维持性血液透析患者动静脉血管通路穿刺管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.09.016

摘要/Abstract

摘要：

目的检索、评价并汇总维持性血液透析患者动静脉血管通路穿刺管理的证据，为加强临床医护人员动静脉血管通路穿刺规范管理提供循证依据。方法系统检索UpToDate临床顾问、美国医疗保健研究与质量局、国际指南协作网、苏格兰校际指南网、英国国家卫生与临床优化研究所、加拿大安大略注册护士协会、医脉通等网站、指南库，以及ACP Journal Club、Cochrane Library、PubMed、Web of Science、CINAHL、中国知网、万方数据库、维普数据库、中国生物医学文献服务系统等数据库中关于维持性血液透析患者动静脉血管通路穿刺管理的证据，文献类型包括临床决策、指南、最佳实践、证据总结、系统评价、专家共识。检索时限为2017年1月—2021年12月。循证团队进行文献筛选、质量评价，并提取、汇总证据。结果最终纳入8篇文献，其中临床决策2篇、指南4篇、系统评价1篇、专家共识1篇。最佳证据包括首次穿刺时机、穿刺前评估及准备、穿刺方法、穿刺成功判定、穿刺并发症处理、穿刺针拔出后按压、穿刺辅助设备、穿刺人员资质及培训8个方面，共25条证据。结论血液净化医护人员需结合具体临床情境、证据的促进因素、阻碍因素及患者意愿，有针对性地选择最佳证据，提高动静脉血管通路一次穿刺成功率，减少穿刺相关不良事件，延长血管通路使用寿命。

关键词: 维持性血液透析, 血管通路, 动静脉内瘘, 穿刺, 证据总结, 循证护理学

Abstract:

Objective To retrieve，evaluate and summarize the best evidence for management of arteriovenous access（AVA） cannulation in maintenance hemodialysis （MHD） patients，and to provide references for consolidation of standardized management of AVA cannulation. Methods We searched UpToDate，AHRQ，SIGN，GIN，NICE，RANO，Medlive and other guideline websites，ACP Journal Club，Cochrane Library，PubMed，Web of Science，CINAHL，CNKI，Wanfang，VIP，SinoMed and other databases to collect relevant clinical decisions，guidelines，best practices，evidence summaries，systematic reviews，and expert consensuses related to management of AVA cannulation in MHD patients. The retrieval time was from January 2017 to December 2021. The evidence-based team evaluated，extracted and summarized the evidence. Results A total of 8 articles were included through literature search，including 2 clinical decisions，4 guidelines，1 systematic review and 1 expert consensus. Finally，25 pieces of best evidence were summarized in 8 aspects，including timing of first cannulation，pre-cannulation evaluation and preparation，cannulation techniques，diagnostic method for successful cannulation，treatment of cannulation-related complications，compression after needle withdrawal，the use of cannulation auxiliary equipment，and qualification and training of cannulation personnel. Conclusion In clinical practice，medical staff should select the best evidence based on the characteristics of the hospital and specific clinical situations，to improve the success rate of primary cannulation of AVA，reduce cannulation-related adverse events，and extend the life span of AVA.

Key words: Maintenance Hemodialysis, Vascular Access, Arteriovenous Fistula, Cannulation, Evidence Summary, Evidence-Based Nursing

董永泽, 许秀君, 沈华娟, 周美玲, 贾艳清. 维持性血液透析患者动静脉血管通路穿刺管理的最佳证据总结[J]. 中华护理杂志, 2023, 58(9): 1135-1141.

DONG Yongze, XU Xiujun, SHEN Huajuan, ZHOU Meiling, JIA Yanqing. Summary of the best evidence for the management of arteriovenous access cannulation in maintenance hemodialysis patients[J]. Chinese Journal of Nursing, 2023, 58(9): 1135-1141.

图/表 3

表1 纳入文献的基本特征（n=8）

Table 1 The basic characteristics of the included literature（n=8）

表2 纳入指南的质量评价结果（n=4）

Table 2 The quality evaluation results of the included guidelines（n=4）

表3 维持性血液透析患者动静脉血管通路穿刺管理的最佳证据总结

Table 3 Summary of the best evidence for the management of arteriovenous access cannulation in maintenance hemodialysis patients

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