外周静脉留置针不同拔管时机的随机对照研究

doi:10.3761/j.issn.0254-1769.2020.02.020

中华护理杂志 ›› 2020, Vol. 55 ›› Issue (2): 272-277.DOI: 10.3761/j.issn.0254-1769.2020.02.020

外周静脉留置针不同拔管时机的随机对照研究

李旭英,孙红(),魏涛,王蕾,郭彩霞,赵改婷,梅赣红,陈英,张敏,程文兰,王一任,陈利芬,钟卫兰

410013 长沙市湖南省肿瘤医院护理部（李旭英,魏涛）;北京医院/国家老年医学中心/中国医学科学院老年医学研究院护理部（孙红,王蕾）;吉林大学中日联谊医院护理部（郭彩霞）;河北医科大学第二医院儿科（赵改婷）;南昌大学第二附属医院护理部（梅赣红）;广西医科大学附属肿瘤医院护理部（陈英）;西安国际医学中心医院护理部（张敏）;河南省人民医院神经外科（程文兰）;中南大学公共卫生学院（王一任）;中山大学附属第一医院护理部（陈利芬）;贵阳市第一人民医院护理部（钟卫兰）

收稿日期:2019-09-15 出版日期:2020-02-15 发布日期:2020-03-04
通讯作者:
作者简介:李旭英:女,博士,主任护师,护理部主任,E-mail: lixuying@hnca.org.cn
基金资助:
湖南省卫生计生委项目(20180456)

A multicenter randomized controlled study on removal indication of peripheral venous indwelling needle

LI Xuying,SUN Hong(),WEI Tao,WANG Lei,GUO Caixia,ZHAO Gaiting,MEI Ganhong,CHEN Ying,ZHANG Min,CHENG Wenlan,WANG Yiren,CHEN Lifen,ZHONG Weilan

Received:2019-09-15 Online:2020-02-15 Published:2020-03-04

摘要/Abstract

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

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

李旭英, 孙红, 魏涛, 王蕾, 郭彩霞, 赵改婷, 梅赣红, 陈英, 张敏, 程文兰, 王一任, 陈利芬, 钟卫兰. 外周静脉留置针不同拔管时机的随机对照研究[J]. 中华护理杂志, 2020, 55(2): 272-277.

LI Xuying, SUN Hong, WEI Tao, WANG Lei, GUO Caixia, ZHAO Gaiting, MEI Ganhong, CHEN Ying, ZHANG Min, CHENG Wenlan, WANG Yiren, CHEN Lifen, ZHONG Weilan. A multicenter randomized controlled study on removal indication of peripheral venous indwelling needle[J]. Chinese Journal of Nursing, 2020, 55(2): 272-277.

图/表 4

表1 两组一般资料的比较[例（百分比,%）]

表2 两组导管相关信息的比较[例（百分比,%）]

表3 96 h内两组导管相关并发症发生率的比较[例（百分率,%）]

表4 两组导管相关并发症发生风险比较[例（百分率,%）]

参考文献 19

[1]	Rickard CM, Ray-Barruel G . Peripheral intravenous catheter assessment:beyond phlebitis[J]. Lancet Haematol, 2017,4(9):e402-e403.
[2]	孙红, 王蕾, 关欣 , 等. 全国部分三级甲等医院静脉治疗护理现状分析[J]. 中华护理杂志, 2014,49(10):1232-1237.
[3]	Marsh N, Webster J, Larson E , et al. Observational study of peripheral intravenous catheter outcomes in adult hospitalized patients:a multivariable analysis of peripheral intravenous catheter failure[J]. J Hosp Med, 2018,13(2):83-89.
[4]	Miliani K, Taravella R, Thillard D , et al. Peripheral venous catheter-related adverse events:evaluation from a multicentre epidemiological study in France (the CATHEVAL Project)[J]. PloS One, 2017,12(1):e168637.
[5]	魏涛, 谭艳, 谌永毅 , 等. 成人外周静脉留置针使用情况调查[J]. 护理学杂志, 2018,33(17):6-9.
[6]	Mermel LA . Short-term peripheral venous catheter-related bloodstream infections:a systematic review[J]. Clin Infect Dis, 2017,65(10):1757-1762.
[7]	Sato A, Nakamura I, Fujita H , et al. Peripheral venous catheter-related bloodstream infection is associated with severe complications and potential death:a retrospective observational study[J]. BMC Infect Dis, 2017,17:434.
[8]	Zingg W, Pittet D . Peripheral venous catheters:an under-evaluated problem[J]. Int J Antimicrob Agents, 2009,34(34 Suppl 4):S38-S42.
[9]	国家卫生与计划生育委员会. 静脉治疗护理技术操作规范[J]. 中国护理管理, 2014,14(1):1-4.
[10]	Webster J, Osborne S, Rickard CM , et al. Clinically-indicated re-placement versus routine replacement of peripheral venous catheters[J]. Cochrane Database Syst Rev,2015(8):D7798.
[11]	美国静脉输液护理学会. 输液治疗实践标准[J]. 中华护理杂志, 2016,51(10s):1-142.
[12]	Chow S, Shao J, Wang H . Sample size calculations in clinical research[M]. 3nd Ed.NewYork:Chapman & Hall/CRC Biostati-stics Series, 2017.
[13]	Xu L, Hu Y, Huang X , et al. Clinically indicated replacement versus routine replacement of peripheral venous catheters in adults:a nonblinded,cluster-randomized trial in China[J]. Int J Nurs Pract, 2017,23:e12595.
[14]	Van Donk P, Rickard CM, McGrail MR ,et al. Routine replacement versus clinical monitoring of peripheral intravenous catheters in a regional hospital in the home program:a randomized controlled trial[J]. Infect Control Hosp Epidemiol, 2009,30(9):915-917.
[15]	Rickard CM, Webster J, Wallis MC , et al. Routine versus clinically indicated replacement of peripheral intravenous cathe-ters:a randomised controlled equivalence trial[J]. Lancet, 2012,380(9847):1066-1074.
[16]	O’Grady NP, Alexander M, Burns LA , et al. Guidelines for the prevention of intravascular catheter-related infections[J]. Am J Infect Control, 2011,39(4 Suppl 1):S1-S34.
[17]	Webster J, Osborne S, Rickard CM , et al. Clinically-indicated replacement versus routine replacement of peripheral venous catheters[J]. Cochrane Database Syst Rev, 2019( 1):CD007798.
[18]	Cicolini G, Manzoli L, Simonetti V , et al. Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours:a large multi-centre prospective study[J]. J Adv Nurs, 2014,70(11):2539-2549.
[19]	Wei T, Li X, Yue Z , et al. Catheter dwell time and risk of catheter failure in adult patients with peripheral venous catheters[J]. J Clin Nurs, 2019,28(23/24):4488-4495.

