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Appraising the quality standard underpinning international clinical practice guidelines for the selection and care of vascular access devices: a systematic review of reviews
  1. Ian Blanco-Mavillard1,
  2. Miguel Angel Rodríguez-Calero2,
  3. Enrique Castro-Sánchez3,
  4. Miquel Bennasar-Veny4,
  5. Joan De Pedro-Gómez5
  1. 1 Quality, Teaching and Research Unit, Hospital de Manacor, Manacor, Spain
  2. 2 Health Care Office, Balearic Islands Health Service, Palma, Spain
  3. 3 NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
  4. 4 Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain
  5. 5 Evidence, Lifestyles and Health Research Group, Research Institute of Health Sciences, Universitat de les Illes Balears, Palma, Spain
  1. Correspondence to Dr Miquel Bennasar-Veny; miquel.bennasar{at}


Objective Catheter-related bloodstream infections are one of the most important adverse events for patients. Evidence-based practice embraces interventions to prevent and reduce catheter-related bloodstream infections in patients. At present, a growing number of guidelines exist worldwide. The purpose of the study was to assess clinical practice guidelines for peripheral and central venous access device care and prevention of related complications.

Design Systematic review of clinical practice guidelines: We conducted a search of the literature published from 2005 to 2018 using Medline/PubMed, Embase, CINAHL, Ovid, ScienceDirect, Scopus and Web of Science. We also evaluated grey literature sources and websites of organisations that compiled or produced guidelines. Guideline quality was assessed with the Appraisal of Guidelines for Research and Evaluation, Second Edition tool by three independent reviewers. Cohen’s kappa coefficient was used to evaluate the concordance between reviewers.

Results We included seven guidelines in the evaluation. The concordance between observers was substantial, K=0.6364 (95% CI 0.0247 to 1.2259). We identified seven international guidelines, which scored poorly on crucial domains such as applicability (medium 39%), stakeholder involvement (medium 65%) and methodological rigour (medium 67%). Guidelines by Spanish Health Ministry and UK National Institute for Health and Care Excellence presented the highest quality.

Conclusions It is crucial to critically evaluate the validity and reliability of clinical practice guidelines so the best, most context-specific document is selected. Such choice is a necessary prior step to encourage and support health organisations to transfer research results to clinical practice. The gaps identified in our study may explain the suboptimal clinical impact of guidelines. Such low adoption may be mitigated with the use of implementation guides accompanying clinical documents.

  • clinical practice guideline
  • implementation
  • evidence-based nursing
  • adverse events
  • vascular access
  • quality appraisal

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  • Contributors All authors made significant contributions to the manuscript. IB-M and MAR-C collected the data. IB-M, MAR-C, JDP-G and MB-V analysed the data. IB-M, MAR-C, EC-S, MB-V and JDP-G drafted and critically revised the manuscript for important intellectual content. All authors read and gave final approval of the version of the manuscript submitted for publication.

  • Funding Enrique Castro-Sánchez is affiliated with the National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in collaboration with Public Health England and Imperial College Healthcare NHS Trust. EC-S has received an Early Career Research Fellowship from the Antimicrobial Research Collaborative at Imperial College London and recognises the support of the Florence Nightingale Foundation as well as the NIHR Imperial Patient Safety Translational Research Center.

  • Competing interests The opinions and points of view included in the article only represent the opinion of the authors and not the NHS, the NIHR, the Department of Health or Public Health England.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The manuscript was a systematic review of published studies; the full references of these studies have been provided in the reference list.

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