Implementation Frameworks, Strategies, and Outcomes in Optimizing Central Venous Access Device Practice in Neonates: A Scoping Review

Abstract

BACKGROUND AND OBJECTIVES: Central venous access devices (CVADs) are critical for neonatal care, but inconsistent CVAD practices remain a challenge and impact clinical outcomes. This scoping review aimed to determine which implementation frameworks, strategies, and outcomes are reported for neonates with CVADs. METHODS: EMBASE, CINAHL (EBSCO), PubMed, Web of Science, and Cochrane Library (CENTRAL) databases were searched. All included studies examined were relevant to study aims, published from 2012 to August 2024, and in English. Two reviewers independently screened each study to determine inclusion eligibility, with a third resolving conflicts. The Mixed Methods Appraisal Tool was used to assess study quality. RESULTS: Of the 2176 studies identified, 44 studies were included, predominantly performed in intensive care units (n = 41; 93%), at a single site (n = 39; 89%), and over a 1- to 5-year period (n = 33; 75%). "Quality improvement" was the most popular implementation framework (n = 27; 61%). Implementation strategies commonly cited were health professional education (n = 35; 80%), audits and surveillance (n = 34; 77%), and bundles (n = 29; 66%). Multiple implementation strategies were often used simultaneously (n = 43; 98%), and effectiveness and implementation outcomes were combined (n = 20; 45%). Infection was the most commonly reported outcome (n = 37; 84%), and intervention compliance was reported in 50% of studies (n = 22). CONCLUSIONS: Current implementation frameworks for CVAD practice are largely driven by unstructured quality improvement initiatives, focusing on a limited range of strategies for health care professionals. Broader, outcome-focused approaches to implementation research in neonatal CVAD practice have not been completed to date.