Abstract:
Introduction: Safe vascular access is integral to anaesthetic and critical care practice. However, despite technological and procedural advances, it remains a frequent source of adverse events and patient harm. Ensuring a safe and effective approach to the selection, insertion and care of vascular access devices should be a priority for all practitioners.
Methods: This updated consensus statement builds upon previous iterations of safe vascular access guidelines. An expert, multidisciplinary, multi-society working party agreed on major themes and conducted a review of literature and best practice to build a comprehensive body of work. This was followed by a two-round Delphi process to agree on specific recommendations and to inform these concise guidelines.
Results: We agreed successfully 15 recommendations encompassing operational, training and clinical issues with an emphasis on a holistic approach to vascular access and long-term vessel health. These recommendations were divided into six major themes, covering: process (vascular access teams and responsiveness key performance indicators); device selection; insertion, including the use of safety standards, ultrasound, catheter tip position and vein/catheter ratios; the management of anticoagulation therapy, catheter-related thrombosis and coagulopathies; specific patient groups, including patients requiring renal replacement therapy, following mastectomy and axillary lymph node resection and the use of peripheral vasoconstrictors; and training in advanced vascular access.
Discussion: It is hoped that these guidelines, together with the larger body of work, will improve the care of patients who require vascular access, embed a more holistic approach to vascular access and lifetime vein preservation, and support staff and hospitals with vascular access service development.
Plain language summary
Putting tubes into veins (called vascular access or putting a ‘drip’ in) is very important for giving people medicine during surgery or when they are very sick. But even with new tools and better ways of doing it, problems still happen and patients can get hurt. Doctors and nurses need to be very careful when choosing, putting in and looking after these tubes. A group of experts from different medical backgrounds worked together to update the rules for doing this safely. They looked at the best ways to do it by reading lots of information and research. Then they voted on the best ideas to make a clear and simple list of suggestions. They came up with 15 important tips that talk about how to safely choose, place and take care of these tubes. These tips are split into six main parts, including: how teams should work and how fast they should help; how to choose the right kind of tube; how to safely put the tube in, using things like ultrasound; how to take care of patients who have blood problems or are on special medicines; special care for patients who have had kidney treatment or breast surgery; and training doctors and nurses to do this better. These new rules are meant to help patients stay safer when they need tubes in their veins. They also help hospitals do a better job and teach staff how to protect veins for future us.
Reference:Johnston AJ, Simpson MJ, McCormack V, Barton A, Bennett J, Chalisey A, Crane J, Curry S, Laycock H, Patel D, See T, Shubhaker J, Singh K, Thornton S. Association of Anaesthetists guidelines: safe vascular access 2025. Anaesthesia. 2025 Sep 17. doi: 10.1111/anae.16727. Epub ahead of print. PMID: 40958714.