Introduction

Ensuring and maintaining vascular access constitute a key element of contemporary healthcare, particularly in anaesthesiology and intensive care. Vascular access enables infusion therapy, medication administration, transfusion of blood products, and monitoring of haemodynamic parameters [1]. Despite its widespread use, vascular access is associated with the risk of complications such as thrombosis, infections, and mechanical injuries, which may lead to deterioration of the patient’s condition, prolonged hospitalisation, and increased treatment costs [2].

Various types of vascular access devices are used in clinical practice, and their selection should take into account the expected duration of therapy, the properties of the administered substances, and the patient’s clinical condition. The most commonly used device remains the short peripheral catheter (SPC). For intermediate-term therapy, midline catheters (MCs) and long peripheral catheters (LPCs) are increasingly important. Central vascular access devices include centrally inserted central catheters (CICCs) and peripherally inserted central catheters (PICCs) [1].

Despite their widespread use, SPCs remain the most common source of irregularities resulting from improper use and maintenance [3]. At the same time, the growing role of MCs as an alternative to peripheral and central vascular access requires appropriate competencies among medical personnel, highlighting the importance of proper vascular access device selection.

The selection of vascular access is a multifactorial process, dependent not only on clinical knowledge but also on organisational and behavioural factors that may contribute to discrepancies between recommendations and clinical practice [4]. Clinical management is based on established guidelines, including the standards of the Infusion Nurses Society (INS), which define the principles of vascular access device selection, insertion, and maintenance [5]. Despite their availability, implementation varies across clinical settings [6, 7].

Nursing personnel play a key role in infusion therapy and are responsible for obtaining, maintaining, and monitoring vascular access. The literature emphasises their high level of practical competence and involvement in clinical decision-making [6, 8]. The development of advanced skills, including the use of ultrasonography, reflects the expanding role of nurses in vascular access management [9, 10].

To improve the quality of care, some healthcare facilities have implemented vascular access teams (VATs), which support the standardisation of procedures and clinical decision-making. The operation of these teams may improve care organisation and facilitate the implementation of evidence-based practice; however, the availability of such teams remains limited [11-13].

Despite the growing importance of vascular access optimisation, data regarding the implementation of guidelines in anaesthesiology practice remain limited. Therefore, research aimed at identifying gaps in knowledge and practice, as well as determining barriers to the implementation of recommendations in Polish healthcare institutions, is warranted. The findings may contribute to improving patient safety and strengthening the role of nursing personnel in the field of infusion therapy and vascular access management.

The aim of the study was to comprehensively assess the level of knowledge, clinical practices applied in everyday patient care in relation to current guidelines and evidence-based practice, as well as awareness of professional competencies among anaesthesiology personnel.

Material and methods

The study was conducted using the diagnostic survey method with an original questionnaire developed in Google Forms. The survey was distributed via social media and among researcher’s colleagues. Data collection was carried out between 20 January and 4 March 2026. A total of 100 respondents participated in the study. The study included two professional groups: nurses and physicians. The participants were divided into four groups: Specialists in Anaesthesiology and Intensive Care, Residents in Anaesthesiology and Intensive Care, Specialists in Anaesthetic and Intensive Care Nursing, and Nurses in Specialty Training in Anaesthetic and Intensive Care Nursing.

The study protocol was approved by the Bioethics Committee of the Medical University of Warsaw (approval no. AKBE/12/2026). It consisted of 43 single-choice and multiple-choice questions grouped into the following sections: demographic data, organisation of care, clinical practice, vascular access device replacement, aseptic technique, and clinical knowledge.

The study included nurses and physicians specialising in in anaesthesiology and intensive care at various stages of training who were actively working in the field of anaesthesiology and intensive care. The inclusion criteria comprised professional practice in healthcare institutions located in Poland and informed consent to participate in the study. The exclusion criteria included lack of employment in the field of anaesthesiology and intensive care, not practising as an anaesthesiologist or anaesthesiology nurse, and lack of consent to participate in the study. Participation in the study was voluntary and anonymous.

