Patient Central Line Survey

This survey is intended for patients, families and caregivers who depend upon central venous access for medical therapy. Central venous access devices include all central lines, like PICCs, ports, tunneled central lines, hemodialysis and apheresis catheters. In this survey, we will call them all “central lines”. 

For all questions in this survey, “the patient” refers to patients who have a central line now or have had one or more central lines in the past, even though the person answering may be the patient or a family member or caregiver of the patient.

The survey was developed to assist the VANGUARD initiative (Venous Access: National Guideline and Registry Development) with the following aims:

  • To understand some of the most critical issues faced by patients, families and caregivers who need central venous access for medical therapies;
  • To learn from patients, families and caregivers about how they want to access health information;
  • To hear whether they are willing to provide information about venous access use and challenges that may not otherwise be included in their medical record;
  • To ask if they are willing to provide information that improves our understanding of the safety and effectiveness of venous access medical devices.

Answers to this survey are confidential. Participation is voluntary. Survey participants are not expected to benefit directly from the survey, and no compensation is offered for participation. Please participate and also please forward this survey to others who might be interested in participating. Thank you!

If you have any questions about this survey please contact Beth Gore, PhD (VANGUARD Patient Liaison) at bgore@avainfo.org.  
 
This is an IRB approved study. 

* 1. Which type or types of central lines has the patient used? (Check all that apply)

* 2. For what reason or reasons did the patient have a central line placed? (Check all that apply)

* 3. At what age did the patient first have a central line?

* 4. How long has it been since the patient first had a central line placed?

* 5. About how many central lines has the patient had?

* 6. About how many times has the patient had a central line removed or replaced because of infection or been treated for a central line infection?

* 7. What other (non-infection) problems has the patient had with a central line (check all that apply)

* 8. Has the patient ever had problems with the central line that weren’t adequately taken care of or known about by health care staff? (Check all that apply)

* 9. Would the patient, family or caregiver be willing to provide information about the central line and related care through an internet connection? (Check all that apply)

* 10. Please take a moment to tell us what are the most important issues about central lines to you as a patient, family member or caregiver that you would like to see addressed. If there is anything else you want to tell us about accessing the patient’s health information, please also enter that here.

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