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Health professionals' lack of knowledge of central venous access devices: the impact on patients

25 July 2019
Volume 28 · Issue 14



the literature on the patient experience of living with a central venous access device (CVAD) is growing, but remains sparse. It suggests that patients accept having a CVAD as it should reduce episodes of repeated cannulations. However, a recent doctoral study found the reality did not live up to this hope.


the study objective was to uncover the global, cross-disease experience of patients with CVADs.


an online survey was sent to an international sample of people living with CVADs.


74 people from eight countries responded. Respondents corroborated the PhD findings: painful cannulation attempts continued after CVAD insertion because of a lack of clinical knowledge. Participants lost trust in clinicians and feared complications due to poor practice.


clinicians often lack the necessary skills to care and maintain CVADs. This leads to a negative patient experience.

Central venous access devices (CVADs) are necessary for the delivery of intravenous (IV) therapies, which can be damaging to the inner layer (intima) of small peripheral veins (Al-Benna et al, 2013). Technological advances have resulted in the following main long-term CVADs in use: peripherally inserted central catheters (PICCs); non–cuffed central venous catheters; tunnelled (cuffed) central venous catheters (TCVCs), which are external devices, and totally implanted vascular access devices (TIVADs), which are implanted under the skin. Depending on the type of treatment being administered, patients can have these devices in place for between few months and many years.

Literature on the clinical advantages and disadvantages of CVADs is plentiful. However, it remains largely technically focused (Simonov et al, 2015; Bodenham, 2016; Voog et al, 2018). The literature on the experiences of patients living with a CVAD suggests that the devices are accepted, with the main attraction being a reduction of repeated painful cannulation (Yamada et al, 2010; Sharp et al, 2014; Alpenberg et al, 2015; Song and Oh, 2016; Parás-Bravo et al, 2018). It is acknowledged, however, that one of the main advantages of central venous access is to preserve the health of veins and prevent damage from vesicant and irritant medications. A recent doctoral study revealed that even when a device was inserted, it did not necessarily prevent challenging cannulation attempts.

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