An interventional study of Training program on long peripheral catheter insertion in Vascular Access Devices, Vascular Access and Vascular Access Complication, sponsored by Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz. Not yet recruiting. Per ClinicalTrials.gov, last updated 2026-10-16.
Sponsored by Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz · Not applicable, Interventional, and Health services research
The purpose of this study is to evaluate the impact of a training intervention aimed at nursing personnel on the appropriateness of the indication of long peripheral venous catheters in candidate pediatric and neonatal patients, comparing the clinical practice of nursing personnel before and after the intervention.
Study Design: Prospective, unicentric quality improvement study.
The study consists of three phases:
The collection of data over a prolonged period is contemplated, can be extended up to 24 months after the intervention, to analyze the maintenance of the adequacy in the indication of peripheral venous catheters, the incidence of complications and the stability of the clinical results. In a complementary way, the maintenance of the knowledge acquired by the nursing staff and the adherence to the protocol in routine clinical practice will be assessed.
Study Population and Total Number of Patients: The study population is structured in two levels: professional population (intervention) and clinical population (pre- and post-intervention).
Professional population (intervention phase) The study population corresponding to the intervention phase will consist of the group of nursing professionals of the Pediatric and Neonatology Service of the Jiménez Díaz Foundation University Hospital , who participate in the training intervention on ultrasound vascular assessment, channeling of long peripheral venous catheters and implementation of the care protocol.
The service has a care staff of 21 nursing professionals (approximately 3 to 5 per shift), distributed among the pediatric hospitalization floor, Pediatric Intensive Care Unit (PICU) and Neonatology Unit.
Regarding their characteristics, the age of the professionals is approximately between 25 and 50 years, with an estimated average of around 35-40 years. Professional seniority varies between approximately 1 and 30 years of experience.
The training intervention will be offered to all staff of the Pediatric Service, although participation will be voluntary, so no sample calculation is established at this stage.
The following will be evaluated for this population:
Schedule and Expected Date of Completion: The study is expected to begin in September 2026 , subject to obtaining approval from the Research Ethics Committee. The development period of the study will extend until October 2028 , including the preparation phase, the collection of pre-intervention data, the implementation of the training intervention and the subsequent follow-up of the participants and pediatric and neonatal patients. The study includes a short-, medium- and long-term follow-up, as well as the closing phase, data analysis and writing of the final report. These dates are estimates and could be adjusted according to the evolution of data collection and clinical follow-up.
Venous cannulation is a common and universal practice, being one of the most frequent invasive interventions in the hospital setting, not without morbidity at times. It consists of direct access to the vascular tree of the patient for therapeutic, diagnostic and monitoring purposes.
Its implementation requires that nursing personnel have updated knowledge based on scientific evidence to select the appropriate vascular catheter and choose the most suitable vein, as well as an adequate technique of insertion, use and maintenance of the catheter. All this with the purpose of providing safe, homogeneous, and quality care to the patient.
The challenge increases in pediatric patients due to their anatomophysiological characteristics, limited collaboration, and the higher frequency of complications related to vascular access, which can cause treatment interruptions and generate emotional stress for both the child and the family due to the need for vascular access. repeated channeling; to identify pediatric patients with difficult venous access, tools such as the DIVA (Difficult Intravenous Access) scale are used, adapted to Spanish as DIVA Score - SP.
The choice of the type of catheter depends on the type of medication, the duration of treatment, and the characteristics of the patient. This decision is crucial for success.
Currently, venous vascular access devices (VAD) are divided, according to the location of the catheter tip, into peripheral venous catheters and central venous catheters.
Three types of peripheral venous catheters are distinguished: short peripheral catheter, long peripheral catheter (minimidline) and midline catheter.
However, the present study will focus exclusively on short and long peripheral catheters, which are the devices subject to intervention and analysis.
Midline catheters were excluded because they are mainly indicated for intravenous therapies of prolonged duration, usually several weeks or even months, a care context that does not correspond to the usual clinical practice of our center. In our hospital, the intravenous treatments administered generally have a shorter duration, so the use of mini-midline catheters is more appropriate, as they are indicated for short-to-medium duration therapies, approximately one to two weeks.
In addition, midline catheters are channeled into deep veins, which can hinder the early detection of certain local complications, as they manifest later clinically compared to short and long peripheral catheters.
Short peripheral catheters have several limitations. Its duration is limited, approximately 2-3 days. Other factors that contribute to its limitations include the rigidity and low biocompatibility of the material and its potential complications.
These limitations lead to the removal of the catheter and, frequently, the placement of a new one, causing interruptions of therapy, increasing hospital costs, vascular exhaustion, as well as pain, anxiety of the patient/family, and distress in the nursing staff.
The failures of this device are due to three factors: patient, device or insertion technique, with some being preventable by appropriate prevention and management measures, including the correct choice of the type of catheter.
In recent years, long peripheral catheters have emerged as an alternative to short peripheral catheters, offering a longer duration and lower risk of complications. These devices, usually made of polyurethane and with lengths that vary between 6 and 15 cm, are inserted in superficial veins of the arm or forearm by direct technique or, in deep venous vessels, under ultrasound guidance, with the tip of the device located in the veins. basilic, brachial or cephalic, which never exceeds the axilla.
