成年患者中线导管留置与维护的最佳证据总结

doi:10.16460/j.issn1008-9969.2022.01.041

摘要/Abstract

摘要： 目的总结成年患者中线导管留置与维护的最佳证据,为临床护理工作提供证据支持。方法采用PICO构建循证护理问题,按照“6S”证据金字塔系统检索建库至2021年2月在UpToDate、BMJ Best Practice、Cochrane Library、JBI循证卫生保健中心数据库、美国国立指南库（National Guideline Clearinghouse, NGC）、美国疾病预防与控制中心（Centers for Disease Control and Prevention,CDC）、英国国家临床医学研究所指南库（National Institute for Health and Care Excellence, NICE）、国际指南协作网（Guideline International Network,GIN）、加拿大安大略注册护士协会（The Registered Nurses' Association of Ontario,RNAO）、CINAHL、EMbase、PubMed、美国静脉输液护理学会（Intravenous Nurses Society,INS）、万方数据库、中国知网、医脉通数据库有关成年患者中线导管留置与维护的文献。由2名循证护理师独立进行文献质量评价及证据筛查,证据汇总后由项目团队归类综合。结果共纳入文献6篇,包括指南4篇,系统评价2篇。从纳入的文献中共提取53条证据,最终综合成27条最佳证据共7个维度,分别是中线导管适应症及禁忌证、导管及穿刺部位选择、导管置入方法、管端位置、导管维护、拔除时机、培训与教育。结论本研究为临床医护人员规范化管理成年患者中线导管提供了循证依据,建议在评估机构环境及利益相关者的意愿后选择性应用最佳证据,以提升护理质量,保证患者安全。

关键词: 成年人, 中线导管, 留置, 维护, 循证护理

Abstract: Objective To summarize the best evidence of indwelling and maintenance of midline catheter in adult patients, and to provide evidence for clinical nursing. Methods The PICO model was used to identify evidence-based nursing problems, and the literature related to the placement and maintenance of midline catheter in adult patients was searched according to the 6S hierarchy of?evidence-based resources in databases of Up To Date, BMJ Best Practice, Cochrane Library, JBI, NGC, CDC, NICE, GIN, RNAO, CINAHL, EMbase, PubMed, INS, Wanfang, CNKI and Yimaitong from the inception to February 2021. The literature was independently evaluated and screened by two evidence-based nurses with master degree, and the evidence were summarized and evaluated by the research team. Results Six articles were included, including 4 guidelines and 2 systematic evaluations. A total of 53 pieces of evidence were extracted from the included literature, and finally 27 pieces of best evidence were integrated into 7 dimensions, including indications and contraindications of midline catheter, selection of midline catheter and puncture site, catheter placement method, catheter end location, catheter maintenance, catheter removal timing, training and education. Conclusion This study provides evidence-based evidence for clinical staff to standardize the management of midline catheters in adult patients. It is recommended to selectively apply the best evidence after evaluating the institutional environment and the willingness of stakeholders to improve the quality of care and ensure patient safety.

Key words: adult, midline catheters, indwelling, maintenance, evidence-based nursing

中图分类号:

R472

许志娟, 李秀轻, 孔晔宏, 史蕾, 乔秋阁, 凌冬兰. 成年患者中线导管留置与维护的最佳证据总结[J]. 护理学报, 2022, 29(1): 41-46.

XU Zhi-juan, LI Xiu-qing, KONG Ye-hong, SHI Lei, QIAO Qiu-ge, LING Dong-lan. Best Evidence Summary of Indwelling and Maintenance of Midline Catheters in Adult Patients[J]. Journal of Nursing, 2022, 29(1): 41-46.