外周静脉留置针不同拔管时机的随机对照研究

A multicenter randomized controlled study on removal indication of peripheral venous indwelling needle

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 19

相关文章 15

编辑推荐

Metrics

[1]	韩冬芳, 田甜, 高畅, 张婧珺, 李小妹. 肺结核患者健康促进行为与健康心理控制源关系的混合研究[J]. 中华护理杂志, 2024, 59(9): 1029-1036.
[2]	司茜茜, 王莹, 赵福云, 马晓骁, 刘均娥. A型主动脉夹层患者Ⅰ期心肺康复护理方案的构建及应用[J]. 中华护理杂志, 2024, 59(9): 1037-1042.
[3]	沈支佳, 陈新宇, 钱志杰, 殷丽梅. 反复低血糖患者血糖管理行为退化特征的混合研究[J]. 中华护理杂志, 2024, 59(9): 1043-1050.
[4]	王丽梅, 李露, 李玉霞, 喻鹏, 罗倩, 张翀旎. 糖尿病周围神经病理性疼痛患者运动恐惧现状及影响因素分析[J]. 中华护理杂志, 2024, 59(9): 1051-1056.
[5]	丁慧敏, 戴莉敏, 蔡冬青, 杨群. 糖尿病前期患者自我管理潜在剖面分析及影响因素研究[J]. 中华护理杂志, 2024, 59(9): 1057-1064.
[6]	刘海婷, 王咏梅, 郑贝贝, 蔡丽丽, 叶林斌, 吴佳芸, 宁丽, 李益民, 陈为霞. 冠心病合并糖尿病患者药物素养自评量表的编制及信效度检验[J]. 中华护理杂志, 2024, 59(9): 1065-1071.
[7]	陈丽霞, 施慧, 朱德政, 曾莹. 成人低血糖恐惧评估工具的质量评价[J]. 中华护理杂志, 2024, 59(9): 1072-1079.
[8]	中国研究型医院学会过敏医学专业委员会, 中华医学会变态反应分会过敏性疾病护理学组（筹）, 中华预防医学会过敏病预防与控制专业委员会, （执笔：王青刘君支凡万文锦田丰英霍晓鹏周文华杨永仕王田田孙劲旅）. 变应原特异性免疫治疗皮下注射护理的专家共识[J]. 中华护理杂志, 2024, 59(9): 1080-1083.
[9]	李琪, 苏晴晴, 张瑶瑶, 王田田, 吕静, 李亚可, 李海燕. 全膝关节置换患者关节遗忘变化轨迹及影响因素研究[J]. 中华护理杂志, 2024, 59(9): 1084-1090.
[10]	刘娅, 刘晓晴, 杨雪凝, 王平, 刘学奎, 罗丹. 结肠镜检查患者肠道准备失败风险预测模型的构建及验证[J]. 中华护理杂志, 2024, 59(9): 1091-1098.
[11]	孙晓晴, 张爱霞, 朱珠, 樊雪梅, 梅士娟, 黄欣欣, 丛胜楠, 谢红燕. 分娩心理创伤评估量表的编制及信效度检验[J]. 中华护理杂志, 2024, 59(9): 1099-1105.
[12]	谢玉生, 黄蓉蓉, 赵雪, 马蕾, 胡雁, 杨倩, 王乾沙, 明玥. 成人重度烧伤患者肠内肠外营养的证据总结[J]. 中华护理杂志, 2024, 59(9): 1106-1113.
[13]	李旭琴, 冯洁惠, 黄昉芳, 俞超, 梁诗雨, 王晓, 李旭芳, 朱含. 1例行机械循环辅助桥接心脏移植患者的术前护理[J]. 中华护理杂志, 2024, 59(9): 1114-1117.
[14]	贾晓静, 陈一竹, 许志英, 和霞, 耿超. 1例尿黑酸尿症双膝关节置换术后患者并发急性心肌梗死的护理[J]. 中华护理杂志, 2024, 59(9): 1118-1121.
[15]	顾培培, 曾妃, 兰美娟, 梁江淑渊, 郭璐瑶, 蔡凌云, 朱岩, 郭鸽. 肺移植患者衰弱影响因素的Meta分析[J]. 中华护理杂志, 2024, 59(9): 1122-1129.