老年住院患者外周静脉留置针出现临床指征拔针的安全性研究

Study of clinically-indicated replacement of peripheral intravenous catheters in old adults

目的评价老年患者外周静脉留置针出现临床指征拔针的安全性。方法选取2017年5月至2018年5月上海交通大学附属新华医院急诊病房1627例使用外周留置针的老年患者,根据随机数字表法分为试验组817例和对照组810例,试验组留置针出现临床指征时拔针,对照组按照常规的72~96 h定期拔针。比较2组留置针留置时间、留置期间相关并发症以及护士的依从性。结果试验组留置时间为(3.43±1.36)d,长于对照组(3.18±1.16)d,差异有统计学意义(t值为4.07,P<0.05)。试验组静脉炎、堵管、外渗及意外脱出的发生率分别11.26%(92/817)、17.87(146/817)、10.77%(88/817)及3.91%(32/817),对照组分别为9.88%(80/810)、15.06%(122/810)、11.23%(91/810)、3.70%(30/810),2组比较差异无统计学意义(χ2值为0.82、2.33、0.09、0.05,均P>0.05);在静脉炎严重程度分级上,试验组静脉炎分级高于对照组,2组比较差异有统计学意义(χ2值为20.99,P<0.05);试验组护士拔针的依从性100.00%(817/817),高于对照组87.65%(710/810),差异具有统计学意义(χ2值为107.47,P<0.05)。结论老年患者外周静脉留置针出现临床指征拔针可以延长留置时间;在拔针标准界定清楚以及严格的监控流程下,老年患者出现临床指征拔针在临床上具有可行性。

Objective To evaluate the safety of clinically-indicated replacement of peripheral intravenous catheters(PIVCs)in old adults.Methods Total of 1627 patients with peripheral intravenous catheters in emergency wards at a tertiary hospital in shanghai were recruited.Patients were randomly divided into an experimental group(817 cases)and control group(810 cases)by random digits tale method.PIVCs in the experiment were replaced only when clinical indications appeared,while PIVCs in the control group were routinely changed every 72-96 hours.Indwelling time,complications associated with PIVCs and nurse compliance were compared after indwelling peripheral intravenous catheters.Results PIVC indwelling time was(3.43±1.36)days in the experimental group,and(3.18±1.16)days in the control group,there was significant difference between two groups(t value was 4.07,P<0.05).The incidence of phlebitis,occlusion,infiltration,and accidental removal in experimental group was 11.26%(92/817),17.97%(146/817),10.77%(88/817),3.91%(32/817),while in the control group 9.88%(80/810),15.06%(122/810),11.23%(91/810),3.70%(30/810).The two groups showed no statistically difference in catheter phlebitis,occlusion,infiltration,and accidental removal(χ2 values were 0.82,2.33,0.09,0.05,P>0.05).The severity of phlebitis in the experiment group was higher than that in the control group,and there was significant difference between two groups(χ2 value was 20.99,P<0.05).Nurse compliance achieved in the experimental group 100.00%(817/817)was higher than that in the control group 87.65%(710/810),which showed statistically difference(χ2 value was 107.47,P<0.05).Conclusion Indwelling time in the clinically-indicated replacement group was longer than that of the routine replacement group.Peripheral intravenous catheters in old adults can be remove as clinically-indicated with a close monitoring of complications.