参考文献

[1] 喻婷,刘文文.改良型中等长度导管在肠外营养患者中的应用[J].中国处方药,2019,17(1):137-138.DOI:10.3969/j.issn.1671-945X.2019.01.092
[2] Moureau N, Chopra V.Indications for Peripheral, Midline and Central Catheters: Summary of the MAGIC Recommendations[J]. Br J Nurs, 2016,25(8):S15-24. DOI:10.12968/bjon.2016.25.8.S15.
[3] Debra L.Wiegand.AACN Procedure Manual for High Acuity, Progressive,and Critical Care[M]. Seventh Edition. St Louis, MO:Elsevier:2017.
[4] Hagle ME,Mikell M.Peripheral venous access.In:Weinstein S,Hagle ME,eds. Plumer's Principles and Practice of Infnsion Therapy[M]. 9thed. Philadelphia, PA:Wolters Kluwer/Lippincott Williams & Wilkins:2014.
[5] 邹晓春,何金爱,宋燕伶.252例留置静脉中长导管患者调查分析[J].护理学报,2016,23(20):48-50.DOI:10.16460/j.issn1008-9969.2016.20.048
[6] Gorski LA, Hadaway L, Hagle ME, et al.Infusion Therapy Standards of Practice, 8th ed[J]. J Infus Nurs, 2021,44(1S Suppl 1):S1-S224.
[7] Gorski LA.Fast Facts for Nurses about Home Infusion Therapy: The Expert's Best Practice Guide in a Nutshell[M].New York, NY: Springer Publishing Company:2017.
[8] 朱政,胡雁,邢唯杰,等.不同类型循证问题的构建[J].护士进修杂志,2017,32(21):1991-1994.
[9] Dicenso A, Bayley L, Haynes RB. Accessing Pre-appraised Evidence: Fine-tuning the 5s Model into a 6s Model[J]. Evid Based Nurs,2009,12(4):99-101. DOI:10.1136/ebn.12.4.99-b.[10] AGREE Project Office. The AGREE II Instrument[EB/OL]. (2009-05-01)[2021-12-8].http://www.agreetrust.org.
[11] 熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AMSTAR[J]. 中国循证医学杂志,2011,11(9):1084-1089.DOI:10.3969/j.issn.1672-2531.2011.09.017.
[12] The Joanna Briggs Institute. Critical Appraisal Tools [EB/OL].(2017-11-24)[2021-12-08].http://joannabriggs.org/research/critical-appraisal-tool.
[13] 刘巧艳,朱力群,周英凤,等 .外周静脉短导管选择与置入的最佳证据分析[J].护士进修杂志, 2020, 3(35):550-555.DOI:10.16821/j.cnki.hsjx.2020.06.014.
[14] 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.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[15] 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.
[16] Chopra V, Flanders SA, Saint S, et al.The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method[J]. Ann Intern Med, 2015,163(6 Suppl):S1-S40. DOI:10.7326/M15-0744.
[17] 傅麒宁,吴洲鹏,孙文彦,等.《输液导管相关静脉血栓形成中国专家共识》临床实践推荐[J].中国普外基础与临床杂志,2020, 27(4):412-418.DOI:10.7507/1007-9424.202001030.
[18] Cawcutt KA, Hankins RJ, Micheels TA, et al.Optimizing Vascular-access Device Decision-making in the Era of Midline Catheters[J]. Infect Control Hosp Epidemiol, 2019,40(6):674-680.DOI:10.1017/ice.2019.49.
[19] Moureau N, Chopra V.Indications for Peripheral, Midline and Central Catheters: Summary of the MAGIC Recommendations[J]. Br J Nurs, 2016,25(8):S15-24.DOI:10.12968/bjon.2016.25.8.s15.
[20] Caparas JV, Hu JP.Safe Administration of Vancomycin through A Novel Midline Catheter: A Randomized, Prospective Clinical Trial[J].J Vasc Access, 2014,15(4):251-256. DOI:10.5301/jva.5000220.
[21] Caparas JV, Hung HS.Vancomycin Administration through a Novel Midline Catheter: Summary of a 5-year,1086-patient Experience in an Urban Community Hospital[J]. Assoc Vasc Access,2017,22:38-41. DOI:10.1016/j.java.2016.10.092.
[22] Cawcutt KA, Hankins RJ, Micheels TA, et al.Optimizing Vascular-access Device Decision-making in the Era of Midline Catheters[J].Infect Control Hosp Epidemiol, 2019,40(6):674-680.DOI:10.1017/ice.2019.49.
[23] Dickson HG, Flynn O, West D, et al.A cluster of Failures of Midline Catheters in a Hospital in the Home Program: A Retrospective Analysis[J]. Infus Nurs, 2019,42(4):203-208.DOI:10.1097/NAN.0000000000000330.
[24] Ullman AJ, Cooke ML, Mitchell M, et al.Dressing and Securement for Central Venous Access Devices (CVADs): A Cochrane Systematic Review[J].Int J Nurs Stud, 2016(59):177-196.DOI:10.1016/j.ijnurstu.2016.04.003.
[25] Marsh N, Webster J, Mihala G, et al.Devices and Dressings to Secure Peripheral Venous Catheters: A Cochrane Systematic Review and Meta-analysis[J]. Int J Nurs Stud, 2017(67):12-19.DOI:10.1016/j.ijnurstu.2016.11.007.
[26] Schiffer CA, Mangu PB, Wade JC, et al.Central Venous Catheter Care for the Patient with Cancer: American Society of Clinical Oncology Clinical Practice Guideline[J]. Clin Oncol, 2013,31(10):1357-1370.DOI:10.1200/JCO.2012.45.5733.
[27] 周英凤,胡雁,顾莺,等.基于证据的持续质量改进模式图的构建[J].中国循证医学杂志,2017,17(5):603-606.DOI:10.7507/1672-2531.201611090.

