DavExpert

DAV-EXP is an expert system for choosing the most suitable venous access device

DAV-EXP is an expert system developed by GAVeCeLT to present an algorithm for choosing the most suitable venous access device (DAV) in a simple and clear way.

We have deliberately excluded from this algorithm the devices positioned for blood exchange maneuvers such as hemodialysis, apheresis and ultrafiltration: we will refer only to the venous access devices indicated for infusion therapies, for hemodynamic monitoring and/or for frequent and repeated blood samples. In the literature there are many algorithms of varying value and accuracy, but the algorithm of choice presented as DAV-EXP is the first - to our knowledge - covering all age groups of patients (newborn - child - adult), in each clinical situation (emergency - election), both in intensive and non-intensive settings, both in the short and medium-long term.

With the help of several GAVeCeLT experts, we have suggested solutions based on the best scientific evidence in the literature, interpreting appropriateness in terms of (1) safety for the patient, (2) clinical effectiveness of the device, and (3) cost - effectiveness of the chosen device in terms of allocation of resources and economic efficiency.

Since the field of venous accesses is constantly evolving, this algorithm should not be interpreted in a dogmatic and 'plastered' manner, but rather as a dynamic and mutable instrument, in tune with the international literature that continually proposes new solutions and new devices. Users of the DAV - EXP are therefore invited to send us comments and suggestions, reporting possible novelties and correcting any oversight or omission.

Lastly, the DAV-EXP should not be considered as a reference guideline, nor as a shortcut for an unmediated, automatic clinical choice; instead, it should be regarded as a tool to facilitate clinical reasoning in potentially complex situations, in which we must keep in mind all the possible solutions and the pros and cons of each choice. The selection of the device for venous access is and will remain a clinical decision that the healthcare professional (physician or nurse) will have to take on a case by case basis, after assessing the needs of the individual patient and the resources of his / her operating unit.