Piredda Michela, Biagioli Valentina, Barrella Beatrice, Carpisassi Ilaria, Ghinelli Roberta, Giannarelli Diana, De Marinis Maria Grazia
Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy.
Department of Biomedicine and Prevention, Faculty of Medicine, School of Nursing, Tor Vergata University, Rome, Italy.
J Clin Nurs. 2017 Apr;26(7-8):1074-1084. doi: 10.1111/jocn.13444. Epub 2017 Feb 7.
This study aimed to identify risk factors for difficult intravenous cannulation in relation to characteristics of patients, healthcare providers and devices in adult patients accessing a radiology service.
Early recognition of patients at risk for difficult peripheral intravenous catheterisation is important to adopt strategies able to increase the likelihood of success in intravenous cannulation, as well as to critically evaluate the use of alternative administration routes or venous devices.
A prospective observational study was conducted in the radiology service of an Italian university hospital from January to August 2013.
Thirteen nurses observed 763 patients during intravenous insertion (53% were female, the mean age was 63 years and 65% had a diagnosis of cancer). For each patient, nurses collected data about potential predictors of difficult intravenous cannulation, which was defined as a procedure lasting more than one minute. Data included characteristics of patient, cannula required, venepuncture performed and operator(s) involved. Logistic regression was performed as univariate and multivariate analysis.
The intravenous insertion time ranged from 45 seconds to 125 minutes. Overall, variables identified as significant independent predictors were chemotherapy received via peripheral cannula (OR = 1·42), veins with many valves (OR = 3·67), fragility (OR = 3·29), visibility (OR = 0·87) and palpability (OR = 0·79) as perceived by nurses.
Although many risk factors were identified, the overall success rate was very high, suggesting that nurses' attention during cannulation protected at-risk patients from multiple attempts. Multicentre studies should further investigate risk factors across different radiology services and clinical settings.
These results can help nurses to recognise risk factors for difficult intravenous access and pay appropriate attention when attempting a venepuncture to preserve patients' peripheral veins.
本研究旨在确定成年患者在接受放射科服务时，与患者特征、医护人员及设备相关的静脉穿刺困难的危险因素。
尽早识别有外周静脉穿刺困难风险的患者，对于采取能够提高静脉穿刺成功率的策略，以及审慎评估替代给药途径或静脉设备的使用至关重要。
2013年1月至8月在一家意大利大学医院的放射科进行了一项前瞻性观察研究。
13名护士在静脉穿刺过程中观察了763例患者（53%为女性，平均年龄63岁，65%被诊断为癌症）。对于每位患者，护士收集了有关静脉穿刺困难潜在预测因素的数据，静脉穿刺困难定义为操作持续时间超过1分钟。数据包括患者特征、所需套管、进行的静脉穿刺及相关操作人员。进行了单因素和多因素逻辑回归分析。
静脉穿刺时间从45秒到125分钟不等。总体而言，被确定为显著独立预测因素的变量有经外周套管接受化疗（比值比=1.42）、有多个瓣膜的静脉（比值比=3.67）、脆弱性（比值比=3.29）、可视性（比值比=0.87）和可触知性（比值比=0.79）（护士的感知）。
尽管识别出了许多危险因素，但总体成功率非常高，这表明穿刺过程中护士的关注保护了有风险的患者避免多次尝试。多中心研究应进一步调查不同放射科服务和临床环境中的危险因素。
这些结果可帮助护士识别静脉穿刺困难的危险因素，并在进行静脉穿刺时给予适当关注，以保护患者的外周静脉。
