Chang Wen P, Peng Yu X
Wen P. Chang, PhD, RN, is Associate Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan, and Supervisor, Department of Nursing, Taipei Medical University Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan. Yu X. Peng, is a college student, Department of Nursing, College of Nursing, Tzu Chi University, Hualien, Taiwan.
Nurs Res. 2018 May/Jun;67(3):252-260. doi: 10.1097/NNR.0000000000000279.
Peripheral venous catheters (PVCs) are commonly used in clinical practice. However, varying degrees of phlebitis often occur in patients receiving intravenous injections. The relevant literature suggests that phlebitis occurrence is highly associated with the catheter gauge, insertion site, and catheterization duration. Nevertheless, no meta-analysis has been performed on the influence of these three factors on the occurrence of phlebitis.
The objective of this study was to determine whether any significant differences exist in the occurrence of phlebitis between catheters of 20 gauge or smaller and those larger than 20 gauge, between catheters inserted in the antecubital fossa and those inserted in other locations on the upper limbs, or between catheters inserted for more than 96 hours and those inserted for 96 hours or less.
Using a systematic approach, we searched for literature published between 2006 and 2017 in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest, and Cochrane Library databases. We used Comprehensive Meta-analysis Version 2 to perform our meta-analysis. After the screening and review processes, we identified 17 studies that met our selection conditions. Among these studies, 14 contained complete data for meta-analysis. These studies involved 4,343 patients and 5,846 PVCs.
Regarding the overall effect size in the meta-analysis, the results of the forest plot comparing catheters of 20 gauge or smaller and those larger than 20 gauge presented a risk ratio (RR) of 0.88 (95% confidence interval [0.67, 1.17], p = .380), indicating no statistically significant difference in the occurrence of phlebitis between catheters of the aforementioned gauges. The results of the forest plot comparing catheters inserted in the antecubital fossa and those inserted in other locations on the upper limbs presented an RR of 1.05 (95% confidence interval [0.82, 1.34], p = .696), indicating no statistically significant difference in the occurrence of phlebitis between catheters inserted in the aforementioned locations. The results of the forest plot comparing catheters inserted for more than 96 hours and those inserted for 96 hours or less presented an RR of 1.13 (95% confidence interval [0.49, 2.61], p = .779), indicating no statistically significant difference in the occurrence of phlebitis between catheters inserted for the aforementioned durations.
The empirical results of this meta-analysis can serve as a reference for hospital management for selecting the PVC gauge, insertion site, and catheterization duration. In addition to the three factors that we analyzed, whether any other factors influence the occurrence of phlebitis in patients with catheter implantation is worth investigating in future research.
外周静脉导管（PVC）在临床实践中常用。然而，接受静脉注射的患者常发生不同程度的静脉炎。相关文献表明，静脉炎的发生与导管规格、穿刺部位及置管时间高度相关。然而，尚未对这三个因素对静脉炎发生的影响进行荟萃分析。
本研究的目的是确定20号及以下导管与大于20号导管之间、肘前窝穿刺导管与上肢其他部位穿刺导管之间、置管超过96小时与置管96小时及以下的导管之间静脉炎发生率是否存在显著差异。
我们采用系统方法，检索了2006年至2017年发表在护理及相关健康文献累积索引（CINAHL）、PubMed、ProQuest和Cochrane图书馆数据库中的文献。我们使用综合荟萃分析2.0版进行荟萃分析。经过筛选和审查过程，我们确定了17项符合我们选择条件的研究。在这些研究中，14项包含完整的荟萃分析数据。这些研究涉及4343例患者和5846根PVC。
关于荟萃分析中的总体效应量，比较20号及以下导管与大于20号导管的森林图结果显示风险比（RR）为0.88（95%置信区间[0.67, 1.17]，p = 0.380），表明上述规格导管之间静脉炎发生率无统计学显著差异。比较肘前窝穿刺导管与上肢其他部位穿刺导管的森林图结果显示RR为1.05（95%置信区间[0.82, 1.34]，p = 0.696），表明上述部位穿刺导管之间静脉炎发生率无统计学显著差异。比较置管超过96小时与置管96小时及以下的导管的森林图结果显示RR为1.13（95%置信区间[0.49, 2.61]，p = 0.779），表明上述置管时间的导管之间静脉炎发生率无统计学显著差异。
本荟萃分析的实证结果可为医院管理选择PVC规格、穿刺部位和置管时间提供参考。除了我们分析的三个因素外，未来研究值得探讨是否有其他因素影响导管植入患者静脉炎的发生。
