Clinical Trials in CVADs: What We Study a Lot, What We Barely Study at All

Study Overview

Central venous access devices (CVADs) are used across hospitals, outpatient clinics, and increasingly at home. Nurses manage these devices across the full lifecycle, from selection and insertion to maintenance, complication management, and removal. But the evidence base is not evenly spread across that lifecycle.

This scoping review created an evidence and gap map of CVAD interventional research published between 2014 and 2024, aiming to show where research is concentrated and where major gaps remain. The team mapped 710 studies and categorised them by study type, population, setting, intervention stage, and outcomes.

Key Findings

• The evidence base is huge, but uneven
  • Of 710 studies, most were primary studies, and a large portion were randomised trials.
• Research is dominated by hospital-based adult care
  • Studies were mostly conducted in high-income countries, focused on adults, and overwhelmingly based in inpatient hospital settings.
•  Insertion and infection prevention get most attention
  • The strongest concentration of studies sits around insertion practices and infection prevention, with ongoing management also heavily studied.
• Device selection and removal are under-studied
  • Far fewer studies focused on choosing the right device in the first place, and removal had the smallest evidence base.
• What we measure is also imbalanced
  • Infection outcomes were reported frequently, while patient-reported outcomes and economic outcomes were relatively rare.

Implications

This paper gives a clear message for future research priorities: CVAD evidence is strong where it has historically been prioritised (insertion and infection), but nursing-critical areas like device selection, removal, patient experience, and cost-effectiveness remain under-supported.

To move toward truly patient-centred CVAD care, the field needs more research that reflects the real world of modern practice, including outpatient and community settings, diverse populations, and outcomes that matter to patients, not just infections.

Read more:https://doi.org/10.1111/jan.70160

Authors: Mari Takashima; Areum Hyun; Tricia Kleidon; Victoria Gibson; Sabrina De Souza; Elouise Comber; Jacqueline Cunninghame; Jefferson Wildes da Silva Moura; Martha Mansah; Deanne August; Patrícia Kuerten Rocha; Nicole Marsh; Amanda Corley; Sam Keogh; Amanda Ullman