采用不同的冲洗频率和量预防外周静脉导管失功：一项针对成年内科-外科住院患者的先导性析因随机对照试验
Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients.
作者信息
Keogh Samantha, Flynn Julie, Marsh Nicole, Mihala Gabor, Davies Karen, Rickard Claire
机构信息
NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Health Sciences Building N48 170 Kessels Road, Nathan, Brisbane, Queensland, 4011, Australia.
Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.
出版信息
Trials. 2016 Jul 26;17(1):348. doi: 10.1186/s13063-016-1470-6.
BACKGROUND
Research has identified high failure rates of peripheral intravenous catheter (PIVC) and varied flushing practices.
METHODS
This is a single-centre, pilot, non-masked, factorial randomised controlled trial. Participants were adults, with a PIVC of expected use ≥24 hours (n = 160), admitted to general medical or surgical wards of a tertiary referral hospital in Queensland (Australia). Patients were randomly allocated to one of four flush groups using manually prepared syringes and 0.9 % sodium chloride: 10 mL or 3 mL flush, every 24 or 6 hours. The primary endpoint was PIVC failure, a composite measure of occlusion, infiltration, accidental dislodgement and phlebitis.
RESULTS
PIVC average dwell was 3.1 days. PIVC failure rates per 1000 hours were not significantly different for the volume intervention (4.84 [3 mL] versus 7.44 [10 mL], p = 0.06, log-rank). PIVC failure rates per 1000 hours were also not significantly different for the frequency intervention (5.06 [24 hour] versus 7.34 [6 hour], p = 0.05, log-rank). Cox proportional hazard regression found neither the flushing nor frequency intervention, or their interaction (p = 0.21) to be significantly associated with PIVC failure. However, female gender (hazard ratio [HR] 2.2 [1.3-3.6], p < 0.01), insertion in hand/posterior wrist (HR 1.7 [1.0-2.7], p < 0.05) and the rate per day of PIVC access (combined flushes and medication pushes) (HR 1.2 [1.1-1.4], p < 0.01) significantly predicted PIVC failure.
CONCLUSION
Neither increased flushing volume nor frequency significantly altered the risk of PIVC failure. Female gender, hand/posterior wrist placement and episodes of access (flushes and medication) may be more important. Larger, definitive trials are feasible and required.
TRIAL REGISTRATION
Australian and New Zealand Clinical Trials Registry: ACTRN12615000025538 . Registered on 19 January 2015.
背景
研究发现外周静脉导管（PIVC）故障率高且冲管方法各异。
方法
这是一项单中心、先导性、非盲法、析因随机对照试验。参与者为入住澳大利亚昆士兰州一家三级转诊医院普通内科或外科病房、预期使用PIVC≥24小时的成年人（n = 160）。患者使用手工配制的注射器和0.9%氯化钠随机分配至四个冲管组之一：每24小时或每6小时冲管10 mL或3 mL。主要终点为PIVC失败，这是一个包括堵塞、渗漏、意外拔管和静脉炎的综合指标。
结果
PIVC平均留置时间为3.1天。每1000小时的PIVC故障率在容量干预方面无显著差异（4.84 [3 mL]对7.44 [10 mL]，p = 0.06，对数秩检验）。每1000小时的PIVC故障率在频率干预方面也无显著差异（5.06 [24小时]对7.34 [6小时]，p = 0.05，对数秩检验）。Cox比例风险回归发现，冲管干预和频率干预及其交互作用（p = 0.21）均与PIVC失败无显著关联。然而，女性（风险比[HR] 2.2 [1.3 - 3.6]，p < 0.01）、在手/后腕部穿刺（HR 1.7 [1.0 - 2.7]，p < 0.05）以及每天PIVC使用次数（联合冲管和推注药物）（HR 1.2 [1.1 - 1.4]，p < 0.01）显著预测PIVC失败。
结论
增加冲管容量和频率均未显著改变PIVC失败风险。女性、在手/后腕部穿刺以及使用次数（冲管和用药）可能更为重要。开展更大规模的确定性试验是可行且必要的。
试验注册
澳大利亚和新西兰临床试验注册中心：ACTRN12615000025538。于2015年1月19日注册。
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