中等长度静脉导管置管不同尖端位置的效果比较

doi:10.3761/j.issn.0254-1769.2022.05.001

摘要/Abstract

摘要：

目的比较中等长度静脉导管尖端位于不同位置的临床应用效果。方法采用多中心随机对照研究,便利选取2020年9月—2021年1月浙江省、福建省、江苏省、辽宁省共6所三级甲等综合医院的住院患者作为研究对象。按照Excel生成的随机数字将其随机分为3组,试验组1的导管尖端位于锁骨下静脉,试验组2导管尖端位于胸壁段腋静脉,对照组导管尖端位于腋静脉远端。比较3组导管相关并发症（包括静脉炎、导管相关性血栓、导管相关性感染、导管堵塞、导管脱出、渗血、渗液）发生率、因并发症拔管率、导管留置时间、拔管后血管内膜异常率。结果共纳入384例患者。试验组1、试验组2和对照组的导管相关并发症总发生率分别为9.93%、14.63%、34.17%,因并发症拔管率分别为2.13%、4.07%、13.33%,导管留置时间分别为12.00（8.00,19.75） d、12.00（8.00,21.00） d、10.00（6.00,17.75） d,拔管后血管内膜异常率分别为0.75%、1.69%、6.36%,3组比较,差异均具有统计学意义（P<0.05）。两两比较结果显示,试验组1和试验组2的导管相关并发症总发生率、因并发症拔管率均低于对照组,差异具有统计学意义（均P<0.017）,试验组1和试验组2比较,差异无统计学意义（P>0.017）;关于导管留置时间,仅试验组1长于对照组,差异具有统计学意义（P<0.017）。结论中等长度静脉导管尖端位于锁骨下静脉或胸壁段腋静脉时,导管相关并发症发生率较低,留置时间较长,临床应用效果更佳。

关键词: 中等长度静脉导管, 导管插入术,外周, 并发症, 风险管理, 护理

Abstract:

Objective To compare the clinical effects of midline’s tip at different position. Methods From September 2020 to January 2021,a multi-center randomized controlled study was used to select 384 inpatients as the research subjects from 6 tertiary A general hospitals in Zhejiang province,Fujian province,Jiangsu province,and Liaoning province. They were randomly divided into 3 groups according to random numbers generated by Excel. The midline’s tips were located in the subclavian vein in the experimental group 1,in the axillary vein of the chest in the experimental group 2,and at the distal of the axillary vein in the control group. The incidences of catheter-related complications（including phlebitis,catheter-related thrombosis,catheter-related infections,catheter occlusion,catheter dislodgment,bleeding,oozing） were compared in 3 groups,as well as unplanned removal rate due to complications,catheter indwelling time,and the incidence of abnormal intima after midline removal. Results A total of 384 patients were included. The total incidence of catheter-related complications in experimental group 1,experimental group 2,and control group were 9.93%,14.63%,and 34.17%. Unplanned removal rate due to complications were 2.13%,4.07%,and 13.33% in 3 groups. Catheter indwelling time were 12.00（8.00,19.75） d,12.00（8.00,21.00） d,and 10.00（6.00,17.75） d. After the removal,the incidence of abnormal intima were 0.75%,1.69%,and 6.36%. The differences of 3 groups were statistically significant（P<0.05）. Among them,the differences in the total incidence of catheter-related complications and unplanned removal rate between the experimental group 1 and the control group,the experimental group 2 and the control group were statistically significant（P<0.017）;the difference between the experimental group 1 and the experimental group 2 was not statistically significant（P>0.017）. In terms of the catheter indwelling time,the difference was statistically significant between the experimental group 1 and the control group（P<0.017）. Conclusion When the tip of midline catheter is located in the axillary vein of the chest or subclavian vein,the incidence of catheter-related complications is lower,with longer indwelling time and better clinical outcome.

Key words: Midline Catheter, Catheterization,Peripheral, Complication, Risk Management, Nursing Care

赵林芳, 蔡志云, 樊小朋, 姜凤娅, 赵磊, 赵锐祎. 中等长度静脉导管置管不同尖端位置的效果比较[J]. 中华护理杂志, 2022, 57(5): 517-524.

ZHAO Linfang, CAI Zhiyun, FAN Xiaopeng, JIANG Fengya, ZHAO Lei, ZHAO Ruiyi. Application comparison of different tip positions of midline catheters[J]. Chinese Journal of Nursing, 2022, 57(5): 517-524.

图/表 3

表1 3组一般资料比较

Table 1 Baseline characteristcs of 3 groups of patients

表2 3组中等长度静脉导管留置情况比较

Table 2 Comparison of 3 groups on midline catheters insertion process

表3 3组导管相关并发症发生率比较[例（百分率,%）]

Table 3 Comparison of complications in the 3 groups[cases （percentage,%）]

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