Sichieri Karina, Iida Luciana Inaba Senyer, Menezes Isa Rodrigues da Silveira Cabral de, Garcia Paulo Carlos, Santos Talita Raquel, Peres Emília, Shimoda Gilcéria Tochika, Maia Flávia de Oliveira Motta, Secoli Silvia Regina, Püschel Vilanice Alves de Araújo
Department of Nursing, University Hospital of the University of São Paulo, São Paulo, Brazil.
Hospital Infections Control Committee, University Hospital of the University of São Paulo, São Paulo, Brazil.
JBI Database System Rev Implement Rep. 2018 Jun;16(6):1454-1473. doi: 10.11124/JBISRIR-2017-003561.
This implementation project aimed to identify the current practice in regards to central venous catheters (CVCs) maintenance to improve knowledge amongst nursing staff and to assess increased compliance with evidence-based best practice.
Central venous catheters are considered an important therapeutic resource for the administration of fluids, drugs, blood, collection of blood samples and hemodynamic monitoring. Despite the benefits, catheter use is associated with complications such as primary infection of the catheter-related bloodstream.
This project utilized the audit and feedback model using the Joanna Briggs Institute Practical Application of Clinical Evidence System. Nine of 10 criteria were audited through direct observation of nursing professionals or patient records in relation to CVC maintenance, and one criterion involved direct questioning of nursing staff. Baseline and follow-up audits were conducted in a 12-bed adult intensive care unit in a university hospital.
The baseline audit revealed deficits between current practice and best practice in some criteria. Barriers to implementation of CVC maintenance best practice criteria were identified, and the strategies were implemented. The post-implementation (follow-up) audit showed improvement in compliance to best practice guidelines in all of the audit criteria, except in one criterion: the use of sterile gloves or surgical tweezers during the execution of the dressing.
Best practice in CVC care was achieved in the hospital, strengthening and guiding nursing care, as well as highlighting the importance of nursing records throughout the care process. However, this project highlighted the need to improve compliance through follow-up audits and periodic training to support best practice.
本实施项目旨在确定中心静脉导管（CVC）维护的当前做法，以提高护理人员的知识水平，并评估对循证最佳实践的依从性提高情况。
中心静脉导管被认为是用于输液、给药、输血、采集血样和血流动力学监测的重要治疗资源。尽管有这些益处，但导管的使用与诸如导管相关血流原发性感染等并发症相关。
本项目采用乔安娜·布里格斯研究所临床证据系统实际应用的审核与反馈模型。通过直接观察护理专业人员或与CVC维护相关的患者记录，对10项标准中的9项进行了审核，一项标准涉及直接询问护理人员。在一家大学医院的一个拥有12张床位的成人重症监护病房进行了基线和随访审核。
基线审核显示，在某些标准方面，当前做法与最佳实践之间存在差距。确定了实施CVC维护最佳实践标准的障碍，并实施了相应策略。实施后（随访）审核显示，除了一项标准（换药时使用无菌手套或手术镊子）外，所有审核标准对最佳实践指南的依从性均有所提高。
该医院实现了CVC护理的最佳实践，加强并指导了护理工作，同时突出了护理记录在整个护理过程中的重要性。然而，本项目强调需要通过随访审核和定期培训来提高依从性，以支持最佳实践。