Statistical analysis was performed using IBM SPSS Statistics software. The chi-square test, Mann-Whitney U test, Kruskal-Wallis H test, and Spearman’s rank correlation were applied. A p-value of < 0.05 was considered statistically significant.

Results

The study included 100 respondents. The largest group consisted of specialists in anaesthetic and intensive care nursing, accounting for 51% (n = 51), followed by nurses in the process of specialisation, who represented 29% (n = 29). Medical doctors who were specialists and those undergoing specialisation each constituted 10% of the sample (n = 10 and n = 10, respectively).

Regarding the respondents self-reported professional and academic qualifications, 67% (n = 67) indicated holding a master’s degree, 44% (n = 44) reported having a professional specialization, 22% (n = 22) held a bachelor’s degree, and 2% (n = 2) held a doctoral degree. As the questionnaire allowed respondents to select more than one answer, the reported percentages refer to the proportion of respondents indicating each qualification relative to the total study sample (N = 100) and therefore do not necessarily sum to 100%.

In terms of care organisation, 52% (n = 52) of respondents reported team-based decision-making regarding the selection of vascular access devices. The most frequently indicated barrier to the functioning of vascular access teams (VATs), for which respondents could select multiple options, was lack of managerial support 73% (n = 73), followed by insufficient staff knowledge 63% (n = 63), lack of support from other departments 44% (n = 44), lack of time 43% (n = 43), equipment-related limitations 36% (n = 36), and legal or competence-related barriers 16% (n = 16).

Access to ultrasound (USG) for healthcare personnel was reported by 77% (n = 77) of respondents, while 12% (n = 12) indicated that it was available exclusively to physicians and 10% (n = 10) to trained staff. One respondent reported no access to ultrasound.

At the same time, the use of this method was limited: 72% (n = 72) of respondents indicated “never,” “rarely,” or “sometimes,” whereas only 28% (n = 28) reported regular use (Fig. 1), indicating a clear discrepancy between availability and practical utilisation.

For the item concerning the formal functioning of vascular access teams (VATs), respondents were allowed to select only one response. Formal VAT functioning was reported by 50% (n = 50) of respondents, with the following service arrangements reported: on-demand service 24% (n = 24), 24-hour coverage 14% (n = 14), daytime service 11% (n = 11), and other 1% (n = 1). The absence of a VAT was reported by 31% (n = 31) of participants, while 19% (n = 19) indicated the presence of informal organisational arrangements.

In clinical practice, routine use of the Zone Insertion Method (ZIM) was reported by 35% (n = 35) of respondents. In cases of unsuccessful cannulation, the most commonly reported approach was seeking assistance from another member of the nursing team (69%, n = 69), while ultrasound guidance was used less frequently (22%, n = 22). Ultrasound was also infrequently used in the diagnosis of vascular catheter occlusion.

The most commonly selected vascular access for planned therapy lasting longer than 4 days, without the need for solutions with an osmolality of > 600 mOsm/l and in the absence of clear indications for central venous catheter insertion, was a short peripheral intravenous cannula, reported by 56% (n = 56) of respondents, followed by a midline catheter
in 29% (n = 29; Fig. 1). Despite the lack of absolute indications, central venous catheters were indicated in 8% (n = 8) of cases.

The most commonly used flushing technique was the pulsatile method using 0.9% sodium chloride (NaCl), reported by 82% (n = 82) of respondents, while 15% (n = 15) reported continuous flushing (Table 1).

Variation in the use of the side port of SPCs was observed: 45% (n = 45) of respondents reported selective use, 39% (n = 39) did not use it, and 11% (n = 11) used it routinely.

In terms of disinfection practices, 36% (n = 36) of respondents reported using both active and passive methods interchangeably, 20% (n = 20) used passive disinfection only, and 17% (n = 17) used active disinfection exclusively.

The assessment of clinical knowledge revealed a lack of uniform practices regarding the transfusion of blood products: 43% (n = 43) of respondents indicated the need for establishing an additional vascular access, while 56% (n = 56) considered it unnecessary (Table 1).

The majority of respondents (73%, n = 73) did not routinely use heparin for flushing arterial lines. The correct catheter-to-vein diameter ratio (1/3) was indicated by 65% (n = 65) of respondents.

