Abstract:
Background: Clinical practice guidelines (CPG) support standardisation of vascular access care, yet the breadth, quality, and currency of arterial catheter (AC) recommendations remain unclear. This review aimed to identify and critically appraise CPG recommendations for AC insertion, management and removal in intensive care, including guideline quality and the evidence underpinning recommendations.
Methods: We conducted a systematic review of AC CPGs by searching databases and grey literature (January 2015-May 2026) for eligible guidelines reporting AC insertion (including indication), management, and/or removal recommendations. Two authors independently screened records, assessed CPG quality using the AGREE II tool, and appraised individual recommendations using a modified version of the Oxford Centre for Evidence Based Medicine (OCEBM) Levels of Evidence. Data were reported descriptively.
Results: A total of 915 records were identified, with six CPGs included. Overall methodological quality varied, with 61.1% (n = 22/36) of AGREE II domain scores meeting or exceeding the predefined adequacy threshold of 60%; however, evidence underpinning many recommendations was low, indirect or extrapolated. Ultrasound-guided and chlorhexidine-impregnated dressings were the only Grade A recommendations identified. Recommendations regarding the use of small gauge catheters and clinically indicated removal were downgraded due to indirectness of supporting evidence.
Conclusions: This review provides a contemporary appraisal of AC CPGs, highlighting variation in methodological quality and limited evidence underpinning many recommendations. These findings highlight the importance of considering both guideline methodological quality and the strength and directness of the evidence underpinning recommendations.
Implications for clinical practice: This review highlights variation in the strength and directness of evidence underpinning AC guideline recommendations, particularly in areas of AC management. Careful consideration of indication, avoidance of unnecessary insertion, and timely removal remain important strategies to minimise AC-associated harm.
Reference:Pearse I, Levido A, Corley A, Barker N, Marsh N, Keogh S. Insertion, management and removal of arterial catheters in intensive care: A systematic review of clinical practice guidelines. Intensive Crit Care Nurs. 2026 May 30;95:104465. doi: 10.1016/j.iccn.2026.104465. Epub ahead of print. PMID: 42217356.