危重症患者外周血管内导管相关静脉炎及并发症的发生率和发病率：一项前瞻性队列研究（AMOR-VENUS研究）
Occurrence and incidence rate of peripheral intravascular catheter-related phlebitis and complications in critically ill patients: a prospective cohort study (AMOR-VENUS study).
作者信息
Yasuda Hideto, Yamamoto Ryohei, Hayashi Yoshiro, Kotani Yuki, Kishihara Yuki, Kondo Natsuki, Sekine Kosuke, Shime Nobuaki, Morikane Keita, Abe Takayuki, Takebayashi Toru, Maeda Mikihiro, Shiga Takuya, Furukawa Taku, Inaba Mototaka, Fukuda Sachito, Kurahashi Kiyoyasu, Murakami Sarah, Yasumoto Yusuke, Kamo Tetsuro, Sakuraya Masaaki, Yano Rintaro, Hifumi Toru, Horiguchi Masahito, Nakayama Izumi, Nakane Masaki, Ota Kohei, Yatabe Tomoaki, Yoshida Masataka, Murata Maki, Fujii Kenichiro, Ishii Junki
机构信息
Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), Tokyo, Japan.
出版信息
J Intensive Care. 2021 Jan 6;9(1):3. doi: 10.1186/s40560-020-00518-4.
BACKGROUND
The lack of precise information on the epidemiology of peripheral intravascular catheter (PIVC)-related phlebitis and complications in critically ill patients results in the absence of appropriate preventive measures. Therefore, we aimed to describe the epidemiology of the use of PIVCs and the incidence/occurrence of phlebitis and complications in the intensive care unit (ICU).
METHODS
This prospective multicenter cohort study was conducted in 23 ICUs in Japan. All consecutive patients aged ≥ 18 years admitted to the ICU were enrolled. PIVCs inserted prior to ICU admission and those newly inserted after ICU admission were included in the analysis. Characteristics of the ICU, patients, and PIVCs were recorded. The primary and secondary outcomes were the occurrence and incidence rate of PIVC-related phlebitis and complications (catheter-related blood stream infection [CRBSI] and catheter failure) during the ICU stay.
RESULTS
We included 2741 patients and 7118 PIVCs, of which 48.2% were inserted in the ICU. PIVC-related phlebitis occurred in 7.5% (95% confidence interval [CI] 6.9-8.2%) of catheters (3.3 cases / 100 catheter-days) and 12.9% (95% CI 11.7-14.2%) of patients (6.3 cases / 100 catheter-days). Most PIVCs were removed immediately after diagnosis of phlebitis (71.9%). Grade 1 was the most common phlebitis (72.6%), while grade 4 was the least common (1.5%). The incidence rate of CRBSI was 0.8% (95% CI 0.4-1.2%). In cases of catheter failure, the proportion and incidence rate per 100 intravenous catheter-days of catheter failure were 21% (95% CI 20.0-21.9%) and 9.1 (95% CI 8.7-10.0), respectively.
CONCLUSION
PIVC-related phlebitis and complications were common in critically ill patients. The results suggest the importance of preventing PIVC-related complications, even in critically ill patients.
TRIAL REGISTRATION
UMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019 , July 1, 2017).
背景
缺乏关于重症患者外周血管内导管（PIVC）相关静脉炎及并发症流行病学的确切信息，导致缺乏适当的预防措施。因此，我们旨在描述重症监护病房（ICU）中PIVC的使用情况以及静脉炎和并发症的发生率/发生情况。
方法
这项前瞻性多中心队列研究在日本的23个ICU中进行。纳入所有年龄≥18岁连续入住ICU的患者。分析包括ICU入院前插入的PIVC以及ICU入院后新插入的PIVC。记录ICU、患者和PIVC的特征。主要和次要结局是ICU住院期间PIVC相关静脉炎及并发症（导管相关血流感染[CRBSI]和导管故障）的发生情况和发生率。
结果
我们纳入了2741例患者和7118根PIVC，其中48.2%是在ICU插入的。PIVC相关静脉炎在7.5%（95%置信区间[CI]6.9 - 8.2%）的导管中发生（3.3例/100导管日），在12.9%（95%CI 11.7 - 14.2%）的患者中发生（6.3例/100导管日）。大多数PIVC在诊断静脉炎后立即拔除（71.9%）。1级是最常见的静脉炎（72.6%），而4级是最不常见的（1.5%）。CRBSI的发生率为0.8%（95%CI 0.4 - 1.2%）。在导管故障的情况下，导管故障的比例和每100静脉导管日的发生率分别为21%（95%CI 20.0 - 21.9%）和9.1（95%CI 8.7 - 10.0）。
结论
PIVC相关静脉炎和并发症在重症患者中很常见。结果表明预防PIVC相关并发症的重要性，即使在重症患者中也是如此。
试验注册
日本临床试验注册中心UMIN - CTR（注册号：UMIN000028019，2017年7月1日）。
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