Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
J Adv Nurs. 2020 Dec;76(12):3346-3362. doi: 10.1111/jan.14565. Epub 2020 Oct 5.
The aim of this systematic review and meta-analysis was to summarize and quantify peripheral intravenous catheter-related complications.
This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies.
The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 -April 2019.
Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman-Tukey double arcsine transformation using random-effects meta-analysis; estimates of heterogeneity were taken from inverse-variance fixed-effect models.
Seventy observational studies and 33 randomized controlled trials were included (76,977 catheters). Peripheral intravenous catheter-related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department-inserted catheters was significantly higher (25.2%; p = .022) than for those inserted in other departments and pain was significantly higher (p < .001) in countries with developing economies compared with developed economies.
Peripheral intravenous catheter complications are unacceptably common worldwide. This review suggests substantial and multi-specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced.
Peripheral intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral intravenous catheters.
本系统评价和荟萃分析的目的是总结和量化外周静脉导管相关并发症。
本系统评价通过 Cochrane 随机对照试验过程和观察研究荟萃分析（队列研究）进行报告。
Cochrane 对照试验中心注册库、PubMed、CINAHL 和 EMBASE 数据库、临床试验注册库（如 ClinicalTrials.gov）以及纳入研究的参考文献列表均从 2000 年至 2019 年 4 月进行检索。
使用专门设计的数据提取工具，两名作者独立识别出适合进行全面审查、数据提取和质量评估的研究。二项结局采用 Freeman-Tukey 双反正弦变换进行随机效应荟萃分析；异质性估计采用逆方差固定效应模型。
纳入 70 项观察性研究和 33 项随机对照试验（76977 个导管）。外周静脉导管相关并发症如下：静脉炎（有定义）19.3%，静脉炎（无定义）4.5%，渗漏/外渗 13.7%，堵塞 8%，漏液 7.3%，疼痛 6.4%，脱出 6.0%。亚组分析发现，急诊科插入的导管渗漏/外渗发生率明显更高（25.2%；p=0.022），而在其他科室插入的导管发生率较低，且在发展中国家疼痛发生率明显更高（p<0.001）。
外周静脉导管并发症在全球范围内非常普遍，令人无法接受。本研究表明，需要多学科做出大量努力来解决与并发症相关的后果。如果减少并发症，患者和卫生服务将获得巨大的潜在收益。
外周静脉并发症会中断重要治疗，给患者带来痛苦，并导致住院时间延长，增加医疗保健成本。本研究发现静脉炎和渗漏是导致导管失败的最常见原因。这些结果为护士提供了一个强有力的循证基础，以便制定有效的干预措施，这对于预防外周静脉置管患者的不良结局至关重要。
