Implementation frameworks, strategies and outcomes in optimizing CVAD practice in paediatrics: A scoping review

Study Overview

This scoping review mapped how evidence-based practices (EBPs) for paediatric central venous access devices (CVADs) have been implemented across hospitals (2012-July 2023). From 1,769 records, 46 studies were included and assessed for frameworks, strategies, and outcomes used to improve CVAD insertion and maintenance and reduce complications.

Key Findings

Frameworks used—often loosely: Over half relied on Quality Improvement (QI) (56%) and PDSA (17%), while 28% used no formal implementation framework—limiting structure, benchmarking, and reproducibility.

Where the action happens: Most studies targeted health professionals and maintenance/post-insertion care (63%); designs were typically pre-post and single-site, with many in oncology/haematology settings.

Common strategies (usually multipronged):
Education of clinicians (65%), bundles (54%), working groups (pre-implementation 63%; during 52%), plus audits/surveillance (50%), checklists (30%), and feedback (30%).

What gets measured gets managed (and it’s mostly effectiveness):
Outcomes centred on CLABSI/CRBSI rates (70%) and bundle compliance (50%). Implementation outcomes and especially service/cost outcomes were under-reported.

PICU vs oncology differences: PICU studies were less likely to use formal frameworks; oncology/haematology more often reported implementation-specific outcomes.

Implications

• To sustainably reduce paediatric CVAD complications, projects should:
• Adopt formal implementation frameworks (beyond generic “QI”) to design, measure, and replicate change.
• Tailor strategies to local context (barriers, workflows, staffing) rather than defaulting to education + bundles.
• Measure beyond clinical effectiveness—include implementation (e.g., fidelity, adoption, sustainability) and service/cost outcomes to guide resourcing and scale-up.
• Report which strategy components work (and why) to move past “rinse-and-repeat” bundles.

Read more:https://onlinelibrary.wiley.com/doi/10.1111/jan.16268 

Authors: Elouise R. Comber, Samantha Keogh, Linda N. Nguyen, Joshua Byrnes, Amanda J. Ullman