ICU成人危重患者中心静脉导管维护技术的 最佳证据总结及应用

Summary and application of the best evidence for central venous catheter maintenance techniques in ICU adult critical patients

目的将ICU成人危重患者CVC维护技术的最佳证据应用于临床实践,旨在提高ICU护士对实践证据应用的依从性,从而降低ICU成人危重患者中心静脉导管相关血流感染(central line-associated bloodstream infection,CLABSI)的发生率.方法应用循证护理的方法得出最佳证据总结并本土化应用于临床.采用护理记录查询法、现场观察法、问卷调查法进行资料收集.证据应用时间为2019年2月—8月,证据应用前后共纳入312例ICU成年患者和62名ICU护士,进行2轮质量审查,分析证据应用过程中的障碍因素,寻找可利用的资源及解决方案,比较证据应用前后ICU成人危重患者CLABSI的发生率、ICU护士对循证证据的依从性及对CVC维护知识的知晓情况.结果最佳证据应用前后,ICU成人危重患者CLABSI的发生率从3.71‰下降至1.22‰;14条依从性较差的CVC维护循证审查指标有显著提高(P<0.05);ICU护士对基于循证的CVC导管维护知识大大提高,差异有统计学意义(P<0.05).结论将基于循证的最佳证据应用于临床护理实践,可以促进ICU成人危重患者CLABSI的防控工作,降低其感染的发生;同时能提高护士的循证依从性,提升临床护理质量.

Objective To apply the best evidence of central venous catheter(CVC)maintenance techniques in ICU adult critical patients,in order to improve ICU nurses'compliance of evidence practice and reduce infection rate of central line-associated bloodstream infections(CLABSI).Methods Summary the evidences by the method of evidence-based nursing and apply them after indigenization.Nursing records,field observation and questionnaire were used to collect the data.The evidence application time was from February 2019 to August 2019.A total of 312 ICU patients and 62 ICU nurses were included in the study.Two rounds of quality reviews were conducted to analyze the obstacles in the application of evidence and figure out available resources and solutions.The rate of CLABSI of ICU adult critical patients,ICU nurses'compliance with evidence practice and knowledge of CVC maintenance were compared before and after the application of evidence.Results After the best evidence application,the CLABSI rate of ICU adult critical patients decreased from 3.71‰to 1.22‰.14 indicators with low compliance in CVC maintenance evidence review were significantly improved(P<0.05).ICU nurses'knowledge of evidencebased CVC catheter maintenance was statistically improved(P<0.05).Conclusion Applying the best evidence to clinical nursing practice can promote the prevention and control of CLABSI in ICU adult critical patients and reduce infection rate.It also can improve the nurses'compliance of evidences and improve the quality of clinical nursing.