Vascular Access
PICCs, CVCs, midlines, ports, CLABSI prevention and vessel health.
The Clinical Database
Evidence-based clinical guidelines and policies for vascular access teams
Featured
guidelines
Updated
August 2026
AVA Clinical Practice Guidelines
The Association for Vascular Access (AVA) Adult Clinical Practice Guidelines, published in JAVA as the January 2026 supplement (Volume 31) — full indexed edition in five parts, with section-by-section scope, relationship to INS/CDC/SHEA-IDSA guidance, and citation format.
Departments
Emergency Medicine
Rapid access, resuscitation and time-critical decision support.
Critical Care
Sepsis, hemodynamics and respiratory support guidelines.
Oncology
Device selection and care for the oncology patient.
Infection Prevention
Bundles, surveillance and infection-control standards.
Nephrology & Dialysis
KDIGO and KDOQI: CKD, AKI, dialysis adequacy, hemodialysis access.
Perioperative & Anesthesia
ASA practice guidelines, ERAS pathways, perioperative cardiovascular evaluation.
Cardiology
ACC/AHA and ESC: heart failure, coronary disease, atrial fibrillation, hypertension.
Neurology & Stroke
AHA/ASA stroke and hemorrhage guidelines, status epilepticus, neurocritical care.
Pediatrics & Neonatal
AAP clinical practice guidelines, PALS and NRP, pediatric sepsis.
Obstetrics & Maternal Care
ACOG and SMFM guidance, AIM safety bundles, maternal sepsis.
Hospital Medicine
Pneumonia, VTE, inpatient glycemic control, C. difficile, medication safety.
Clinical Pharmacy
Stewardship, vancomycin dosing, high-alert medications, Beers criteria.
Surgery & Trauma
ATLS, EAST and ACS TQIP guidelines, surgical prophylaxis, hemorrhage control.
Editorial Notes
Editorial notes on evidence infrastructure and clinical knowledge tooling.
Recently updated
The latest revisions across every specialty
Central Line & PICC Dressing Change: Step-by-Step Procedure
Step-by-step sterile procedure for changing a central venous catheter or PICC dressing: frequency, CHG antisepsis, transparent vs gauze dressings, securement, MARSI prevention, and documentation.
Central Line Removal: Step-by-Step Clinical Procedure (CVC and Tunneled)
Step-by-step clinical procedure for removing a central venous catheter and tunneled catheters: Trendelenburg positioning, air-embolism prevention, Valsalva, hemostasis, tip culture, and site-specific considerations.
ECG-Guided PICC Placement: Tip Confirmation Technique
How ECG-guided (intracavitary ECG) PICC placement works: the P-wave method for real-time tip confirmation at the cavoatrial junction, electrode setup, interpretation, limitations, and when a chest X-ray is still needed.
Groshong Catheter: Information, Care and Maintenance, and Complications
Complete Groshong catheter guide: the pressure-sensitive three-way valve, why it is locked with saline only, indications, care and maintenance, complications, and how it compares to Hickman and Broviac catheters.
How to Access an Implanted Port: Step-by-Step Clinical Procedure
Step-by-step clinical procedure for accessing an implanted port (port-a-cath): site assessment, non-coring needle selection, sterile technique, blood return confirmation, flushing, dressing, and deaccessing.
PICC Line Removal: Step-by-Step Clinical Procedure
Step-by-step clinical procedure for safe PICC line removal: positioning, controlled withdrawal, air-embolism and resistance precautions, catheter tip measurement, hemostasis, and documentation.
Analysis, perspectives, and healthcare innovation
Cortisol Levels in Hospital Staff and Work Efficiency
This article examines how elevated cortisol levels—the body's primary stress hormone—affect hospital staff's health and work performance. It explains that healthcare workers face unique stressors such as high-stakes patient care, excessive workloads, and lack of institutional support, which can lead to chronically elevated cortisol and subsequent health issues including anxiety, depression, cognitive impairment, and cardiovascular problems. These effects ultimately reduce work efficiency and can compromise patient safety. The article reviews research on cortisol patterns in emergency care providers, discusses how the COVID-19 pandemic exacerbated these challenges, and offers strategies for managing cortisol levels through lifestyle modifications (exercise, sleep hygiene), stress management techniques (mindfulness, CBT), organizational changes (workload management, flexibility), and when necessary, medical interventions. It concludes by urging healthcare organizations to prioritize staff well-being through transparent, supportive management practices to maintain both employee health and quality patient care.
APIs Over Guidelines
Clinical guidelines as static PDFs are failing healthcare. Why API-first medical knowledge distribution is essential for modern clinical decision support, and how The Clinical Database publishes its corpus in machine-readable form.