外周静脉置管失败、护士人员配备水平和护理复杂性的个体因素：一项回顾性多中心队列研究。
Peripheral intravenous catheter failure, nurse staffing levels and care complexity individual factors: A retrospective multicentre cohort study.
机构信息
Infectious Disease Department, Bellvitge University Hospital, L'Hospitalet de Llobregat (Barcelona), Barcelona, Spain.
Medicine and Health Science Faculty, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat (Barcelona), Barcelona, Spain.
出版信息
PLoS One. 2024 May 9;19(5):e0303152. doi: 10.1371/journal.pone.0303152. eCollection 2024.
INTRODUCTION
Short peripheral intravenous catheter (PIVC) failure is a common complication that is generally underdiagnosed. Some studies have evaluated the factors associated with these complications, but the impact of care complexity individual factors and nurse staffing levels on PIVC failure is still to be assessed. The aim of this study was to determine the incidence and risk factors of PIVC failure in the public hospital system of the Southern Barcelona Metropolitan Area.
METHODS
A retrospective multicentre observational cohort study of hospitalised adult patients was conducted in two public hospitals in Barcelona from 1st January 2016 to 31st December 2017. All adult patients admitted to the hospitalisation ward were included until the day of discharge. Patients were classified according to presence or absence of PIVC failure. The main outcomes were nurse staffing coverage (ATIC patient classification system) and 27-care complexity individual factors. Data were obtained from electronic health records in 2022.
RESULTS
Of the 44,661 patients with a PIVC, catheter failure was recorded in 2,624 (5.9%) patients (2,577 [5.8%] phlebitis and 55 [0.1%] extravasation). PIVC failure was more frequent in female patients (42%), admitted to medical wards, unscheduled admissions, longer catheter dwell time (median 7.3 vs 2.2 days) and those with lower levels of nurse staffing coverage (mean 60.2 vs 71.5). Multivariate logistic regression analysis revealed that the female gender, medical ward admission, catheter dwell time, haemodynamic instability, uncontrolled pain, communication disorders, a high risk of haemorrhage, mental impairments, and a lack of caregiver support were independent factors associated with PIVC failure. Moreover, higher nurse staffing were a protective factor against PIVC failure (AUC, 0.73; 95% confidence interval [CI]: 0.72-0.74).
CONCLUSION
About 6% of patients presented PIVC failure during hospitalisation. Several complexity factors were associated with PIVC failure and lower nurse staffing levels were identified in patients with PIVC failure. Institutions should consider that prior identification of care complexity individual factors and nurse staffing coverage could be associated with a reduced risk of PIVC failure.
简介
外周短导管（PIVC）失效是一种常见的并发症，通常被漏诊。一些研究评估了与这些并发症相关的因素，但护理复杂性个体因素和护士人员配备水平对 PIVC 失效的影响仍有待评估。本研究的目的是确定巴塞罗那南部大都市区公立医院系统中 PIVC 失效的发生率和危险因素。
方法
对 2016 年 1 月 1 日至 2017 年 12 月 31 日在巴塞罗那的两家公立医院进行了回顾性多中心观察性队列研究。所有住院病房收治的成年患者均纳入研究，直至出院日。根据是否存在 PIVC 失效对患者进行分类。主要结局是护士人员配备覆盖率（ATIC 患者分类系统）和 27 项护理复杂性个体因素。数据于 2022 年从电子健康记录中获得。
结果
在 44661 名带有 PIVC 的患者中，有 2624 名（5.9%）患者记录到导管失效（2577 名[5.8%]静脉炎和 55 名[0.1%]外渗）。女性患者（42%）、入住内科病房、非计划性入院、导管留置时间较长（中位数 7.3 天 vs 2.2 天）和护士人员配备覆盖率较低（平均 60.2% vs 71.5%）的患者中，PIVC 失效更为常见。多变量逻辑回归分析显示，女性性别、内科病房入院、导管留置时间、血流动力学不稳定、疼痛未得到控制、沟通障碍、出血风险高、精神障碍以及缺乏照顾者支持是与 PIVC 失效相关的独立因素。此外，较高的护士人员配备是 PIVC 失效的保护因素（AUC，0.73；95%置信区间[CI]：0.72-0.74）。
结论
约 6%的住院患者发生 PIVC 失效。多个复杂性因素与 PIVC 失效相关，并且在 PIVC 失效的患者中发现了较低的护士人员配备水平。各机构应考虑，事先识别护理复杂性个体因素和护士人员配备覆盖率可能与降低 PIVC 失效的风险相关。
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