中心静脉导管堵塞预防及处理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.23.004

摘要/Abstract

摘要：

目的检索、评价和汇总中心静脉导管堵塞预防及处理的最佳证据。方法依据“6S”证据模型，自上而下检索BMJ Best Practice、UpToDate、美国指南网、澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute，JBI）循证卫生保健中心数据库、Scopus、医脉通、CINAHL、中国知网、万方数据库、中国生物医学文献数据库等，纳入2011年8月—2021年8月涉及中心静脉导管堵塞预防及处理的所有证据，包括临床实践指南、系统评价、证据总结、最佳实践、专家共识及原始文献。2名研究人员独立对相关文献进行质量评价，并对最终纳入文献所提取的证据进行标准化整合及汇总。结果共纳入14篇文献，其中，指南3篇、系统评价3篇、证据总结4篇、专家共识3篇、Meta分析1篇。形成26条最佳证据，涵盖静脉治疗团队、置管部位及方式、冲封管工具及操作、堵塞预防策略、堵塞处理策略、健康教育6个部分。结论中心静脉导管堵塞预防及处理的最佳证据总结形成过程严谨、科学，具有临床实用性，护理人员根据患者实际情况制订个性化导管堵塞预防策略，规范导管堵塞的处理策略，降低中心静脉导管堵塞的发生率。

关键词: 静脉治疗, 中心静脉导管, 导管插入术, 中心静脉, 堵塞, 预防, 循证护理学

Abstract:

Objective To search，evaluate and summarize the best evidence for prevention and management of central venous catheterization. Methods According to the "6S" evidence model，related databases including BMJ Best Practice，UpToDate，NGC，JBI evidence-based database，Scopus platform，Yimaitong Guide.com，CINAHL，CNKI，Wanfang Database，CBM were searched from top to bottom. All evidence related to the prevention and management of central venous catheterization from August 2011 to August 2021 was included，involving clinical practice guidelines，systematic reviews，evidence summaries，best practice，expert consensuses，and original literature. 2 researchers independently evaluated the quality of relevant literature and standardized the integration and summary of the evidence finally included in the literature. Results Totally 14 pieces of the literature were included，involving 3 guidelines，3 systematic reviews，4 evidence summaries，3 expert consensuses and 1 meta-analysis. Finally，28 pieces of best evidence were formed，including 6 dimensions，namely intravenous treatment team，cathetering site and method，catheter flushing tool and operation，blockage prevention strategy，blockage treatment strategy，and patient education. Conclusion The best evidence for the prevention and management of central venous catheter blockage is helpful for clinical nurses to formulate personalized catheter blockage prevention strategies according to the actual situation of patients，to standardize the management strategies of catheter blockage，so as to reduce the incidence of central venous catheter blockage and ensure the safety of patients.

Key words: Intravenous Therapy, Central Venous Catheter, Catheterization, Central Venous, Blockage, Prevention, Evidence-Based Nursing

李怀燕, 李育玲, 于静, 孟效红, 崔映琴. 中心静脉导管堵塞预防及处理的最佳证据总结[J]. 中华护理杂志, 2022, 57(23): 2842-2850.

LI Huaiyan, LI Yuling, YU Jing, MENG Xiaohong, CUI Yingqin. Evidence summary for prevention and management of central venous catheter occlusion[J]. Chinese Journal of Nursing, 2022, 57(23): 2842-2850.

图/表 5

图1 文献筛选流程

Figure 1 Literature screening process

表1 纳入文献的一般特征（n=14）

Table 1 General characteristics of the included literature（n=14）

表2 纳入指南的方法学质量评价（n=3）

Table 2 Methodological quality evaluation included in the guidelines（n=3）

表3 纳入系统评价和Meta分析的方法学质量评价（n=4）

Table 3 Methodological quality evaluation of systematic evaluation and meta-analysis（n=4）

表4 中心静脉导管堵塞预防及处理的最佳证据总结

Table 4 Evidence summary for prevention and management of central venous catheter occlusion

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