Holder Max R, Stutzman Sonja E, Olson DaiWai M
The University of Texas Southwestern Medical Center, Dallas, Texas. Max R. Holder, BSN, RN, is the manager of the vascular access team in the Imaging Department at the UT Southwestern Medical Center. Sonja E. Stutzman, PhD, is the research manager for the Neuroscience Nursing Research Center at the UT Southwestern Medical Center. DaiWai M. Olson, PhD, RN, is a staff nurse and associate professor of neurology and neurotherapeutics at the UT Southwestern Medical Center.
J Infus Nurs. 2017 May/Jun;40(3):176-182. doi: 10.1097/NAN.0000000000000219.
Approximately 90% of hospitalized patients have a short peripheral intravenous catheter (SPC) placed. Methods of inserting the catheter have evolved over time and now include the use of ultrasound (US)-guided procedures for placement. Little is known about the impact that US-guided procedures have on the vein. This study compared the rate of venous thrombosis in patients with and without US-guided catheter placement. This prospective, single-blind, observational study assessed for venous thrombosis in 153 veins from 135 patients. Veins were evaluated by a research nurse blinded to the method of placement between 48 and 72 hours after the SPC was placed. The Fisher exact test showed a significant difference between vessel compressibility and catheter insertion method (P = .0012). The proportion of noncompressible veins was significantly greater when US was used in comparison with freehand SPC insertion. The Mantel-Haenszel chi-square value of 10.34 (P = .0013) showed that US insertion technique is associated with a higher likelihood of noncompressible veins. This pilot study provides compelling evidence that the use of US to assist with catheter placement is associated with a higher rate of noncompressible veins at day 2 or 3. Further studies are needed with a larger sample to determine the generalizability of the results from this pilot study.
大约90%的住院患者会置入一根外周短静脉导管(SPC)。导管插入方法随着时间推移不断演变,现在包括使用超声(US)引导下的置管操作。关于超声引导操作对静脉的影响,人们了解甚少。本研究比较了接受和未接受超声引导下导管置入患者的静脉血栓形成率。这项前瞻性、单盲观察性研究评估了135例患者153条静脉的血栓情况。在置入SPC后48至72小时,由一名对置管方法不知情的研究护士对静脉进行评估。Fisher精确检验显示血管可压缩性与导管插入方法之间存在显著差异(P = 0.0012)。与徒手插入SPC相比,使用超声时不可压缩静脉的比例显著更高。Mantel-Haenszel卡方值为10.34(P = 0.0013),表明超声插入技术与不可压缩静脉的更高可能性相关。这项初步研究提供了令人信服的证据,即使用超声辅助导管置入与第2天或第3天不可压缩静脉的发生率较高有关。需要进行更大样本量的进一步研究,以确定这项初步研究结果的普遍性。