新生儿PICC导管尖端继发性异位预防和处理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.18.015

摘要/Abstract

摘要：

目的检索、评价和汇总新生儿PICC导管尖端继发性异位预防和处理的最佳证据，为临床实践提供依据。方法检索UpToDate、BMJ Best Practice、国际指南协作网、美国国家指南库、英国国家卫生与临床优化研究所网站、苏格兰校际指南网、加拿大安大略注册护士学会网站、美国静脉输液护士协会网站、Cochrane Library、澳大利亚乔安娜布里格斯研究所网站、Embase、PubMed、Web of Science、CINAHL、中国生物医学文献数据、中国知网、万方数据库、维普期刊数据库，获取关于新生儿PICC导管尖端继发性异位预防和处理的文献，包括临床决策、推荐实践、最佳实践、指南、证据总结、系统评价、Meta分析、专家共识，检索时限为建库至2023年4月。由2名研究者采用统一的标准对文献进行独立质量评价和证据提取，由医院血管通路小组将提取的证据进行整合。结果共纳入12篇文献，其中指南4篇、临床决策1篇、专家共识2篇、Meta分析5篇。最终从7个方面形成了35条最佳证据，包括置管前评估、导管选择、置管部位、导管固定及敷料更换、置管后观察与维护、继发性异位的处理、静脉治疗团队的组建及培训。结论该研究总结了新生儿PICC导管尖端继发性异位预防和处理的最佳证据，建议医护人员结合医院及新生儿的实际情况选择证据，制订相关预防措施，以降低新生儿PICC导管尖端继发性异位发生率。

关键词: 经外周静脉置入中心静脉导管, 静脉治疗, 异位, 循证护理学, 新生儿护理

Abstract:

Objective To retrieve，evaluate and summarize the best evidence for the prevention and management of peripherally inserted central catheter（PICC） secondary tip malposition in neonates，so as to provide a basis for clinical practice. Methods We searched UpToDate，BMJ Best Practice，Guidelines International Network，National Guideline Clearinghouse，National Institute for Health and Care Excellence，Scottish Intercollegiate Guidelines Network，Registered Nurses Association of Ontario，Intravenous Nurses Society，Cochrane Library，Joanna Briggs Institute，Embase，PubMed，Web of Science，CINAHL，SinoMed，CNKI，WanFang，VIP. The relevant literature on the prevention and management of PICC secondary catheter tip malposition in neonates were obtained，including clinical decision-making，recommended practice，best practice，guidelines，evidence summaries，systematic reviews，meta-analyses，and expert consensuses. The search time limit was from the establishment of the database to April 2023. There were 2 researchers who independently evaluated the quality of the literature and extracted evidence using unified standards，and the extracted evidence was integrated by the vascular access team of the hospital. Results A total of 12 articles were included，including 4 guidelines，1 clinical decision，2 expert consensuses and 5 Meta-analyses. Finally，35 pieces of best evidence were formed from 7 aspects，including pre-catheterization evaluation，catheter selection，placement site，catheter fixation and dressing change，observation and maintenance after catheterization，treatment of secondary catheter tip malposition，establishment and training of intravenous treatment team. Conclusion This study summarizes the best evidence for the prevention and treatment of PICC secondary catheter tip malposition in neonates. It is recommended that medical staff select evidence based on the actual situation of hospitals and neonates，and formulate relevant nursing measures to reduce the incidence of PICC secondary catheter tip malposition in neonates.

Key words: Peripherally Inserted Central Catheter, Venous Therapy, Malposition, Evidence-Based Nursing, Neonatal Nursing

沈婷, 余婷, 聂玲, 印玉静, 陶怡, 马月兰, 刘永戍, 蒋玲. 新生儿PICC导管尖端继发性异位预防和处理的最佳证据总结[J]. 中华护理杂志, 2023, 58(18): 2273-2281.

SHEN Ting, YU Ting, NIE Ling, YIN Yujing, TAO Yi, MA Yuelan, LIU Yongshu, JIANG Ling. Summary of the best evidence for the prevention and management of PICC secondary catheter tip malposition in neonates[J]. Chinese Journal of Nursing, 2023, 58(18): 2273-2281.

图/表 5

表1 PubMed检索策略

Table 1 PubMed search strategies

图1 文献筛选流程图

Figure 1 Flow chart of the literature

表2 纳入文献的基本特征（n=12）

Table 2 Characteristics of included studies（n=12）

表3 指南的质量评价结果（n=4）

Table 3 Results of quality evaluation of the guidelines（n=4）

表4 新生儿PICC导管尖端继发性异位预防和处理的最佳证据总结

Table 4 Summary of the best evidence for prevention and management of neonatal PICC catheter secondary malposition

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