Paediatric Central Venous Access Devices: An Evidence and Gap Map of Global Research

Résumé fourni par la source

CONTEXT: Central venous access devices (CVADs) are essential in paediatric care but pose significant risks. Synthesising existing evidence is needed to guide safe, effective, and equitable practice amid evolving interventions and complex management needs. OBJECTIVE: To develop an evidence and gap map (EGM) to identify, categorise, and visualise paediatric evidence on interventions aimed at improving CVAD outcomes. DATA SOURCES: Following Campbell Collaboration guidance, systematic searches were conducted in PubMed, CINAHL, Scopus, and CENTRAL (date limits: 2014 to 30 June 2024). STUDY SELECTION: Eligible studies included patients (0-18 years) evaluating an intervention to improve CVAD outcomes, including randomised and non-randomised trials, implementation studies, and systematic reviews. DATA EXTRACTION: Two reviewers independently screened and extracted data on CVAD type, intervention, setting, outcomes, and study design. Data were descriptively analysed and visualised in Tableau. RESULTS: Of 952 studies in the broader EGM, 151 were paediatric-specific. Most were conducted in high-income countries (72%) and high-acuity settings, including critical care (41.9%) and oncology (38.5%). CVAD type was unspecified in 80.1% of studies. Systematic reviews (22.5%) and randomised controlled trials (28.5%) were available, though 40.4% of studies were before-and-after studies without controls. Common interventions addressed infection prevention, insertion technologies, and flushing. Clinical outcomes, particularly bloodstream infection (27.8%), dominated reporting, while patient-reported, economic, and device removal outcomes were rarely reported (< 2%). LIMITATIONS: Only studies from the last 10 years and English-language databases were included. No formal quality appraisal was conducted. CONCLUSIONS: Significant evidence gaps exist. Future research should prioritise rigorous, paediatric-specific studies across diverse settings and outcome domains. TRIAL REGISTRATION: Open Science Framework (OSF) q6gcr: https://osf.io/q6gcr/overview.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.