Impacto de los equipos hospitalarios multiprofesionales de acceso vascular guiado por ecografía

Introduction Vascular access is essential for administering intravenous therapies in both hospital and outpatient settings.The traditional technique, based on palpation and visualization of veins, has significant limitations, particularly in patients with variable anatomies or underlying medical conditions. Ultrasound- guided vascular cannulation has emerged as an innovative solution, providing greater accuracy and safety in catheter placement while also enhancing patient comfort and confidence. However, the use of ultrasound-guided vascular cannulation and specialized training in vascular access management still face challenges and variability in their implementation in clinical practice within Spanish hospitals. Furthermore, the involvement of multidisciplinary teams, composed of physicians, specialized nurses, technicians, and other professionals, would ensure a comprehensive and high-quality approach to intravenous therapy management. Objective To evaluate the safety, efficacy, and effectiveness of ultrasound-guided vascular access in patients requiring intravenous therapy, comparing its therapeutic benefits with traditional techniques. Additionally, the impact of implementing multidisciplinary teams on improving these procedures is analyzed. Methods A systematic literature search was conducted in the following reference databases until May 2023: Medline (Ovid), Embase (embase.com), Web of Science, Cochrane Library, Cinahl (Ebsco) and INAHTA. Additionally, websites such as CADTH, AHRQ, NICE, HIS, HIQA, and those belonging to the Spanish Network of Health Technology Assessment Agencies (RedETS) were explored. A search was also conducted to identify cost studies and economic evaluations in the main databases for economic studies: NHS EED and CEA Registry, as well as in the Medline and Embase databases, using economic terms and filters. Two independent researchers carried out the selection of studies and their quality analysis. The synthesis of results was conducted qualitatively. The quality of studies was evaluated using the AMSTAR-2 tool for systematic reviews and the FLC 3.0 tool from Osteba for economic evaluation studies. Results Studies have been identified to evaluate the effectiveness, safety, efficiency, and organizational aspects of ultrasound-guided vascular access and multidisciplinary vascular access teams in the hospital setting. Fifteen systematic reviews were identified and analyzed, providing information on the efficacy/effectiveness and safety of ultrasound-guided vascular access with critically low, low, moderate, and high-quality evidence, two systematic reviews addressing organizational aspects of ultrasound-guided cannulation, and five economic evaluation studies. In terms of efficacy/effectiveness, the results showed that ultrasound- guided cannulation can significantly increase the success rates of catheter placement and first-attempt success, particularly in patients with difficult intravenous access (DIVA), both for peripheral and central venous access. In the pediatric population, most studies showed statistically significant improvements in these variables for peripheral venous access. The use of ultrasound guidance may reduce the number of cannulation attempts, although not all studies demonstrate this reduction. Ultrasound guidance did not show a reduction in cannulation time for peripheral vascular access (PIV), but a decrease in procedure duration for central venous access (CV) was observed in the adult population. Studies on patient satisfaction showed mixed results, with higher satisfaction in DIVA patients, although only one found significant differences in the general population. Additionally, patients using a specialized vascular access team reported high levels of satisfaction, with reduced pain, and healthcare professionals experienced a lower workload. Multidisciplinary ultrasound-guided vascular access teams are composed of physicians, nurses, specialized nurses, technicians, and interventional radiologists, who present heterogeneous experience, training, and education across the various studies. In terms of costs, the results of several studies reveal that implementing a specialized vascular access team and using ultrasound for venous cannulation lead to cost and resource savings. Conclusions Ultrasound-guided vascular access can be an alternative to the traditional method. In terms of safety, some studies report a decrease in complications, particularly in CVA in adults and children; other studies found no significant differences in overall complications for PIV. In patients with DIVA, ultrasound-guided vascular access shows higher satisfaction compared to the traditional method. Regarding efficacy/effectiveness, the use of ultrasound guidance reduces the number of cannulation attempts in most of the studies reviewed, but this reduction was not consistent across all studies. Ultrasound guidance significantly increases the success rate, both for PIV and CVA, especially in difficult patients, such as pediatric patients or those with DIVA. For central venous access, the results favor ultrasound use in the adult population, while for peripheral access, there is no significant difference in procedure time between ultrasound-guided cannulation and the traditional method. Organizational challenges are identified, including staff training and resource availability. Studies highlight the need for standardized training to optimize outcomes and ensure uniform practice across different clinical settings. Training in ultrasound for intravenous cannulation improves clinicians’ competence and confidence, but it is necessary to standardize educational programs and ensure the availability of equipment to optimize clinical outcomes and patient satisfaction. Economic analyses suggest savings with the implementation of ultrasound guidance for both central and peripheral venous cannulation, reducing costs, improving resource utilization, and demonstrating economic benefits that outweigh the initial costs of development and training.