Webster Joan, Northfield Sarah, Larsen Emily N, Marsh Nicole, Rickard Claire M, Chan Raymond J
1 Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
2 Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia.
J Vasc Access. 2018 Jul;19(4):370-374. doi: 10.1177/1129729818757965. Epub 2018 Mar 21.
Many patients are discharged from hospital with a peripherally inserted central catheter in place. Monitoring the peripherally inserted central catheter insertion site for clinical and research purposes is important for identifying complications, but the extent to which patients can reliably report the condition of their catheter insertion site is uncertain. The aim of this study was to assess the inter-observer agreement between nurses and patients when assessing a peripherally inserted central catheter site.
The study was based on inpatients who were enrolled in a single-centre, randomised controlled trial comparing four different dressing and securement devices for peripherally inserted central catheter sites. A seven-item peripherally inserted central catheter site assessment tool, containing questions about the condition of the dressing and the insertion site, was developed. Assessment was conducted once by the research nurse and, within a few minutes, independently by the patient. Proportions of agreement and Cohen's kappa were calculated.
In total, 73 patients agreed to participate. Overall, percentage agreement ranged from 83% to 100% (kappa = .65-.82). For important clinical signs (redness, swelling, ooze, pus and tracking), there were high levels of percentage agreement (99%-100%).
The high level of agreement between nurse/patient pairs make the instrument useful for assessing peripherally inserted central catheter-associated signs of localised infection, allergic or irritant dermatitis or dressing dislodgement in a community setting.
许多患者出院时仍留置外周静脉穿刺中心静脉导管。出于临床和研究目的监测外周静脉穿刺中心静脉导管的插入部位对于识别并发症很重要，但患者能够可靠报告其导管插入部位状况的程度尚不确定。本研究的目的是评估护士和患者在评估外周静脉穿刺中心静脉导管部位时的观察者间一致性。
该研究基于参与一项单中心随机对照试验的住院患者，该试验比较了四种不同的外周静脉穿刺中心静脉导管部位敷料和固定装置。开发了一个包含七个项目的外周静脉穿刺中心静脉导管部位评估工具，其中包含有关敷料状况和插入部位的问题。研究护士进行一次评估，患者在几分钟内独立进行评估。计算一致性比例和科恩kappa系数。
共有73名患者同意参与。总体而言，一致性百分比范围为83%至100%（kappa系数=0.65-0.82）。对于重要的临床体征（发红、肿胀、渗液、脓液和条索状），一致性百分比很高（99%-100%）。
护士/患者对之间的高度一致性使得该工具可用于在社区环境中评估外周静脉穿刺中心静脉导管相关的局部感染、过敏性或刺激性皮炎或敷料移位的体征。