相关文章 15

[1]	殷青霞, 王莉慧, 区洁霞, 文红, 罗笑婷, 刘赛君, 黄心梅, 刘灿灿. 克罗恩病患者饮食管理的证据总结[J]. 护理学报, 2022, 29(1): 47-52.
[2]	李萍, 靳小雯, 李燕玲, 徐玉兰, 喻姣花, 李卓颖, 李应, 邓睿. 成年患者结直肠镜检查肠道准备不充分的预防及管理证据总结[J]. 护理学报, 2021, 28(9): 22-28.
[3]	陈佳, 熊巍, 张丽芳, 张纯. 手臂内收30°时腔内心电图下PICC导管尖端定位的效果观察[J]. 护理学报, 2021, 28(7): 69-73.
[4]	高兴莲, 余文静, 肖瑶, 胡娟娟, 赵诗雨, 杨英. 手术患者围术期压力性损伤预防及管理最佳证据总结[J]. 护理学报, 2021, 28(6): 22-26.
[5]	朱玮玮, 许阳子, 霍婉君, 陈慈玉, 李远添, 凌冬兰. 老年痴呆患者疼痛评估及管理最佳证据总结[J]. 护理学报, 2021, 28(5): 32-37.
[6]	杨华文, 易凤琼, 曾彦超, 钟昌艳, 熊中雨, 朱遵燕. 全麻术后患者超早期拔除尿管的临床研究[J]. 护理学报, 2021, 28(5): 66-69.
[7]	王亚玲, 王冰寒, 张艳, 尹雪, 蒋辛, 熊晓明, 黎华丽. 急性缺血性脑卒中患者溶栓术后预防出血转化的最佳证据总结[J]. 护理学报, 2021, 28(3): 46-52.
[8]	刘珊珊, 王颖, 贾守梅, 邓蓉, 蒋艳, 陈芳, 罗云婷. 慢性肝病住院患者营养筛查评估与管理循证实践[J]. 护理学报, 2021, 28(19): 33-38.
[9]	蔡莹莹, 张俊峰, 郑可欣, 张兰芳, 余璐萍, 曾文, 陈梦云, 黄琼珊. 老年肿瘤患者跌倒评估及管理最佳证据总结[J]. 护理学报, 2021, 28(18): 22-27.
[10]	杜雪萍, 陈婵玲, 陈燕珣, 郑庭凯, 张映清. 降低老年住院患者留置尿管相关尿路感染发生率的集束化护理实践[J]. 护理学报, 2021, 28(18): 12-16.
[11]	熊照玉, 李素云, 杨赛, 柯卉, 黄海燕, 周慧敏, 晏蓉, 刘云访, 刘天艺. 构建住院患者肠内营养相关便秘预警分级标准及干预方案[J]. 护理学报, 2021, 28(17): 70-75.
[12]	沈燕, 陈兰, 费凯红, 潘恒德, 俞佳琦, 王莹, 姜艳华, 张洁, 姚叶英. 肝移植术后患者早期活动最佳证据总结[J]. 护理学报, 2021, 28(16): 16-21.
[13]	康莉, 王翠玲, 田佳, 许晨丽. 上消化道术后患者肠内营养喂养不耐受预防及管理的最佳证据总结[J]. 护理学报, 2021, 28(16): 22-26.
[14]	卢舒颖, 刘宁, 廉民学. 糖尿病患者急性卒中后血糖监测及管理的最佳证据总结[J]. 护理学报, 2021, 28(15): 42-47.
[15]	张艳红, 罗彩凤, 米元元, 朱丽群, 刘巧艳, 严雪琴, 张政怡, 黄汉鹏. 慢性阻塞性肺疾病患者长期氧疗管理的最佳证据总结[J]. 护理学报, 2021, 28(15): 35-41.

Metrics

Viewed

Full text

Abstract

Cited

Shared