[Framework for responsible venous access and IV management]. / Allen op één lijn ? Kaders voor verantwoorde veneuze toegang en infuusmanagement.

Intravascular catheters are indispensable in current healthcare. The introduction of a peripheral venous or central venous catheter and managing infusion therapy are care processes that over time have become integral to the organisation, and in which multiple care providers play a role. Introducing an IV appears to be a straightforward repetitive task, but often proves to be a considerable burden to the patient and a source of dissatisfaction, morbidity and mortality. Inadequate decision-making, inexperience and lack of a guideline can lead to poor IV management. There is a need for improvement in many care facilities. A programmatic approach such as the Vessel Health and Preservation Principle can be a great asset in this. In this article we outline the framework for responsible vascular access and infusion therapy.

Evidence-based consensus on the insertion of central venous access devices: definition of minimal requirements for training.

There is a lack of standard minimal requirements for the training of insertion techniques and maintenance of central venous access devices (CVADs). An international evidence-based consensus task force was established through the World Congress of Vascular Access (WoCoVA) to provide definitions and recommendations for training and insertion of CVADs. Medical literature published from February 1971 to April 2012 regarding 'central vascular access', 'training', 'competency', 'simulation', and 'ultrasound' was reviewed on Pubmed, BioMed Central, ScienceDirect, and Scopus databases. The GRADE and the GRADE-RAND methods were utilized to develop recommendations. Out of 156 papers initially identified, 83 papers described training for central vascular access placement. Sixteen recommendations are proposed by this task force, each with an evidence level, degree of consensus, and recommendation grade. These recommendations suggest central venous access education include didactic or web-based teaching with insertion procedure, infection prevention, complications, care, and maintenance of devices, along with laboratory models and tools for simulation practice incorporating ultrasound. Clinical competence should be determined by observation during clinical practice using a global rating scale rather than by the number of procedures performed. Ensuring safe insertion and management of central venous devices requires standardized education, simulation practice, and supervised insertions.