Department of Pediatric Intensive Care Unit, Dr. Behcet Uz Children's Disease and Surgery Training and Research Hospital, Izmir, Turkey.
Infections Control Committee, Dr. Behcet Uz Children's Disease, and Surgery Training and Research Hospital, Izmir, Turkey.
J Vasc Access. 2022 Nov;23(6):885-889. doi: 10.1177/11297298211015500. Epub 2021 May 13.
Central line-associated bloodstream infection is one of the four primary health-care-associated infections applicable to pediatric intensive care units defined by The Centers for Disease Control and Prevention. According to current guidelines, it is essential to flush vascular access devices before each infusion to assess catheter function and prevent catheter-related complications.
This prospective trial aimed to assess the potential differences between pre-filled and manually prepared saline syringe use during vascular access device management in a pediatric intensive care unit.
Volunteered registered pediatric intensive care unit nurses were asked to implement the flushing solution to an extension line of a central venous catheter in vitro. After the randomization process with opaque sealed envelopes, they have started either with manual preparation or used sterile pre-filled saline syringes. Sterile application steps forms were used for monitoring the manual preparation of saline syringes versus the pre-filled saline syringes phase. Each volunteer repeated the steps for 3, 5, and 10 mL syringe volumes with the manually prepared and pre-filled saline syringes. After completing the procedures, failed steps and durations were transferred into a database to be analyzed by a blinded investigator.
A total of 41 nurses volunteered and 123 forms for three attempts per one nurse were filled for each group. In the manual preparation group, the number of at least one failure in the necessary steps was 89 (72.3%) and the same number in the pre-filled syringe group was 6 (4.9%), and significantly lower in the pre-filled saline syringe group ( < 0.001). The overall time for preparing to flush was 86.0 ± 22.3 s (ranging from 46 to 173 s) for manual prepared syringes and 35.2 ± 9.4 s (ranging from 18 to 100 s) ( < 0.001) for pre-filled saline syringes.
Our results demonstrate that the risk for breaking the aseptic no-touch technic was higher in the manual preparation group. We have also demonstrated that the flushing time was shorter with pre-filled syringes compared to manually prepared ones, which may contribute to decreasing the workload of the nurses and may increase the quality of care in the intensive care units. The use of pre-filled saline syringes may decrease the central line-associated bloodstream infections incidence and may increase the quality of care by saving extra time in the pediatric intensive care unit.
中心静脉导管相关性血流感染是疾病预防控制中心定义的儿科重症监护病房四大主要医疗保健相关感染之一。根据现行指南，在每次输液前冲洗血管通路装置以评估导管功能并预防导管相关并发症至关重要。
本前瞻性试验旨在评估在儿科重症监护病房中，管理血管通路装置时使用预充式和手动准备的生理盐水注射器之间的潜在差异。
自愿参与的注册儿科重症监护病房护士被要求在体外对中心静脉导管的延长线进行冲洗溶液。在使用不透明密封信封进行随机分组后，他们开始使用手动准备或使用无菌预充生理盐水注射器。使用无菌应用步骤表来监测生理盐水注射器的手动准备与预充生理盐水注射器阶段。每位志愿者用手动准备和预充生理盐水注射器重复 3、5 和 10mL 注射器体积的步骤。完成程序后，将失败的步骤和持续时间转移到数据库中，由一位盲法研究员进行分析。
共有 41 名护士自愿参与，每位护士进行三次尝试，每组填写了 123 份表格。在手动准备组中，至少有一个必要步骤失败的人数为 89 人（72.3%），预充式注射器组为 6 人（4.9%），预充生理盐水注射器组明显较低（ < 0.001）。准备冲洗的总时间为手动准备注射器 86.0 ± 22.3 s（范围为 46 至 173 s），预充生理盐水注射器 35.2 ± 9.4 s（范围为 18 至 100 s）（ < 0.001）。
我们的结果表明，在手动准备组中，违反无菌无接触技术的风险更高。我们还证明，与手动准备的注射器相比，预充式注射器的冲洗时间更短，这可能有助于减轻护士的工作量，并可能提高重症监护病房的护理质量。使用预充生理盐水注射器可能会降低中心静脉导管相关性血流感染的发生率，并通过在儿科重症监护病房中节省额外的时间来提高护理质量。
