RCT Evidence on Vascular Access Devices in Emergency Departments: What Do We Know?

Vascular access device (VAD) insertion is a critical procedure in emergency departments (EDs), but evidence guiding best practices remains limited. This scoping review synthesised existing randomised controlled trial (RCT) research on VADs used in EDs, highlighting key innovations and gaps in the literature.

Study Overview
The review examined 48 RCTs published between 2012 and 2024, covering studies from multiple countries. The focus was on all types of VADs used in EDs, including PIVCs, central venous catheters, arterial lines, and intraosseous devices. The aim was to map the research landscape and identify priorities for future studies.

Key Findings
1. 85% of trials focused on PIVCs, with very few studies on other VAD types.

2. Most studies investigated:

• Vessel visualisation technologies (e.g., ultrasound guidance)
• Catheter design improvements
• Securement methods (e.g., tissue adhesives, integrated dressings)
• Distraction techniques (e.g., virtual reality for pain/anxiety reduction)

3. Ultrasound generally improved first-attempt success, particularly for patients with difficult IV access.

4. Securement innovations like tissue adhesive reduced device failure.

5. Distraction strategies were mainly studied in children, showing promise for pain relief.

Conclusion
This review highlights that most ED vascular access RCTs focus narrowly on PIVCs, leaving significant gaps in evidence for other device types and long-term outcomes. The authors call for broader, high-quality trials to guide best practice across the full range of VADs used in emergency care.

Read More:https://www.sciencedirect.com/science/article/pii/S2588994X25000193?via%3Dihub  

Authors: Hui (Grace) Xu, Yang (Camila) Zhao, Jed Duff, Nicole Marsh