An Explanatory Model of Vascular Access Care Quality: Results of a Cross-Sectional Observational Study

Round 1

Reviewer 1 Report

Thank you for the opportunity to review this paper. The authors tried to argue over the quality of the nursing vascular access care using a multi-item questionnaire, called INCATIV.

1.      This questionnaire was reported by the same authors of this paper in 2021. The point that seems unclear to me is if this paper is a further validation of their questionnaire. The authors report 5 centers participating in a study conducted in May 201 6 (as written in the text) and with the results already published in 2021. Considering the same authors, it can be considered an external validation but a “redundant” study.

2.      It is not clear how the authors defined a VA as bad, very bad, good etc. No explanation of the criteria or scoring system is given.

3.      The authors stated that phlebitis is a predictor of poor VA care. In my point of view, phlebitis is simply the consequence of a poor VA and not necessary to poor nursing care. Other complications should be considered such as infection of the insertion site, bacteremia, hematoma without or with active bleeding in the insertion site, deep thrombosis, and skin necrosis for extravascular infusion.

4.     Another point to be considered is the frequency the VA is used. For instance, is it used once or twice daily? Is it used for brief IV therapies or for prolonged infusion (es fluids on 12 or 24 hours.

5.      Table 4, improve the structure, it is not understandable.

6.      I’m not an English speaker but it is clear that syntaxis should be edited better. 

Author Response

Dear reviewer, thank you for reviewing our document. We are very grateful for your response. We have taken your comments into account to improve the manuscript. We will now move on to try to respond to each of your comments.

Author Response File: Author Response.pdf

Reviewer 2 Report

This is a good and well-written article on how to enhance vascular access care. All the same, you could provide additional background information to further justify the importance of the study considering that it was undertaken roughly 8 years ago, and further enhance the discussion under the method section (design and data collection tool).

The quality of English is good, however, additional suggestions are:

Line 38 - consider nevertheless instead of however, despite this.

Please rephrase lines 118 - 120 under ethical considerations.

Do you need to include 'is also related to a negative quality assessment' in lines 185/186.

Evidence-based practices is alright without the word good in line 217

You may consider the word through instead of repeating via in line 222

Please consider between male or female/gender instead of of sex in line 229.

Author Response

Dear reviewer, thank you for reviewing our document. We are very grateful for your response. We have taken your comments into account to improve the manuscript. 

Author Response File: Author Response.pdf

Reviewer 3 Report

Thank you for the opportunity to review the results of this interesting study. My recommendations largely relate to grammatical corrections. Best wishes for publication. 

Comments for author File: Comments.pdf

Author Response

Dear reviewer, thank you for reviewing our document. We are very grateful for your response. We have taken your comments into account to improve the manuscript. 

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Dear,

In this revised paper, the authors sought to demonstrate the importance of a bundle of variables necessary for the vascular access management. The topic is of great importance for the nursing VAD care on the daily basis.

The revised paper has improved some aspects.

However, the manuscript is very difficult to read and this is mainly due to lots of redundancy and repetition throughout all the paper.

Example I. “This is now the main hypothesis of this study, if we control and manage these variables, optimal VA care can be ensured. To this end, this study aimed to determine the contribution of the variables involved in the quality of VA care in patients admitted to hospitals in the Valencian Community.”  These are two sentences for demonstrating the same thing.

Example II. “The questionnaire consisted of 22 items divided into four parts: patient-related variables, variables related to VA characteristics, variables related to daily VA care, and complication variables.” Repetition of the word “variables”- Might be better: The questionnaire consisted of 22 items divided into four parts in regard to variables patient-related, VA characteristics, daily VA care and complications.

Example III.  “Nevertheless, in agreement with other studies, age does appear to be a risk factor.” This sentence is difficult to understand. Might be, you should remove “Nevertheless”

I kindly invite the authors to improve this paper on this aspect.

Table 5. Improve this one. Add a legend explaining what do B, Wald, Df, Sig mean.

Author Response

Dear reviewer,

Thank you for reviewing our document. We are very grateful for your suggestions.

Author Response File: Author Response.pdf