The available evidence shows that these catheters, compared to short ones, provide a more stable and longer-lasting vascular access, reducing the frequency of complications and the need for repeated venipunctures. This contributes to improving safety, efficiency of care, the experience of the patient and their families, and optimizing hospital costs.
It has a number of advantages over short peripheral catheters, including a lower number of complications, due to the following:
Location of the tip: the tip of the catheter is placed in a vein of larger caliber, with greater blood flow and better hemodilution, decreasing chemical irritation and the risk of chemical phlebitis, infiltration and patient discomfort.
Mechanical stability: greater length of the catheter within the vessel provides more secure fixation, reducing the risk of displacement or accidental exit and helping to minimize PFC (phlebitis complications).
-Insertion technique : the use of the Seldinger technique allows a more controlled cannulation, reducing venous trauma and local complications.
On the other hand, the use of long peripheral venous catheters is often associated with the use of ultrasound as a support tool compared to short peripheral catheters, which provides several advantages:
However, despite the fact that recent studies and research suggest the use of long peripheral venous catheters when a prolonged treatment is required in the pediatric population, in routine clinical practice its use continues to be limited, mainly due to the lack of updated protocols and the limited specific training of personnel. The use of short peripheral venous catheters predominates even in patients potentially candidates for long catheters.
Several studies have described relevant rates of complications and failure associated with the use of short peripheral venous catheters in the pediatric population, as well as differences in clinical results when compared with long peripheral catheters.
This discrepancy between the available evidence and clinical practice justifies the need to develop strategies aimed at improving the adequacy in the choice of venous access device. In this context, the implementation of an intervention aimed at nursing personnel is proposed with the aim of increasing the appropriate use of long peripheral catheters in pediatric and neonatal patients.
The results of this work could contribute to improving the quality of care, reducing the number of venipunctures, minimizing the pain and anxiety of the patient and their family, reducing the emotional and care burden of the nursing staff and optimizing the use of resources. available.
Finally, this study presents a clear practical applicability, since it will allow the development and implementation of a protocol validated for cannulation of long peripheral venous catheters in pediatrics, based on the available scientific evidence, as well as the design and development of a specific training plan for pediatric nursing personnel. These actions aim to improve adherence to evidence-based practices, contributing to safer, more efficient, and higher-quality pediatric care.
Hypothesis: The implementation of a training intervention aimed at nursing personnel will increase the adequacy in the indication of long peripheral venous catheters in candidate pediatric and neonatal patients, compared to usual clinical practice prior to the intervention.
Primary objective
-To evaluate the impact of a training intervention aimed at nursing personnel on the appropriateness of the indication of long peripheral venous catheters in candidate pediatric and neonatal patients, comparing the clinical practice of nursing personnel before and after the intervention.
Secondary Objectives
Complications and clinical results:
Clinical practice and appropriateness:
Educational intervention and professionals:
Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz is the lead sponsor of 74 studies on the registry; 25 are open to participants now.
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Nursing professionals:
Patients:
Exclusion Criteria:
Nursing professionals:
Patients:
Single group, pre-post design. Pediatric nurses receive a training program on long peripheral catheters. Outcomes are measured in the participating nurses and in the pediatric and neonatal patients they care for, before and after the training.
Behavioral: Training program on long peripheral catheter insertion
Structured educational program for pediatric nurses on the insertion and maintenance of long peripheral catheters. The program combines theoretical content and hands-on practical training. Content includes indications and device selection, insertion technique, aseptic technique, catheter securement and maintenance, and early recognition and prevention of complications such as phlebitis, occlusion, infiltration, and accidental dislodgement.
Percentage of Long Peripheral Venous Catheter Insertions With an Appropriate Indication
Percentage of long peripheral venous catheter insertions performed by participating nurses in pediatric and neonatal patients whose indication meets the unit's protocol criteria for long peripheral catheters. The appropriateness of the indication will be recorded at each insertion using an ad hoc data collection form. Calculated as (number of insertions with an appropriate indication / total number of long peripheral venous catheter insertions) x 100. The baseline pre-intervention period will be compared with each post-intervention data collection window.
Time frame: Baseline (3-month pre-intervention period) and 0-3, 6-9 and 12-15 months after completion of the training program
Change From Baseline in Nurses' Knowledge Score on Long Peripheral Venous Catheters
Knowledge of participating nurses about long peripheral venous catheters (indications and device selection, insertion technique, aseptic technique, securement and maintenance, and prevention and early recognition of complications) will be assessed with an ad hoc questionnaire of multiple-choice items. The score is expressed as the percentage of correct answers (range 0-100%), where higher scores indicate greater knowledge. Results will be reported as the change from the pre-training score at each post-training time point.
Time frame: Baseline, immediately after completion of the training program, and at 3, 6 and 12 months after completion of the training program
Percentage of Peripheral Venous Catheters With at Least One Complication
Percentage of peripheral venous catheters in pediatric and neonatal patients cared for by participating nurses that present at least one complication between insertion and removal. Complications include phlebitis, infiltration/extravasation, occlusion and accidental dislodgement, assessed by nursing staff and recorded on an ad hoc data collection form. Calculated as (number of catheters with at least one complication / total number of catheters) x 100. The baseline pre-intervention period will be compared with each post-intervention data collection window. Results will also be reported by age group.
Time frame: Baseline (3-month pre-intervention period) and 0-3, 6-9 and 12-15 months after completion of the training program
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