External Reviewer Notes

2024 CVAA Guidelines External Reviewer Notes

September 30, 2024

This document will provide you some contextual information before you begin your review of the CVAA Guidelines.
**Read this thoroughly before beginning your review.

Methodology Summary:

The framework guiding the development and implementation of this project was based on a modified version of the ADAPTE Methodology of Guideline Development, which takes a systematic approach to adapting existing guidelines produced in one setting for use in a different organizational context.

To update the 2019 CVAA Guidelines, we adhered to the original 2019 methodology, identifying English-language national and international vascular access and infusion therapy guidelines published by professional organizations (see below). These guidelines were appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument to evaluate the quality, currency, content, and acceptability/applicability to guide the selection process. The AGREE II scores were subsequently used to compare the strength of evidence when developing recommendations if there was a discrepancy between two guidelines. To ensure currency, guideline publication dates included 2014-2024.

In the absence of newer guidelines discussing topics, resources with earlier publications dates were included. A hand-search was completed for Canadian authoritative documents to reflect Canadian practice and regulations (e.g., Health Canada).

An examination of the extensive literature review (including 2016 Royal College of Nursing [RCN] rapid review) supporting the recently published guidelines (e.g., Infusion Nurses Society, 2024; RCN, 2016) validated the decision not to undertake a new extensive literature review. The RCN Standards (2016) and epic3 Guidelines (2014) were included despite the older publication dates due to the quality of evidence supporting these guidelines.

Included Source Guidelines:

  • 2015 Best Practice Guidelines in the Care and Maintenance of Pediatric CVCs
    AVA (Association for Vascular Access) “PediSIG“
  • 2019 Occlusion Management Guideline “CVAA”      
  • 2014 National Evidence-Based Guidelines for Preventing Healthcare Associated Infections in NHS Hospitals in England “epic3”
  • 2018 Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy - Infectious Diseases Society of America “IDSA”
  • 2024 Infusion Therapy Standards of Practice - Infusion Nurses Society “INS”
  • 2016 Standards for Infusion Therapy - Royal College of Nursing “RCN”
  • 2021 RNAO BPG Vascular Access - Registered Nurses Association of Ontario “RNAO”
  • 2022 Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals - Society for Healthcare Epidemiology of America “SHEA”

Grading:

If no grade/reference is included in a sub-bulleted recommendation, the grade/reference from the parent/root statement applies.

IA = Strong recommendation with high to moderate quality evidence
IB = Strong recommendation with low to very low-quality evidence
IC = Strong recommendation with published consensus
ICVAA = Strong recommendation with Guideline Development Group (GDG) consensus

IIA = Weak recommendation with high to moderate quality evidence
IIB = Weak recommendation with low to very low-quality evidence
IIC = Weak recommendation with minimal or no scientific evidence
IICVAA = Weak recommendation with GDG consensus

UCVAA = Unable to make recommendation

Miscellaneous:

  • The use of ‘consider’ is intentional based on the strength of evidence for this recommendation. “Use” is a stronger recommendation.
  • The final Guidelines will be translated into French
  • Table of Contents, Abbreviations, Glossary, and Appendices to come
    • We have included the Glossary from the 2019 Canadian Vascular Access and Infusion Therapy Guidelines as an example of the type of glossary we will be developing.

Survey:

You must complete this survey as your External Review.

While you can change your answers on any survey page until you complete or exit the survey, you cannot leave the survey and return to it. It is recommended that you complete your comments separately and then enter them into the survey at one time.

The survey questions are:

  • Is the language in the Guidelines clear and easy to understand?
  • Are there any recommendations or considerations that are missing from the Guidelines?
  • Overall, do you find the Guidelines practical and realistic?
  • Are there any comments for the Guideline Development Group at this stage?
  • Sections for each chapter topic to add specific comments/corrections – please ensure you organize any comments accordingly.

Specific Comments/Corrections:

  • Specific comments/corrections are ONLY to be included if crucial and required.
  • Ensure you add any comments/corrections in the appropriate section (e.g. topical anesthesia in Pain Management)
  • Indicate the number of the specific recommendation referred to (e.g., Chapter 5, 4.c.i or Chapter 29, 13.b)
  • Include your suggested wording of the revised recommendation
  • Suggestions or edits must be accompanied by supporting evidence and reference

The deadline to complete the survey is Thursday October 31, 2024 by 4:00pm EST.

Any questions, please contact Melissa Stark at cvaa@cvaa.info