NICU患儿外周静脉输液外渗预防与处理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2024.08.015

摘要/Abstract

摘要：

目的检索、评价并汇总国内外关于NICU患儿外周静脉输液外渗预防与处理的最佳证据，为临床实践与标准制订提供参考。方法系统检索国内外计算机决策支持系统、指南网、相关学会网站、数据库中与NICU患儿外周静脉输液外渗预防与处理相关的文献，检索时限为建库至2023年7月，文献类型包括临床决策、指南、专家共识、证据总结、系统评价。由2名研究人员独立对纳入文献进行质量评价，并对最终纳入文献进行证据翻译、提取及整合。结果共纳入9篇文献，其中临床决策1篇、指南3篇、专家共识3篇、证据总结2篇，从危险因素、导管留置、导管维护、外渗评估、外渗处理、团队组建与教育培训6个方面总结25条证据。结论该研究总结的NICU患儿外周静脉输液外渗预防与处理的最佳证据可为临床实践提供参考，建议医护人员结合临床情景、患儿的实际情况审慎地选择并应用证据，以保障外周静脉输液的安全。

关键词: 重症监护病房, 新生儿, 外周静脉, 输注, 静脉内, 外渗, 预防, 循证护理学

Abstract:

Objective To systematically search，evaluate and summarize the best evidence for prevention and management of extravasation in peripheral intravenous infusion in NICU neonates，and provide a reference for clinical practice and standard formulation. Methods A comprehensive systematic search of websites and databases was conducted to explore literature on prevention and management of extravasation in NICU neonates，including clinical decisions，guidelines，expert consensuses，evidence summaries and systematic reviews. The search encompassed the entire period from database inception to July 2023. 2 researchers independently evaluated the quality of the literature，extracted and integrated the evidence. Results The study included a total of 9 articles，comprising 1 clinical decision，3 guidelines，3 expert consensus documents，and 2 evidence summaries. Ultimately，25 pieces of evidence were synthesized，covering risk factors，catheter indwelling and maintenance，extravasation assessment and treatment，and team building，education and training. Conclusion The evidence provided practical and specific recommendations that can guide healthcare institutions in formulating strategies to prevent and treat extravasation during peripheral intravenous infusion in NICU neonates，while also offering evidence-based guidance for applying the evidence in clinical practice.

Key words: Intensive Care Units, Neonate, Peripheral Vein, Infusions, Intravenous, Extravasation, Prevention, Evidence-Based Nursing

陶伏莹, 石秦川, 张盼盼, 蔡如意, 徐倩, 蒋佳男, 付东英, 黄晓燕, 田莹莹. NICU患儿外周静脉输液外渗预防与处理的最佳证据总结[J]. 中华护理杂志, 2024, 59(8): 996-1004.

TAO Fuying, SHI Qinchuan, ZHANG Panpan, CAI Ruyi, XU Qian, JIANG Jia’nan, FU Dong-ying, HUANG Xiaoyan, TIAN Yingying. Evidence summary for prevention and management of extravasation in peripheral intravenous infusion in NICU neonates[J]. Chinese Journal of Nursing, 2024, 59(8): 996-1004.

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 Literature screening flow chart

表2 纳入文献的基本特征(n=9)

Table 2 Characteristics of the included studies(n=9 )

表3 纳入指南的方法学质量评价结果（n=4）

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

表4 NICU患儿外周静脉外渗预防与处理的最佳证据总结

Table 4 Summary of the best evidence for prevention and management of extravasation in NICU neonates

