超声引导外周血管介入术与传统技术相比，可提高住院患者首次尝试成功率：SPECTRA 随机临床试验。

UltraSound guided PEripheral Catheterization increases first-atTempt success RAte in hospitalized patients when compared with conventional technique: SPECTRA - Randomized Clinical Trial.

机构信息

Nursing school, Graduate Program, Universidade Federal do Rio Grande do Sul, Brazil.

Vascular Access Program at Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil.

出版信息

J Vasc Access. 2024 Sep;25(5):1450-1459. doi: 10.1177/11297298231162132. Epub 2023 Mar 27.

DOI:10.1177/11297298231162132

PMID:36971377

Abstract

BACKGROUND

Peripheral intravenous catheter (PIVC) insertion is the most common invasive procedure in the hospital setting. Ultrasound guided PIVC insertion in specific populations and settings has shown patient care benefits.

OBJECTIVE

To compare the success rate of first attempts of ultrasound guided PIVC insertion performed by nurse specialists with conventional PIVC insertion performed by nurse assistants.

METHOD

Randomized, controlled, single-center clinical trial registered on the ClinicalTrials.gov platform under registration NTC04853264, conducted at a public university hospital from June to September 2021. Adult patients hospitalized in clinical inpatient units with an indication for intravenous therapy compatible with a peripheral venous network were included. Participants in the intervention group (IG) received ultrasound guided PIVC performed by nurse specialists from the vascular access team, while those in the control group (CG) received conventional PIVC by nurse assistants.

RESULTS

The study included a total of 166 patients: IG ( = 82) and CG ( = 84), mean age 59.5 ± 16.5 years, mostly women ( = 104, 62.7%) and white ( = 136, 81.9%). Success rate on the first attempt of PIVC insertion in IG was 90.2% and in CG was 35.7% ( < 0.001), with a relative risk of 2.5 (95% CI 1.88-3.40) for success in IG versus CG. Overall assertiveness rate was 100% in IG and 71.4% in CG. Regarding procedure performance time, the medians in IG and CG were 5 (4-7) and 10 (6-27.5) min respectively ( < 0.001). As for the incidence of negative composite outcomes, IG had lower rates compared to CG, 39% versus 66.7% ( < 0.001), generating a 42% lower probability of negative outcomes in IG, 0.58 (95% CI: 0.43-0.80).

CONCLUSION(S): Successful first-try insertion was higher in the group receiving ultrasound-guided PIVC. Moreover, there were no insertion failures and IG presented lower insertion time rates and incidence of unfavorable outcomes.

摘要

背景

外周静脉置入中心静脉导管（PIVC）插入是医院环境中最常见的有创操作。在特定人群和环境中，超声引导的 PIVC 插入已显示出对患者护理的益处。

目的

比较由专科护士进行的超声引导 PIVC 插入与由助理护士进行的常规 PIVC 插入的首次尝试成功率。

方法

这是一项在 2021 年 6 月至 9 月于一所公立大学附属医院进行的、随机、对照、单中心临床试验，在 ClinicalTrials.gov 平台上注册，注册号为 NTC04853264。纳入对象为需要静脉治疗且符合外周静脉网络的住院患者。干预组（IG）接受血管通路团队专科护士进行的超声引导 PIVC，而对照组（CG）接受助理护士进行的常规 PIVC。

结果

本研究共纳入 166 名患者：IG（ = 82）和 CG（ = 84），平均年龄 59.5 ± 16.5 岁，大多数为女性（ = 104，62.7%）和白人（ = 136，81.9%）。IG 组首次 PIVC 插入成功率为 90.2%，CG 组为 35.7%（ < 0.001），IG 组与 CG 组相比，成功率的相对风险为 2.5（95%CI 1.88-3.40）。IG 组的总体果断率为 100%，CG 组为 71.4%。关于操作时间，IG 组和 CG 组的中位数分别为 5（4-7）和 10（6-27.5）分钟（ < 0.001）。在复合不良结局的发生率方面，IG 组低于 CG 组，分别为 39%和 66.7%（ < 0.001），IG 组发生不良结局的概率降低了 42%，为 0.58（95%CI：0.43-0.80）。