Abstract:

Objective To investigate the clinical safety of pulling peripheral venous indwelling needle according to clinical indications,and compare its effect with conventional indwelling needle extraction. Methods A multicenter randomized controlled trial was conducted with a total of 3,669 patients in 12 tertiary general hospitals from March 2019 to July 2019. The patients were randomly allocated into the observation group（group A） and the control group （group B） by the random number table. The puncture methods were consistent between the two groups. Researchers compared the indwelling time,the incidence of catheter-related complications within 96 hours,and the risk ratio of catheter-related complications during the entire indwelling period（phlebitis,occlusion,and infiltration,suspected infection） between two groups,among which phlebitis was the primary outcome indicator and other complications as secondary outcome measures. Results A total of 3,642 patients were enrolled in the study with 1,803 cases in group A and 1,839 cases in group B. The indwelling time of group A was（85±52）h and it was longer than that of （71±30） h in group B with a statistical difference（P<0.001）. Within 96 h of indwelling time,there was no statistical differences in the risk of phlebitis,infiltration and suspected infection between two groups（P>0.05）. During the entire indwelling period,the risk of occlusion in group A was higher than that in group B with a statistical difference（P<0.05）. The other indicators showed no statistical difference. Conclusion The placement of indwelling needle based on clinical indications can prolong the indwelling time without increasing the risk of phlebitis,infiltration and suspected infection,but the risk of occlusion will increase. If the catheter is removed according to clinical indications,monitoring and evaluation of occlusion should be strengthened.

Key words: Peripheral Venous Indwelling Needle, Complication, Indication of Extubation, Risk Management, Catheterization, Peripheral, Nursing Care

摘要：

目的 比较依据临床指征拔除留置针和常规拔除留置针的效果。 方法 2019年3月—7月,采用多中心随机对照研究,选取12所三级甲等综合医院的3 669例患者作为研究对象,按照随机数字表法分为试验组和对照组,试验组依据临床指征拔除留置针,对照组常规拔除留置针,比较两组的外周静脉留置针留置时间、96 h内各导管相关并发症的发生率和整个留置期间各导管相关并发症（静脉炎、堵管、渗液、怀疑感染）发生的风险,其中静脉炎为主要结局指标,其他并发症为次要结局指标。 结果 共3 642例患者纳入研究,其中试验组1 803例,对照组1 839例。试验组外周静脉留置针留置时间为（85±52） h,对照组留置时间为（71±30） h,两组留置时间比较,差异具有统计学意义（P<0.001）;96 h内,主要结局指标静脉炎的发生率在两组之间的差异无统计学意义（P>0.05）,次要结局指标中除堵管有统计学意义（P=0.005）,其余指标的差异均无统计学意义（P>0.05）;整个留置期间,两组主要结局指标静脉炎发生风险的差异无统计学意义（P>0.05）,次要结局指标中除堵管外,其余指标的差异均无统计学意义（P>0.05）。 结论 依据临床指征更换外周静脉留置针,留置时间更长且不会增加静脉炎、渗液及怀疑感染的发生风险,但堵管的发生风险会增大,如根据临床指征拔管,需加强堵管的监测与评估。

关键词: 留置针, 并发症, 拔管指征, 风险管理, 导管插入术, 外周, 护理