PICC导管相关皮肤损伤预防的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.16.011

摘要/Abstract

摘要： 目的检索、评价、整合国内外PICC导管相关皮肤损伤预防实践的证据，为临床规范管理导管相关皮肤损伤提供循证依据。方法系统检索BMJ Best Practice、UpToDate、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、加拿大安大略护理学会网站、美国静脉输液护士协会网站、美国国立综合癌症网、美国肿瘤护理协会网站、医脉通、Cochrane Library、澳大利亚乔安娜布里格斯循证卫生保健中心数据库、PubMed、Embase、CINAHL、中国台湾学术文献数据库、中国知网、万方医学网、维普期刊数据库、中国生物医学文献服务网中关于PICC导管相关皮肤损伤预防的相关文献，包括临床决策、指南、证据总结、最佳实践、推荐实践、系统评价、专家共识和政府文件，检索时限为建库至2021年9月12日。指南由4名专家单独进行评价，其余文献由2名研究者独立进行评价，对符合要求的文献提取证据并分级，最后由专家小组进行证据汇总及合并，归纳证据主题。结果共纳入12篇文献，包括1篇政府文件、3篇指南、4篇证据总结、3篇专家共识、1篇系统评价。最终形成评估、皮肤清洁与消毒、敷料选择、操作与固定技术、置管部位皮肤保护、患者健康教育、监管与培训7个证据主题和26条最佳证据。结论 PICC导管相关皮肤损伤的最佳证据可为临床转化提供资源准备、为护士进行科学有效的护理实践提供临床决策依据。专科护理人员应合理选择最佳证据进行本土化应用，并不断更新最佳证据，规范护理实践，保障患者安全。

关键词: 肿瘤, 经外周静脉置入中心静脉导管, 导管插入术，外周, 导管相关皮肤损伤, 循证护理学

Abstract:

Objective To retrieve，evaluate，integrate the evidence of catheter related skin injuries prevention practices in cancer patients with PICC from home and abroad，and then summarize the relevant best evidence to provide evidence-based practice for clinical standardized management of catheter related skin injuries. Methods Evidence on prevention of catheter related skin injuries in cancer patients with PICC was systemically retrieved in the websites and databases，namely the BMJ Best Practice，UpToDate，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，National Comprehensive Cancer Network，Oncology Nursing Society，medlive，Cochrane Library，Joanna Briggs Institute，PubMed，Embase，CINAHL，Taiwan academic literature database，CNKI，WanFang，VIP，SinoMed，including clinical decision-making，guidelines，evidence summaries，best practice，recommended practice，systematic reviews，expert consensuses，and government documents. The literature retrieval period was from the database construction to September 12，2021. The guidelines were individually evaluated by 4 experts，and the remaining literature was independently evaluated by 2 researchers. The literature that met the criteria was extracted and graded. Finally，the expert group integrated the evidence and summarized the evidence topics. Results A total of 12 articles were involved，including 1 government document，3 guidelines，4 evidence summaries，3 expert consensuses，and 1 systematic review. Finally，7 evidence topics and 26 pieces of best evidence were formed，including assessment，skin cleaning and antisepsis，dressing selection，operation and securement techniques，skin protection at PICC insertion site，patient education，supervision and training. Conclusion The best evidence of catheter related skin injuries in cancer patients with PICC can provide resources preparation for clinical transformation and offer nurses clinical decision-making for scientific and effective nursing practice. Specialist nurses should reasonably choose the best evidence for localized application，and constantly update the best evidence，standardize nursing practice，and ensure the safety of patients.

Key words: Neoplasms, Peripherally Inserted Central Venous Catheter, Catheterization，Peripheral, Catheter Related Skin Injury, Evidence-Based Nursing

柳静, 刘春芳, 李秀川, 张琦, 杨雪凝, 李雪儿, 方紫妍, 张静. PICC导管相关皮肤损伤预防的最佳证据总结[J]. 中华护理杂志, 2022, 57(16): 1987-1994.

LIU Jing, LIU Chunfang, LI Xiuchuan, ZHANG Qi, YANG Xuening, LI Xueer, FANG Ziyan, ZHANG Jing. The best evidence summary for the prevention of catheter related skin injuries in cancer patients with PICC[J]. Chinese Journal of Nursing, 2022, 57(16): 1987-1994.

图/表 5

图1 文献筛选流程图注：JBI为澳大利亚乔安娜布里格斯研究所;NGC为美国国家指南库;NICE为英国国家卫生与临床优化研究所;GIN为国际指南协作网;SIGN为苏格兰校际指南网;RNAO为加拿大安大略护理学会;NCCN为美国国立综合癌症网;ONS为美国肿瘤护理协会;INS为美国静脉输液护士协会。

Figure 1 Flow chart of literature

表1 纳入文献的一般特征（n=12）

Table 1 Characteristics of included studies（n=12）

表2 指南的评价结果（n=3）

Table 2 Quality evaluation of guidelines（n=3）

表3 指南质量评价的一致性检验结果（n=3）

Table 3 Consistency test results of the intraclass correlation coefficient（n=3）

表4 PICC导管相关皮肤损伤预防的最佳证据总结

Table 4 The best evidence summary for the prevention of catheter related skin injuries in cancer patients with PICC

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