参考文献 41

[1]	李欣, 谢奇君, 张媔秋, 等. 辅助生殖技术后的母婴结局:基于倾向性评分匹配研究[J]. 中国妇幼健康研究, 2023, 34(2):28-33.
	Li X, Xie QJ, Zhang MQ, et al. Maternal and infant outcomes after assisted reproductive technology:a propensity score matching study[J]. Chin J Woman Child Health Res, 2023, 34(2):28-33.
[2]	Gorski LA. 2021 infusion therapy standards of practice updates[J]. J Infus Nurs, 2021, 44(4):189-190. DOI PMID
[3]	么莉. 护理质量指标监测基本数据集实施指南[M]. 北京: 科学技术文献出版社, 2022.
	Yao L. Guidelines for data sets of nursing quality indicators[M]. Beijing: Scientific and Technical Documents Publishing House, 2022.
[4]	姜珊, 魏春艳, 李硕, 等. 早产儿静脉治疗外渗性损伤护理处置的研究进展[J]. 中华现代护理杂志, 2022, 28(29):4131-4136.
	Jiang S, Wei CY, Li S, et al. Research progress on nursing and disposal of extravasation injury in premature infants treated by intravenous[J]. Chin J Mod Nurs, 2022, 28(29):4131-4136.
[5]	Atay S, Sen S, Cukurlu D. Incidence of infiltration/extravasation in newborns using peripheral venous catheter and affecting factors[J]. Rev Esc Enferm USP, 2018,52:e03360.
[6]	儿童静脉输液治疗临床实践循证指南工作组. 儿童静脉输液治疗临床实践循证指南[J]. 中国循证儿科杂志, 2021, 16(1):1-42.
	Working Group on Clinical Practice Evidence-based Guide-lines for Intravenous Infusion Therapy in Children. Clinical practice guideline on infusion therapy in children[J]. Chin J Evid Based Pediatr, 2021, 16(1):1-42.
[7]	中华护理学会静脉输液治疗专业委员会. 临床静脉导管维护操作专家共识[J]. 中华护理杂志, 2019, 54(9):1334-1342. DOI URL
	Intravenous Therapy Committee of Chinese Nursing Associa-tion. Expert consensus on venous catheter maintenance[J]. Chin J Nurs, 2019, 54(9):1334-1342. DOI URL
[8]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. Composition of different types of evidence-based problems[J]. J Nurses Train, 2017, 32(21):1991-1994.
[9]	AGREE Next Steps Consortium. The AGREE Ⅱ instrument[EB/OL].(2017-11-30)[2023-07-25]. https://www.agreetrust.org/wp-content/uploads/2017/12/AGREE-II-Users-Man-ual-and-23-item-Instrument-2009-Update-2017.pdf.
[10]	Mc Arthur A, Klugarova J, Yan H, et al. Critical appraisal tools checklist for text and opinion[EB/OL].(2017-07-15)[2023-07-25]. https://jbi.global/critical-appraisal-tools.
[11]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703.
	Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research:the quality evaluation of diagnostic and economic evaluation[J]. J Nurses Train, 2018, 33(8):701-703.
[12]	雒晓燕, 崔仁善, 许秀梅, 等. 基于“互联网+”的护理干预对癌症患者疼痛影响的Meta分析[J]. 中华护理杂志, 2023, 58(9):1056-1062. DOI URL
	Luo XY, Cui RS, Xu XM, et al. Effectiveness of“Internet+” nursing intervention model on pain in cancer patients:a Meta-analysis[J]. Chin J Nurs, 2023, 58(9):1056-1062.
[13]	周英凤, 顾莺, 胡雁, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:干预性研究的质量评价[J]. 护士进修杂志, 2018, 33(2):24-26.
	Zhou YF, Gu Y, Hu Y, et al. JBI evidence-based health center’s quality assessment tool for different types of research:quality evaluation of intervention research[J]. J Nurses Train, 2018, 33(2):24-26.
[14]	Buter J, Steele KT, Chung KC, et al. Extravasation injury from chemotherapy and other non-antineoplastic vesicants[EB/OL]. (2023-01-04)[2023-07-25]. https://www.uptodate.cn/contents/extravasation-injury-from-chemotherapy-and-other-non-antineopla-stic-vesicants#H17.