In the diagnosis of vascular access occlusion, 54% (n = 54) of respondents did not use ultrasound, 38% (n = 38) used it occasionally, and 8% (n = 8) used it routinely.

The most commonly used stabilisation method was suture fixation, reported by 74% (n = 74) of respondents, whereas sutureless securement systems were used by 26% (n = 26) of participants (Table 1).

Almost all respondents (98%, n = 98) indicated that nurses may insert midline catheters and LPCs. The possibility of cannulation of the external jugular vein by nursing staff was confirmed by 84% (n = 84) of respondents, indicating a relatively high level of awareness regarding professional competencies, although awareness varied among respondents.

The results obtained indicate that the level of knowledge regarding vascular access did not differ significantly depending on professional group (H = 6.390, p = 0.094), length of service (H = 4.582, p = 0.205), or place of employment (H = 3.328, p = 0.344). The only factor that significantly differentiated knowledge levels was educational attainment (H = 2.097, p = 0.036; Table 2).

Higher levels of knowledge were observed among respondents undergoing specialisation training, both among nursing and medical staff. Differences also concerned familiarity with the INS guidelines: H = 20.372, p < 0.001; Gruppo di Accessi Venosi a Lungo Termine (GAVeCeLT): H = 11.408, p = 0.010; European Recommendations on Peripheral Intravenous Access (ERPIUP): H = 12.229, p = 0.007; national recommendations: H = 12.099, p = 0.007 (Table 3).

Discussion

Clinical experience without continuing education does not ensure the maintenance of up-to-date medical knowledge. A similar perspective was presented in the study by Horntvedt et al., which demonstrated that the development of evidence-based practice (EBP) competencies, such as the ability to formulate research questions and critically appraise the methodological quality of studies, depends primarily on educational approaches and teaching strategies employed by academic instructors, rather than solely on years of clinical experience [14]. These skills constitute a key component of clinical problem-solving across autonomous healthcare professions. The cited literature supports the findings of the present study, indicating that knowledge acquired through continuous professional development may be more closely associated with the implementation of evidence-based practice than clinical experience alone. Proper and conscious application of EBP is a fundamental element in ensuring patient safety [14]. In the present study, educational level (p = 0.036) was identified as a statistically significant factor associated with the level of knowledge regarding vascular access. At the same time, length of professional experience (p = 0.205) was not significantly associated with knowledge level. Similar findings were reported by Furuki et al., who demonstrated a strong association between educational level (p < 0.001) and clinical knowledge, without indicating a statistically significant relationship between years of professional experience and knowledge level [15]. The importance of continuous education in accordance with EBP principles is also supported by previous reports [6].

Knowledge of guidelines and recommendations regarding vascular access was assessed across the studied professional groups, and the following hypothesis was formulated: there are no statistically significant differences in the level of knowledge of current vascular access recommendations between the studied groups. This hypothesis was rejected. Nursing staff demonstrated the highest mean values (M) compared with medical staff. This indicates that professional group affiliation may be associated with differences in the level of guideline knowledge. Higher mean values (M) of knowledge related to guidelines and recommendations among nursing staff may reflect the need to continuously update knowledge during specialist training, as well as differences in educational models, including a more theoretical approach in medical education and a stronger emphasis on practical aspects in nursing education. Chiu et al. present different findings, highlighting the role of systemic and cultural factors in shaping the level of knowledge and clinical practice [16]. At the same time, these findings may be considered alongside observations reported by Furuki et al., who emphasised the key role of practical education and training in knowledge of recommendations and guidelines [15, 16]. This approach is consistent with the concept of practical nursing education, which is reflected in better outcomes in the implementation of knowledge among individuals participating in clinically oriented training. The lack of correlation between years of professional experience and knowledge level may suggest that maintaining up-to-date clinical knowledge requires greater emphasis on continuous professional development rather than relying solely on work experience, which remains an important foundation of clinical competence.

Differences between professional groups also concerned practical knowledge. Nursing staff more frequently correctly identified SPC flow parameters as well as principles for selecting an appropriate catheter-to-vein size ratio. This may be related to greater exposure to infusion-related procedures and their clinical consequences. Proper catheter selection is crucial for reducing complications and optimizing therapy, which highlights the role of nurses in the implementation of standards developed, among others, by the INS [5].

