Sundararajan K, Wills S, Chacko B, Kanabar G, O'Connor S, Deane A M
Intensive Care Unit, Robert Gerard Wing, Royal Adelaide Hospital, Adelaide, South Australia.
Anaesth Intensive Care. 2014 Jul;42(4):473-9. doi: 10.1177/0310057X1404200408.
The objectives were to describe the incidence of accidental vascular catheter removal (AVCR) in an Australian Intensive Care Unit (ICU) and evaluate whether the fixation method or patient delirium increased the risk of AVCR. This prospective observational study was based in a tertiary level ICU between April 2011 and October 2012. All vascular catheters were secured either by sutures or by a suture-less securement device (STATLOCK(™), Bard Medical, Covington, GA, USA) as per the treating clinician. Data were obtained from bedside nursing staff, with daily screening for delirium completed by the ICU medical team using the Confusion Assessment Method-ICU. 2361 patients were admitted during this period with 1032 patients screened and data available for 322 patients (452 vascular catheters). AVCR occurred in 15 patients (16 vascular catheters) (5.0%) with an incidence of AVCR of 2.77 per 100 catheter-days. Delirious patients were 13-fold more likely to have an AVCR event (odds ratio=13.3; 95% confidence interval 4.36, 40.52; P <0.0001). There was a non-significant trend to an increase in AVCR when using the suture-less securement device (odds ratio=2.6; 95% confidence interval 0.87, 7.8; P=0.09) but delirious patients were no more likely to have an AVCR episode when a suture-less securement device was used (P=0.95). In this study the use of suture-less securement did not seem to increase the risk of AVCR. However, there was a non-significant trend towards increased AVCR when using suture-less securement devices, which may reflect a ß error.
本研究旨在描述澳大利亚重症监护病房（ICU）意外血管导管拔除（AVCR）的发生率，并评估固定方法或患者谵妄是否会增加AVCR的风险。这项前瞻性观察性研究于2011年4月至2012年10月在一家三级ICU进行。所有血管导管均由治疗医生根据情况采用缝线或无缝线固定装置（STATLOCK™，巴德医疗公司，美国佐治亚州卡温顿）进行固定。数据由床边护理人员提供，ICU医疗团队使用重症监护病房意识模糊评估方法每日完成谵妄筛查。在此期间，共收治2361例患者，其中1032例患者接受筛查，322例患者（452根血管导管）有可用数据。15例患者（16根血管导管）发生AVCR（5.0%），AVCR发生率为每100导管日2.77次。谵妄患者发生AVCR事件的可能性高13倍（优势比=13.3；95%置信区间4.36,40.52；P<0.0001）。使用无缝线固定装置时，AVCR有增加的趋势，但无统计学意义（优势比=2.6；95%置信区间0.87,7.8；P=0.09），但使用无缝线固定装置时，谵妄患者发生AVCR事件的可能性并不更高（P=0.95）。在本研究中，使用无缝线固定似乎不会增加AVCR的风险。然而，使用无缝线固定装置时，AVCR有增加的趋势，但无统计学意义，这可能反映了Ⅱ类错误。