[15]	新生儿医源性皮肤损伤的评估要点和预见性护理的专家共识工作组, 海峡两岸医药卫生交流协会第一届新生儿专业委员会新生儿护理与护理管理学组, 国家儿童医学中心复旦大学附属儿科医院. 新生儿医源性皮肤损伤的评估要点和预见性护理的专家共识[J]. 中国循证儿科杂志, 2020, 15(3):161-165.
	Expert Consensus Working Group on Expert Consensus on Key Points Assessment and Predictive Nursing of Neonatal Iatrogenic Skin Injury,Neonatal Care and Nursing Mana-gement Group of the First Session of the Neonatal Profes-sional Committee of the Cross-Straits Medical and Health Exchange Association, National Children’s Medical Center, Children’s Hospital of Fudan University. Expert consensus on key points assessment and predictive nursing of neonatal iatrogenic skin injury[J]. Chin J Evid Based Pediatr, 2020, 15(3):161-165.
[16]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence recommendation level system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[17]	中华护理学会静脉输液治疗专业委员会. 静脉导管常见并发症临床护理实践指南[J]. 中华现代护理杂志, 2022, 28(18):2381-2395.
	Intravenous Therapy Committee of Chinese Nursing Associa-tion. Clinical nursing practice guidelines for common compli-cations of intravenous catheters[J]. Chin J Mod Nurs, 2022, 28(18):2381-2395.
[18]	新生儿医源性皮肤损伤处理的专家共识专家组, 中国医药教育协会新生儿护理分会, 复旦大学附属儿科医院. 新生儿医源性皮肤损伤处理的专家共识[J]. 中国循证儿科杂志, 2021, 16(4):255-261.
	Expert Consensus Working Group on Expert Consensus on the Management of Neonatal Iatrogenic Skin Injury, Neonatal Nursing Branch of China Medical Education Association, Children’s Hospital of Fudan University. Expert consensus on the management of neonatal iatrogenic skin injury[J]. Chin J Evid Based Pediatr, 2021, 16(4):255-261.
[19]	Valdez FC. Peripheral intravenous catheter(PIVC) care:edu-cation and training of staff[EB/OL].(2022-07-18)[2023-07-25]. https://ovidsp.dc2.ovid.com/ovidb/ovidweb.cgi?&S=BFMDF-PCEDHEBPDOHIPLJEFPFMLJLAA00&Link+Set=S.sh.21%7c1%7csl_190.
[20]	Porritt KB. Peripheral intravenous catheter(PIVC) care:inser-tion[EB/OL].(2021-04-16)[2023-07-25]. https://ovidsp.dc2.ovid.com/ovidb/ovidweb.cgi?&S=BFMDFPCEDHEBPDOHIPLJEFPF-MLJLAA00&Link+Set=S.sh.46%7c1%7csl_190.
[21]	O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections[J]. Clin Infect Dis, 2011, 52(9):e162-e193.
[22]	Schulmeister L. Extravasation management:clinical update[J]. Semin Oncol Nurs, 2011, 27(1):82-90. DOI PMID
[23]	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(1):CD007798.
[24]	Bond M, Crathorne L, Peters J, et al. First do no harm:pain relief for the peripheral venous cannulation of adults,a syste-matic review and network meta-analysis[J]. BMC Anesthesiol, 2016, 16(1):81. DOI URL
[25]	Blanco-Mavillard I, de Pedro-Gómez JE, Rodríguez-Calero Má, et al. Multimodal intervention for preventing peripheral intra-venous catheter failure in adults(PREBACP):a multicentre,cluster-randomised,controlled trial[J]. Lancet Haematol, 2021, 8(9):e637-e647.
[26]	Hassanein SMA, Tantawi HR, Sadek BN, et al. Impact of stru-ctured simulation-based and on-job training program on nurses’ competency in pediatric peripheral intravenous cannu-lation:children’s hospital experience[J]. Nurse Educ Today, 2021,98:104776.