A significant issue remains the discrepancy between the availability of ultrasound (USG) and its actual utilisation. Despite widespread access (77%), only 28% of respondents reported its regular use. According to clinical guidelines, ultrasound guidance improves cannulation success rates and reduces the number of attempts [5, 10]. The low frequency of use may be attributed to time constraints, lack of confidence in one’s competence, limited team support, and the absence of routine identification of patients with difficult intravenous access (DIVA).

An additional barrier is the persistence of landmark-based techniques, despite recommendations for their gradual replacement with image-guided methods [17].

A similar pattern was observed in cases of failed cannulation, where team-based assistance was preferred over the use of ultrasound. This indicates that the availability of technology does not automatically translate into its implementation in clinical practice. These findings are consistent with previous reports highlighting a high level of awareness regarding the use of ultrasound, accompanied by limited integration into routine practice [6, 10, 18].

Analysis of clinical decision-making suggested the absence of full standardisation in vascular access selection. Despite the lack of indications, 8% of respondents opted for central venous access. According to INS and ERPIUP guidelines, the choice of vascular access should depend on the duration of therapy, the physicochemical properties of administered agents, and the risk of complications [5, 18]. This finding may reflect established clinical practices, equipment-related limitations, or insufficient availability of specialised vascular access teams [13, 19].

Variability in clinical practice also concerned the use of heparin for arterial line flushing (c² = 15.354, p = 0.018). The majority of respondents indicated that its routine use was not justified, which is consistent with current recommendations emphasizing the need for individualised clinical management [20].

Lack of standardisation was also observed in transfusion practices, where 43% of respondents reported the need for establishing an additional vascular access despite the absence of clear indications. Such practices may increase procedural invasiveness and patient burden, whereas guidelines recommend the use of an existing vascular access whenever possible [5, 21].

With regard to vascular access stabilisation, suture fixation predominated despite recommendations favouring sutureless securement systems. These systems were used less frequently in paediatric patients, which may be related to concerns regarding their effectiveness. However, the literature indicates that sutureless systems may improve safety and reduce complication rates [5, 22, 23].

In organisational aspects, the findings indicate limited availability of vascular access teams (VATs). Only 14% of respondents reported 24-hour VAT coverage, while 31% indicated the absence of formal structures. The main barriers included lack of managerial support, insufficient knowledge, and time constraints. Effective VAT functioning requires systemic support and clearly defined organisational structures [11, 12], and their implementation may contribute to improvements in the quality of care and patient safety [8, 13].

The obtained results indicate that improving vascular access practice requires both educational interventions and organisational changes. The implementation of standardised protocols, the development of training programs, and the strengthening of vascular access teams (VATs) may enhance adherence to clinical guidelines and improve patient safety.

Limitations of the study

The study has several methodological limitations. The use of an original questionnaire carries a risk of measurement error, while reliance on self-reported data limits the ability to directly assess clinical practice. An additional limitation of the study was the small number of physicians compared with nurses, which may have reduced the statistical power of the analyses and increased the risk of overinterpretation of the observed differences. The imbalance in group sizes was primarily related to the staffing structure of the participating units, where the number of anaesthesiology nurses exceeds the number of physicians, as well as to the lower participation of physicians in the survey.

Conclusions

Respondents undergoing specialist training, particularly nursing staff, had numerically higher knowledge scores and better familiarity with current vascular access guidelines. The level of knowledge was not significantly associated with professional group, workplace, or length of professional experience, but was significantly associated with education level. A discrepancy between knowledge and its application in clinical practice was identified, indicating a lack of standardisation in clinical procedures. The observed gaps suggest a need for both educational interventions and organisational changes, including the development of vascular access teams. The findings highlight the important role of nursing staff in vascular access management and the limited availability of specialised teams in Poland.

Disclosures

This research received no external funding.

The study was approved by the Bioethics Committee of the Medical University of Warsaw (Approval No. AKBE/12/2026).

The authors declare no conflict of interest.