-19, place these patients at heightened risk of complications. Vascular access device insertion, care, and maintenance in the critically ill COVID-19 population must be understood to investigate whether this population is at increased risk of vascular access device complications and vessel health compromise. INCLUSION CRITERIA: All study designs will be eligible for inclusion in this review. The intensive care unit will be the main focus of the review. Results will be limited to adults with disease progression severe enough to require admission to critical care. METHODS: A search of Embase, MEDLINE (Ovid), Web of Science, and PubMed will be conducted. Clinical trial data will also be sought. As recommended by JBI, a 3-step search process will be followed. Data will be extracted using a data extraction instrument based on a template from JBI. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and the results will be presented in a PRISMA flow diagram. Publication dates will be filtered from 2019 to the present; only English-language results will be included.

Peripheral intravenous cannulation decision-making in emergency settings: a qualitative descriptive study.

OBJECTIVES: Rates of unused ('idle') peripheral intravenous catheters (PIVCs) are high but can vary per setting. Understanding factors that influence the decision-making of doctors, nurses and paramedics in the emergency setting regarding PIVC insertion, and what factors may modify their decision is essential to identify opportunities to reduce unnecessary cannulations and improve patient-centred outcomes. This study aimed to understand factors associated with clinicians' decision-making on whether to insert or use a PIVC in the emergency care setting. DESIGN: A qualitative descriptive study using in-depth semistructured interviews and thematic analysis. SETTING: Gold Coast, Queensland, Australia, in a large tertiary level emergency department (ED) and local government ambulance service. PARTICIPANTS: Participants recruited were ED clinicians (doctors, nurses) and paramedics who regularly insert PIVCs. RESULTS: From the 15 clinicians interviewed 4 key themes: knowledge and experience, complicated and multifactorial, convenience, anticipated patient clinical course, and several subthemes emerged relating to clinician decision-making across all disciplines. The first two themes focused on decision-making to gather data and evidence, such as knowledge and experience, and decisions being complicated and multifactorial. The remaining two themes related to the actions clinicians took such as convenience and anticipated patient clinical course. CONCLUSION: The decision to insert a PIVC is more complicated than clinicians, administrators and policy-makers may realise. When explored, clinician decisions were multifaceted with many factors influencing the decision to insert a PIVC. In actual practice, clinicians routinely insert PIVCs in most patients as a learnt reflex with little cognitive input. When considering PIVC insertion, more time needs to be devoted to the awareness of: (1) decision-making in the context of the clinician's own experience, (2) cognitive biases and (3) patient-centred factors. Such awareness will support an appropriate risk assessment which will benefit the patient, clinician and healthcare system.