小儿外周静脉导管敷贴固定和更换的最佳证据应用

Application of the best evidence for peripheral venous catheter dressing fixation and replacement in pediatric patients

目的将基于循证的小儿外周静脉导管敷贴固定和更换的最佳证据应用于临床实践,规范儿科护士外周静脉导管敷贴固定和更换操作,提升静脉治疗专科护理质量。方法检索静脉输液相关领域的计算机决策支持系统、临床实践指南、系统评价、原始研究等循证资源。通过文献质量评价,纳入2篇指南和1篇系统评价作为证据资源的参考文献。总结12条证据,通过可行性、适宜性和临床意义进行评价,产生7条最佳证据,并转化为4条临床审查指标。遵循Joanna Briggs Institute(JBI)循证护理中心的临床证据实践应用系统的标准程序进行证据的临床应用,采用问卷调查法、现场观察法、访谈、查阅护理记录收集数据。以护士每条审查指标执行率、静脉炎和意外拔管的发生率及外周静脉导管留置时间评价证据应用的效果。结果基线审查中外周静脉敷料出现潮湿、松脱和(或)明显污染时护士应更换敷料等3条依从性差的执行项目,在证据应用后执行率显著提高(P<0.001)。证据应用后禁食和非禁食患儿外周静脉导管留置时间延长,差异有统计学意义(P<0.001)。证据应用前后静脉炎发生率比较,差异无统计学意义(P>0.05),意外拔管发生率比较,差异有统计学意义(P<0.001)。结论在临床护理中应用基于循证的小儿外周静脉导管敷贴固定和更换的最佳证据,可规范护士外周静脉导管敷贴固定和更换操作的护理行为,延长外周静脉导管留置时间,降低意外拔管发生率,提高儿科静脉治疗专科护理质量。

Objective Applying the best evidence of peripheral venous catheter dressing fixation and replacement in clinical practice,to standardize the pediatric nursing care procedure for peripheral venous catheter dressing fixation and replacement,and to improve the specialist nursing care quality of intravenous therapy.Methods Computer decision support system,clinical practice guidelines,systematic reviews and original articles related to intravenous infusion were searched. Through literature quality appraisal,2 guidelines and 1 systematic review were included as references for evidence resources and 12 items of evidence were summarized. After feasibility,suitability and clinical significance evaluation,7 items of best evidence were generated,and finally 4 clinical review indicators were formed. Clinical application of evidence was conducted according to the standard procedures of JBI evidence-based nursing center’s clinical evidence practice application system (JBI-PACES). Data were collected by questionnaire survey,field observation,interviews and nursing records reviewing. Effects of application were evaluated by nurse’s compliance of standard practice,incidence of phlebitis,incidence of unplanned extubation,and catheter indwelling time.Results Three items with poor compliance such as changing dressing for moisture,looseness and/or significant contamination during baseline assessment were significantly improved after the application of best evidence(P<0.001). The length of catheter indwelling was significantly prolonged(P<0.001). There was no significant difference in the incidence of phlebitis(P>0.05). The incidence of unplanned extubation was significant reduced(P<0.001).Conclusion Application of best evidence for pediatric peripheral venous catheter dressing fixation and replacement can standardize nursing care procedure,extend the indwelling time,reduce the incidence of unplanned extubation,and improve the quality of specialist nursing care for pediatric intravenous therapy.