儿科中心静脉导管移除的最佳证据应用

Application of best evidence of pediatric central venous catheters removal

[目的]建立切实有效的儿童中心静脉导管维护的培训方案,提高护士依据证据进行中心静脉维护的执行力及相关知识知晓率,避免因导管移除不当导致的相关并发症的发生。[方法]遵循JBI循证护理中心的临床证据实践应用系统(JBI-PACES)的标准程序,包括证据应用前基线审查、证据的临床应用和证据应用后的再审查,在JBI在线临床治疗及护理证据网络(COnNECT+)数据库中获取中心静脉置管移除的相关证据并制定相应审查标准,分析每条证据应用存在的障碍因素并拟定可获得的解决方法。以护士对每条审查标准的执行率评价证据应用的有效性。[结果]证据应用前后纳入192例次接受中心静脉导管的患儿,参与质量审查的护士30人。第1轮质量审查后,基线审查中第1条体位的标准执行率由证据应用前的12.5%升至75.0%;第2条查看血小板计数在证据应用后护士执行率达到33.0%;第3条Valsalva呼吸指导在证据应用后护士执行率达到40.0%;第4条检查导管完整性执行率由基线审查84.3%上升至93.0%,第5条应用闭合性敷料和第6条细菌培养执行率均为100.0%。第2轮质量审查后,第2条查看血小板计数在证据应用后护士执行率达到95.0%;第3条Valsalva呼吸指导在证据应用后护士执行率达到93.0%,其余4条执行率均达到100.0%。[结论]儿科中心静脉置管移除最佳证据的临床应用,可规范护士移除中心静脉导管的护理行为,并提高临床护理质量。

Objective： To establish the training program for cCfectivc maintenance in children with central venouscatheter,so as to improve nurses？ implementation on central venous maintenance based on evidences and theirawareness rate of related knowledge？ so as to avoid related complications caused by incorrect catheter removal. Methods： The standard practice of Practical Application Clinical Evidence System （PACES） inJ BI evidence- based care centerwas followed, including the baseline review before evidence application, clinical application of evidences,and reexamination after the application of evidences. The relevant evidences of the central venous catheter removal were obtained,and to formulate the corresponding examination standards in the JBI Clinical Online Network of Evidence for Care and Therapeutics（COnNECT＋） database,to analyze the existing obstacle factors in each evidence apply and drawing up the available solutions. The eftion was evaluated in terms of the rate of implementation of each review standard by the nurses. Results ： Before and after the application of the evidences？ a total of 192 children with central venous catheterizarolled？ and 30 nurses participated in the quality examination. After the first round of quality reviews in baseline review,irst？the execution rate of position standard increased to 75. 0 % from 12. 5 % before the evidences were applied. Second,the executive rate of checking platelet count after the application of evidences reached 33. 0%. Third？the executive rate of Valsalva breathing instructions after the application of evidences reached 40. 0%. Fourth, the executive rate of checking catheters integrity increased from 84. 3 % to 93. 0%. Both fifth and sixth, the execution rate of both closed dressings application and bacterial cultures was 100. 0%. After the secondround of quality review, the execution rate of checking platelet count reached to 95. 0%. Third, the execution rate of Valsalva breathing instructions reached 93. 0%. The execution rate of the remaining 4 items reached 100. 0%. Conclusions ： The clinical application of the best evidences for best evidence of pediatric central venous catheters removal could regulate nurses？care behaviors of central venous catheter removal and improve the quality of clin-ical care.