Post-insertion Care of Central Venous Catheter: A Contextualized Clinical Guideline

Clinical guidelines play a significant role in improving the quality of patient care. Considering the lack of clinical guidelines for the care of central venous catheters in the country, this study aimed to compile a contextualized central venous catheter clinical guideline for being used in Iranian clinical settings.

Contextualizing central venous catheters guideline was based on a developed approached by ADAPTE international collaboration network with three stages of set-up, adaptation and finalization. In the preparation stage, after establishing an organizing committee, the initial search of resources was done to check the feasibility of the study, to identify the required resources and skills and to also write the adaptation proposal. The adaptation phase started with a comprehensive search of resources to retrieve the maximum number of related guidelines. The search of sources led to the retrieval of 410 guidelines, which were reduced to 14 after screening the titles and abstracts based on the purpose of the study and the inclusion criteria. Then, the full text of the 14 included guidelines was reviewed in terms of methodological quality and the result was presented in the expert panel meeting. The methodological quality of the guidelines was evaluated with the AGREEII and a score of more than 70% was considered as an acceptable quality. In this way, one of the guidelines was selected and the adaptation process began. Finally, a translated draft of the guideline recommendations was reviewed in the expert and users panel, respectively. While making the suggested amendments, the level of their agreement with each of the recommendations were reviewed based on Likert scale from 1 to 9 (completely disagree to completely agree). Achieving a consensus more than 80 to assign grades 7 to 9 to each recommendation was resulted in keeping the recommendation. Finally, in the finalization stage, the contextualized version of the selected clinical guide was compiled for being used in Iranian clinical settings.

The full text of the 14 retrieved guidelines were reviewed. Among them, the “Central Venous Access Device (CVAD) Post Insertion Management” clinical practice guideline developed by NSW Agency for Clinical Innovation, with a quality score of 90.4% was selected for adoption. In addition, more than 80% of the stakeholders and expert panel agreed with assigning grades 7 to 9 to all recommendations of this guideline. As a result, all of the 50 recommendations of the guideline in assessment and intervention domains were accepted to be applied in Iranian clinical settings with a few modifications to make recommendations clearer and more understandable for users.

The adopted version of CVAD post-insertion management clinical practice guideline with all 50 recommendations is applicable in caring of Iranian hospitalized adult patients with CVAD.