Adverse events with arterial catheters in units of intensive care: a scope review protocol
Creators: name: Gomes, Patriny
name: BRAZ, ADRIANA
name: Paes, Graciele
Publisher: name: Open Science Framework
Year: 2023
Subjects: subject: Medicine and Health Sciences
subject: arterial catheter
subject: arterial line
subject: arterial pressure
subject: blood pressure determination
subject: critical care nursing
subject: hemodynamic monitoring
subject: intensive care units
subject: intra arterial lines
subject: patient harm
subject: patient safety
subject: scoping review

description: Background: Contemporary medicine has undergone significant changes with the advent of technology in the hospital setting. With the introduction of medical devices in clinical practice, accurate and real-time data became available to professionals responsible for caring for critical and complex patients. The challenge is present as professionals need specialized training toknow how to interpret this data in order to favor safe and effective decisionmaking(1). Hemodynamic monitoring is performed using catheters connected to monitors that show data and variables obtained in real time. It is useful in diagnoses, therapies and even in the prevention of alterations and injuries, in clinical and surgical contexts. Among the various monitoring data, invasive blood pressure is a non-specific data, but of great value regarding the evaluation of the patient's blood volume, use of inotropes and vasopressor(1,2). According to Vincent et al. (2011) the ideal monitoring is one that provides important, accurate and reproducible variables for therapeutic decision-making, addition to easy interpretation and availability. It must be an economical method that allows a quick response and, above all, does not cause harm to the patient(4). The installation of an arterial line is one of the invasive procedures performed in order to establish hemodynamic monitoring and, even with its clear importance in critical care contexts, it is still an invasive procedure, endowed with risks and subject to cause harm to patients. It is done through a percutaneous artery puncture, with the installation of a catheter connected to a pressurized system with a pressure transducer. This technology is capable of capturing pressure oscillations detected by the circuit and transforming them into electrical signals that will be encoded into waves of pressure readings and then displayed on multiparametric monitors(5,6). The procedure has well-defined indications in clinical practice, being for patients: critical, in intensive care units, especially with circulatory shock; in use of vasoactive medications; undergoing major surgery, the main cardiac, neurological and pulmonary; undergoing procedures in which the loss of a large volume of blood is expected; on mechanical ventilation with the need for serial blood gas analysis; and in need of frequent laboratory tests(7). Several incidents may be related to the implantation of an arterial catheter, namely: hematoma formation, device loss, hemorrhage, arteriovenous fistula formation, vessel stenosis, vascular failure, limb ischemia, thrombosis, distal necrosis, embolization, dissection artery, pseudoaneurysm formation and bloodstream infection. Erroneous decision-making related to the administered dose of vasoactive medications, due to wave analysis failure and system calibration, in addition to inadequate circuit assembly, also have a great impact on intensivist practice(7,8). According to Gerland (2014) it is estimated that more than a third of patients admitted to intensive care units (ICU) have an arterial line established during their stay and that, in the USA, about 2 million arterial catheters are inserted per year. In addition, the occurrence of adverse events associated with arterial catheters has a high impact on mortality rates, length of stay, delay in patient assessment and hospital costs. Failures related to improper cateter maintenance, displacement, bleeding, ischemia, and infections require cateter replacement in about 60% of cases. The development of strategies for early recognition and prevention of these events, with regard to safe practices, is necessary in this context (GERLAND, 2014 and DURIE; BECKMANN; GILLIES, 2002 apud LARSEN et al., 2021)(9-11). A preliminary search was conducted between December 2022 and January 2023 in the information sources JBI Evidence Synthesis, Cochrane Database of Systematic Reviews, CINAHL, PubMed, and Open Science Framework (OSF). On January 12, 2023, no scoping reviews or ongoing systematic reviews were found. Only one systematic guideline review, published in 2022, was identified. However, the study comprised seven guidelines focusing only on bloodstream infection for various vascular catheters. This makes clear the existing gap in publications of specific reviews and guidelines for arterial catheters and with the approach of other possible adverse events(12). A broad review of the literature becomes relevant to promote discussions and support the care of critical patients in a systematic way, in order to mitigate the occurrence of incidents related to this type of device, improving the quality indicators of the institutions, reducing the time of hospitalization, increasing patient satisfaction and considerably reducing costs related to highly complex care. Given the above, the objective of this study is to map the adverse events associated with the use of arterial catheters in critically ill patients in the scientific production. METHOD: This is a scope review that will be conducted in accordance with the methodology proposed by JBIinstitute. Using the checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses-PRISMA adapted for scope reviews, the PRISMA-ScR. Review question The research question was constructed using the PCC strategy, with the mnemonic elements being: P – population; C – Concept and C – Context. The elements were defined as: P (adult patients using arterial catheters); C (adverse events) and C (intensive care or critical care units). In such a way that the research question was: “Which adverse events related to the use of arterial catheters in adult ICU patients are most evident in the literature?”