[27]	Kaur S, Kaur P, Kumar Y, et al. Development and validation of the intravenous infiltration and extravasation risk assess-ment tool (IIERAT) for pediatric patients[J]. Indian Pediatr, 2022, 59(9):688-691. DOI
[28]	姜艳鑫, 范东, 赵娟, 等. 26 G留置针在成人血液病病人静脉输血中的应用[J]. 护理研究, 2023, 37(7):1255-1258.
	Jiang YX, Fan D, Zhao J, et al. Application of 26 G indwelling needle in intravenous blood transfusion of adult patients with hematopathy[J]. Chin Nurs Res, 2023, 37(7):1255-1258.
[29]	Ullman AJ, Takashima M, Kleidon T, et al. Global pediatric peripheral intravenous catheter practice and performance:a secondary analysis of 4206 catheters[J]. J Pediatr Nurs, 2020, 50:e18-e25. DOI URL
[30]	李梦婷, 陈朔晖. 新生儿疼痛表情自动识别系统的研究进展[J]. 中华护理杂志, 2019, 54(11):1644-1647. DOI URL
	Li MT, Chen SH. Research progress on automatic recognition technology of neonatal pain expression[J]. Chin J Nurs, 2019, 54(11):1644-1647.
[31]	沈巧, 郑显兰, 史源, 等. 中国新生儿疼痛管理循证指南(2023年)[J]. 中国当代儿科杂志, 2023, 25(2):109-127.
	Shen Q, Zheng XL, Shi Y, et al. Evidence-based guideline for neonatal pain management in China(2023)[J]. Chin J Con-temp Pediatr, 2023, 25(2):109-127.
[32]	Hoff R, Vervisch K, De Coen K, et al. Continuous infusion vs. intermittent flushing of peripheral cannulas in neonates using a needleless connector:a prospective cohort study[J]. J Perinat Med, 2019, 47(4):464-469. DOI URL
[33]	Simona R. A pediatric peripheral intravenous infiltration asse-ssment tool[J]. J Infus Nurs, 2012, 35(4):243-248. DOI URL
[34]	De Leo A, Leung BC, Giele H, et al. Management of extrava-sation injuries in preterm infants[J]. Surg Sci, 2016, 7(9):427-432. DOI URL
[35]	Amjad I, Murphy T, Nylander-Housholder L, et al. A new approach to management of intravenous infiltration in pediatric patients:pathophysiology,classification,and treatment[J]. J Infus Nurs, 2011, 34(4):242-249. DOI URL
[36]	David V, Christou N, Etienne P, et al. Extravasation of noncy-totoxic drugs[J]. Ann Pharmacother, 2020, 54(8):804-814. DOI URL
[37]	Ong J. Recommendations for management of noncytotoxic vesicant extravasations[J]. J Infus Nurs, 2020, 43(6):319-343. DOI PMID
[38]	Smolders EJ, Benoist GE, Smit CCH, et al. An update on ex-travasation:basic knowledge for clinical pharmacists[J]. Eur J Hosp Pharm, 2020, 28(3):165-167. DOI URL
[39]	Stefanos SS, Kiser TH, MacLaren R, et al. Management of no-ncytotoxic extravasation injuries:a focused update on medi-cations,treatment strategies,and peripheral administration of vasopressors and hypertonic saline[J]. Pharmacotherapy, 2023, 43(4):321-337. DOI URL
[40]	Engström Å, Forsberg A. Peripheral intravenous catheter diffi-culty-a clinical survey of registered nurse and critical care nurse performance[J]. J Clin Nurs, 2019, 28(3/4):686-694. DOI URL
[41]	江莹, 黎万汇, 陈莹莹, 等. 经外周静脉输注血管活性药物风险管理范围的综述[J]. 中华护理杂志, 2021, 56(7):1105-1110. DOI URL
	Jiang Y, Li WH, Chen YY, et al. A scoping review on risk management of peripheral vasoactive medication[J]. Chin J Nurs, 2021, 56(7):1105-1110. DOI URL