超声引导技术在危重患者外周静脉穿刺中的循证应用

Evidence-based Nursing Practice of Ultrasound-guided Technique in Peripheral Venipuncture in Critically Ill Patients

目的应用循证护理方法获取超声引导外周静脉穿刺的相关证据,探讨使用超声技术引导外周静脉穿刺的方法,并评价其效果。方法根据循证医学PICOS原则,提出临床问题并转换成检索式,在数据库中检索相关证据。经过评价后,筛选出可供参考的相关证据。选取2018年6月11日-8月31日四川大学华西医院呼吸与危重症医学科收治的危重患者23例作为研究对象,采用非随机对照试验,分为试验组(n=12)和对照组(n=11),试验组采用超声引导外周静脉穿刺,对照组采用传统外周静脉穿刺,对两组在初次置管成功率、穿刺次数、置管成功所需时间、留置针消耗数量、穿刺相关并发症发生率等方面进行比较。结果试验组在穿刺次数、置管成功所需时间、留置针消耗数量方面比对照组少,差异有统计学意义(P<0.001)。试验组初次置管成功率高于对照组,差异有统计学意义(P<0.001)。两组在穿刺相关并发症的发生率方面比较,差异无统计意义(P>0.05)。结论通过超声引导技术的循证及用证,使危重患者的外周静脉置管成功率得到提高,同时使护理人员循证及用证能力得到提升。

Objective To obtain the relevant evidence of ultrasound-guided peripheral venipuncture by evidence-based nursing,so as to explore the method of ultrasound-guided peripheral venipuncture and evaluate its effect.Methods According to the PICOS principle of evidence-based medicine,clinical questions were raised and converted to search formulas,and relevant evidence was retrieved in the database.After evaluation,relevant evidence for reference was screened out.A total of 23 critically ill patients admitted to the Department of Respiratory and Critical Care Medicine,West China Hospital of Sichuan University from June 11 to August 31,2018 were included in the study and divided into the experimental group(n=12)and the control group(n=11)by non-randomized controlled trial.Ultrasound-guided peripheral venipuncture was performed in the experimental group,while conventional peripheral venipuncture was used in the control group.The two groups were compared in terms of success rate of the initial catheterization,number of punctures,time required for successful catheterization,amount of indwelling needles consumed,and incidence of puncture-related complications.Results The number of punctures,time required for successful catheterization,and amount of indwelling needles consumed in the experimental group were less than those in the control group,and the differences were statistically significant(P<0.001).The success rate of initial catheterization in the experimental group was higher than that in the control group,and the difference was statistically significant(P<0.001).There was no statistically significant difference between the two groups in the incidence of puncture-related complications(P>0.05).Conclusion The practice of evidence-based nursing in the application of ultrasonic guidance technique increases the success rate of peripheral venipuncture catheterization in critically ill patients and improves nursing staff's ability to apply evidence-based nursing.