外周静脉穿刺困难的危险因素。PIVV2多中心病例对照研究。
Risk Factors for Difficult Peripheral Intravenous Cannulation. The PIVV2 Multicentre Case-Control Study.
作者信息
Rodriguez-Calero Miguel Angel, de Pedro-Gomez Joan Ernest, Molero-Ballester Luis Javier, Fernandez-Fernandez Ismael, Matamalas-Massanet Catalina, Moreno-Mejias Luis, Blanco-Mavillard Ian, Moya-Suarez Ana Belén, Personat-Labrador Celia, Morales-Asencio José Miguel
机构信息
Nurse Director Office, Health System of the Balearic Islands (Ib-Salut), Carrer de la Reina Esclaramunda, 9. Piso 3, 07003 Palma Mallorca, Spain.
Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain.
出版信息
J Clin Med. 2020 Mar 15;9(3):799. doi: 10.3390/jcm9030799.
BACKGROUND
Difficult peripheral intravenous cannulation (DPIVC) is associated with serious complications related to vascular access. These complications might be avoided if the risk factors were identified previously, enabling the detection of potentially difficult situations at an early stage. The aim of this study is to consider these risk factors, to determine the influence of the hospital setting, to examine the association between DPIVC and the different techniques of catheter insertion and to analyse the importance of the clinician's experience in this context.
METHODS
Case-control study following a previously published protocol, conducted in 48 units of eight public hospitals in Spain. Adult patients requiring a peripheral intravenous cannula were prospectively included in the study population during their hospital stay. Over a period of 11 months, for consecutive eligible patients, nurses in each participating unit recorded data on their assessment of the vascular access performed and the technique used. Variables related to these medical personnel were also recorded. One of the researchers reviewed the patients' clinical history to compile the relevant health variables and to characterise the healthcare process. The statistical analysis included association tests among the main study variables. The risk factors were analysed using bivariate logistic regression. The variables found to be statistically significant were included in a multivariate logistic regression model incorporating each of the healthcare environments identified.
RESULTS
The study population was composed of 2662 patients, of whom 221 (8.3%) presented with DPIVC. A previous history of difficulty, the presence of non-palpable veins, acute upper limb alterations and punctures in the ante-cubital fossa were found to be independent risk factors for DPIVC. Differences were found in the frequency of occurrence of DPIVC and in some risk factors, according to the healthcare context. The variables related to the characteristics of the hospital personnel did not influence the study event.
CONCLUSION
The present study identifies four independent risk factors for DPIVC that can be incorporated into algorithms aimed at preventing its occurrence and facilitating the referral of patients to vascular access specialist teams.
背景
外周静脉穿刺困难（DPIVC）与血管通路相关的严重并发症有关。如果能提前识别风险因素，在早期阶段检测出潜在的困难情况，这些并发症或许可以避免。本研究的目的是考虑这些风险因素，确定医院环境的影响，研究DPIVC与不同插管技术之间的关联，并分析临床医生经验在这种情况下的重要性。
方法
按照先前发表的方案进行病例对照研究，在西班牙八家公立医院的48个科室开展。成年住院患者如需外周静脉置管，则前瞻性纳入研究人群。在11个月的时间里，各参与科室的护士连续记录符合条件患者的血管通路评估情况及所用技术的数据。还记录了与这些医务人员相关的变量。一名研究人员查阅患者临床病史，整理相关健康变量并描述医疗过程。统计分析包括主要研究变量之间的关联测试。使用二元逻辑回归分析风险因素。将具有统计学意义的变量纳入包含所确定的各个医疗环境的多元逻辑回归模型。
结果
研究人群包括2662例患者，其中221例（8.3%）存在DPIVC。既往穿刺困难史、不可触及的静脉、上肢急性病变以及肘前窝穿刺是DPIVC的独立危险因素。根据医疗环境，DPIVC的发生频率和一些风险因素存在差异。与医院工作人员特征相关的变量未影响研究事件。
结论
本研究确定了DPIVC的四个独立危险因素，可纳入旨在预防其发生并便于将患者转诊至血管通路专家团队的算法中。
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