Implementation frameworks, strategies and outcomes in optimizing central venous access device practice in paediatrics: A scoping review.
Elouise R Comber, Samantha Keogh, Linda N Nguyen and 2 others
PMID 38896020WHAT IT FOUND
Paediatric central line care studies mostly used quality improvement, education, bundles and working groups, but many lacked formal frameworks or cost outcomes, so it is hard to know which implementation efforts work.
Key findings
01The review included 46 paediatric CVAD implementation studies, most focused on health professionals and maintenance care, and most were single-site quantitative pre-post designs.
02Quality improvement and PDSA were the most common frameworks, but 28% of studies used no formal implementation framework.
03Most studies used multiple strategies, especially education, working groups and bundles, and reported infection or bundle compliance outcomes rather than cost outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
A scoping review maps what has been done; it cannot say whether any framework or strategy worked. Neonatal, home care, non-English and studies before 2012 were excluded. Most included studies were single-site and quasi-experimental, so results may not transfer to other hospitals. 24% of studies did not clearly list a sample size. 28% used no formal implementation framework, and outcome measures were sometimes misaligned with aims. Because 91% used multiple strategies together, the review cannot separate which parts mattered. Few studies reported service or cost outcomes, so affordability and sustainability are unclear.
Declared interests
The authors declared no conflicts of interest. One author was supported by a University of Queensland and Cancer Council Queensland research training scholarship.
The easy way to misread this
Do not read this as proof that education, bundles or quality improvement reduce central line infections. The review mapped studies that used several strategies together, and it did not identify which components caused any change.