. Inclusion criteria Type of participants: The scope review in question will consider as participants those adult patients over 18 years of age who are using an arterial catheter for hemodynamic monitoring, which may be inserted in the radial, femoral, brachial, axillary and dorsalis pedis arteries. That is, studies in which patients are only using other intravascular devices, without including arterial ones, will not be included. Concept: This review will consider studies on adverse events associated with the use of arterial catheters. According to the World Health Organization (WHO), adverse events are all incidents that result in harm to the patient, including impairment of some body structure or function, injury, suffering, disability or death. The WHO characterizes the various factors that may contribute to the occurrence of these incidents, being circumstances, actions or influences capable of originating, contributing and even increasing the risk of occurrence of these events, which may be due to human, systematic or external origin. In the meantime, the study will consider any incidents that occurred during the insertion, maintenance, handling or removal of arterial catheters, with the occurrence of any harm to the patient(13,14). Context: Studies carried out in Intensive Care Units (ICUs) will be considered, regardless of the specialty, which may be clinical, surgical or cardiac, in public or private hospital institutions. As long as they are sectors intended for the treatment of critical and complex patients. Types of evidence sources The review will include articles of different methodological designs, primary or secondary, which may be quantitative, qualitative or mixed, as well as guidelines and expert opinions, as long as they respond to the research question. Theses and dissertations may also be included, as well as relevant productions that are on the reference list of the included studies. No temporal, geographic or language cut will be established. Data collection will take place in the following databases: LILACS, through the Biblioteca Virtual em Saúde; MEDLINE, through the National Library of Medicine National Institutes of Health (PUBMED); EMBASE; CINAHL, by EBSCOhost; and WEB OF SCIENCE. The search in gray literature will also be performed, using the Google Scholar. Search strategy The search in the databases will be carried out in three stages. The first step consists of an initial search in two databases, Medline (PUBMED) and CINAHL. Aiming to analyze words contained in titles and abstracts of articles captured, in addition to indexing terms. Subsequently, the second step will be performed with a comprehensive search containing all indexed terms and keywords in all included databases. Search strategies for each database will be structured with the help of a librarian. The third and final step will be with the Search manual in the reference lists of the studies included in the review. In the case of studies with full texts unavailable in the databases, the authors will be contacted. Selection of studies After searches have been carried out in the databases, accessed via the Portal Periódicos Capes, the results will be exported to the reference manager EndNote Web, where duplicates will be identified and then deleted. Subsequently, the study sample will be exported to therayyan software, Where the blind evaluation will be carried out by two reviewers. The inclusion and exclusion criteria will be applied by the two reviewers independently, analyzing titles and abstracts. Soon after, a consensus meeting will be held to compare the selected studies. A third reviewer will be consulted in case there is disagreement regarding the inclusion of a study. Then, after capturing the pre-selected studies, the studies will be read in full. The analysis will be carried out in detail, based on the inclusion criteria already established, possible exclusions must be justified. This entire process will be described in a narrative and detailed way by completing the PRISMA-ScR flowchart. Data extraction Data from the included studies will be independently extracted by two reviewers, using an extraction form developed by the reviewers. This form must contain data recommended by the JBI manual, such as: authors, year of publication, country of origin (where the source was published or conducted), objectives, population, context, and sample size within the source of evidence (if applicable), methodology, type of intervention (if applicable), results, and key findings related to the scoping review question. A pilot test will be carried out with the initial form. The extraction test will be done on at least two selections. The extraction form can be modified in the course of the selection, depending on the need. The necessary modifications will be detailed in the review, as well as the entire data extraction process. At the end of the extractions, the data extracted by the two reviewers will be compared and in case of disagreement, the third reviewer will be called. Data analysis and presentation The data found in the review will be presented in tables and charts, with descriptive and narrative analysis of the results, providing a broad view of the approach to adverse events associated with arterial catheters in the scientific literature. In the end, the objective is to answer the research question. STRATEGY: Search strategy applied in the Medline database (Pubmed), on January 15, 2023, which resulted in 129 publications. ((("blood pressure determination"[mh] OR "blood pressure determination"[tiab] OR "blood pressure monitors"[tiab] OR "blood pressure monitor"[tiab] OR "blood pressure"[mh] OR "blood pressure"[tiab] OR "arterial pressure"[mh] OR "arterial pressure"[tiab] OR "arterial pressures"[tiab] OR "hemodynamic monitoring"[mh] OR "hemodynamic monitoring"[tiab] OR "vascular access devices"[mh] OR "vascular access devices"[tiab] OR "vascular access device"[tiab] OR "intra arterial lines"[tiab] OR "intra arterial line"[tiab] OR "arterial lines"[tiab] OR "arterial line"[tiab] OR "arterial catheter"[tiab] OR "arterial catheters"[tiab])) AND (("patient harm"[mh] OR "patient harm"[tiab] OR "patient safety"[mh] OR "patient safety"[tiab]))) AND (("intensive care units"[mh] OR "intensive care units"[tiab] OR "intensive care unit"[tiab] OR "icu intensive care units"[tiab] OR "critical care"[mh] OR "critical care"[tiab] OR "intensive care"[tiab] OR "critical care nursing"[mh] OR "critical care nursing"[tiab])) REFERENCES: 1 - AL-QATATSHEH, A. et al. 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Treasure Island (FL): StatPearls Publishing, 2022. PMID: 32310587. 8 - OGLIARI, A. L. C.; PIAZZETTA, G. R.; FILHO, C. G. M. Punção arterial. VITTALLE - Revista de Ciências da Saúde, [S. l.], v. 33, n. 1, p. 124–131, 2021. 9 - LARSEN, E. N., et al. A pilot randomised controlled trial of dressing and securement methods to prevent arterial catheter failure in intensive care. Australian Critical Care, 34, n. 1, p. 38-46, 2021. 10 - BRULL, S. J.; PRIELIPP, R. C. Vascular air embolism: A silent hazard to patient safety. J Crit Care. 2017 Dec;42:255-263. 2017. 11 - OU, Q., et al. Arterial catheterization and in-hospital mortality in sepsis: a propensity score-matched study. BMC Anesthesiol. 2022 Jun 9;22(1):178, 2022. 12 - WANG, Y., et al Appraising the quality of guidelines for peripheral arterial catheters care: A systematic review of reviews. Aust Crit Care. 2022 Jul 1:S1036-7314(22)00064-9. doi: 10.1016/j.aucc.2022.03.014. 13 - WHO. Global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care. Geneva: World Health Organization; 2021. 14 - WHO. Conceptual Framework for the International Classification for Patient Safety. Geneva: World Health Organization; 2009.