外周静脉导管的处理——从不合规到基于证据的需求。

The handling of peripheral venous catheters--from non-compliance to evidence-based needs.

机构信息

Department of Surgery, Skånes University Hospital of Lund, Lund University, Lund, Sweden.

出版信息

J Clin Nurs. 2010 Dec;19(23-24):3358-63. doi: 10.1111/j.1365-2702.2010.03410.x. Epub 2010 Oct 22.

DOI:10.1111/j.1365-2702.2010.03410.x

PMID:20964751

Abstract

AIM

To study nurses' compliance to national guidelines (Sweden) for peripheral venous catheters and to establish the complication frequency connected to time in situ and bore size.

BACKGROUND

Worldwide, there are no standard peripheral venous catheters guidelines, and the need for elective replacement has been challenged. Furthermore, the time interval and need for elective change of peripheral venous catheters has cost implications for hospitals.

DESIGN

Prospective register study.

METHODS

The health care professionals in one surgical ward in a university hospital in the south of Sweden prospectively registered peripheral venous catheters parameters. Four hundred and thirteen peripheral venous catheters were registered for time in situ, size and complications. A cost analysis was performed. Non-parametric statistics were used, and p<0.05 was regarded as significant.

RESULT

Compliance to the guideline of time in situ was 30.2%, and the frequency of thrombophlebitis was 6.5%. Peripheral venous catheters left in situ for more than 72 hours caused more thrombophlebitis (p=0.03). There was no difference in thrombophlebitis rate when peripheral venous catheters were changed within 24 hours compared with peripheral venous catheters that were changed within 72 hours. No difference was seen regarding complications between peripheral venous catheters sized 0.9 mm/22 gauge or 1.1 mm/20 gauge.

CONCLUSION

The present Swedish national guidelines, advocating peripheral venous catheter change every 24 hours, should be altered since peripheral venous catheters left in situ for up to 72 hours were not found to be related to a greater risk of developing thrombophlebitis. Nor is it compatible with a greater risk to use a peripheral venous catheter of 1.1 mm/20 gauge instead of 0.9 mm/22 gauge. The change in guidelines would decrease money spent, 250 100 Euro in Sweden, thus allowing time for the nurses to do other tasks and save discomfort for the patients.

RELEVANCE TO CLINICAL PRACTICE

National guidelines should be based on evidence and current facts, and evaluation of guidelines should be given priority.

摘要

目的

研究护士对（瑞典）外周静脉导管国家指南的遵从情况，并确定与留置时间和导管规格相关的并发症发生率。

背景

全球范围内尚无外周静脉导管指南的标准，择期更换的必要性受到了挑战。此外，外周静脉导管的更换时间间隔和必要性对医院的成本有影响。

设计

前瞻性登记研究。

方法

瑞典南部一所大学医院的一个外科病房的医护人员前瞻性地登记外周静脉导管的参数。共登记了 413 例外周静脉导管的留置时间、导管规格和并发症。进行了成本分析。采用非参数统计方法，p<0.05 为差异有统计学意义。

结果

对留置时间指南的遵从率为 30.2%，血栓性静脉炎的发生率为 6.5%。留置时间超过 72 小时的外周静脉导管导致更多的血栓性静脉炎（p=0.03）。在 24 小时内更换外周静脉导管与在 72 小时内更换外周静脉导管相比，血栓性静脉炎的发生率没有差异。0.9mm/22 号和 1.1mm/20 号的外周静脉导管之间，并发症的发生率没有差异。

结论

目前瑞典国家指南建议每 24 小时更换外周静脉导管，应该进行修改，因为留置时间不超过 72 小时的外周静脉导管不会增加发生血栓性静脉炎的风险。使用 1.1mm/20 号的外周静脉导管而不是 0.9mm/22 号的外周静脉导管也不会增加风险。修改指南可以减少 250100 欧元的支出，从而为护士节省时间，让他们有时间做其他工作，并减少患者的不适。