Tan Ying Hua Grace, Tai Wai Ling Stephanie, Sim Crystal, Ng Hui Leng Isabel
Nursing Service, Tan Tock Seng Hospital, Singapore City, Singapore.
J Clin Nurs. 2017 Jan;26(1-2):133-139. doi: 10.1111/jocn.13451.
To evaluate current practices in managing peripheral venous catheters through catheter lifespan, reasons for removal and identifying potential predictors of catheter complications.
Peripheral venous catheter insertion is a common minimally invasive procedure performed during patient admission. Current routine replacement of catheters may not be required in the light of recent evidence.
A prospective observational study was carried out in April 2013.
One hundred patients were selected by systematic sampling. Ward nurses with support from three research nurses collected data for two weeks, ceasing earlier if patient no longer required venous catheters, was discharged, passed on or was transferred to a nongeneral ward setting. Analysis for potential predictors was carried out using random-effects model.
A total of 218 catheters were sampled, with a median catheter lifespan of 2·0 days. Half the catheters were removed because of complications with only 13 catheter removals due to phlebitis (grade 1+) in the first three days. Percentage of catheters removed due to complications also decreased as indwelling time increased. Twenty-three catheters (8·3%) could also have been saved as they were rendered 'not required/discharge' on day 1. Only insertion on the outer forearm was found to be associated with the likelihood of developing venous catheter complications.
Phlebitis rates in our setting are comparable to other published studies with all phlebitis cases occurring before the third day. The median catheter lifespan of two days is shorter than routine three-day replacement, which warrants an urgent review of current insertion and maintenance practices in our local setting.
Changing practice from routine replacement to clinically indicated has benefits to nurses and patients in terms of manpower time and costs. However, an effort to maximise peripheral catheter lifespan is necessary through daily vigilant catheter care and regular audits of practices.
通过导管留置期、拔除原因以及确定导管并发症的潜在预测因素，评估外周静脉导管的管理现状。
外周静脉导管插入术是患者住院期间常见的一种微创操作。鉴于最近的证据，目前常规更换导管可能并无必要。
2013年4月开展了一项前瞻性观察研究。
通过系统抽样选取100名患者。病房护士在三名研究护士的协助下收集了两周的数据，如果患者不再需要静脉导管、出院、转诊或转至非普通病房，则提前停止收集。使用随机效应模型对潜在预测因素进行分析。
共抽取了218根导管，导管中位留置期为2.0天。一半的导管因并发症而拔除，在前三天仅有13根导管因静脉炎（1级及以上）而拔除。随着留置时间的增加，因并发症拔除的导管百分比也有所下降。23根导管（8.3%）在第1天因“不再需要/出院”而本可避免拔除。仅发现前臂外侧插入导管与发生静脉导管并发症的可能性相关。
我们研究中的静脉炎发生率与其他已发表研究相当，所有静脉炎病例均发生在第三天之前。导管中位留置期为两天，短于常规的三天更换时间，这就需要我们紧急审查本地目前的插入和维护操作。
将实践从常规更换改为根据临床指征进行更换，在人力时间和成本方面对护士和患者都有益处。然而，有必要通过每日对外周导管的密切护理和定期的操作审核，努力使外周导管的留置期最大化。
