血液净化用中心静脉导管相关血流感染防控管理的最佳证据总结

Summary of Best Evidence for the Prevention and Control Management of Bloodstream Infections Associated with Central Venous Catheters for Blood Purification

目的检索、评价并汇总血液净化用中心静脉导管相关血流感染防控管理的证据,为血液透析护理提供循证依据。方法根据“6S”证据模型,系统检索数据库及网站中血液净化用中心静脉导管相关血流感染防控的临床实践指南、专家共识、系统评价、证据总结、最佳临床实践等。检索时限为建库至2023年7月25日。由两名研究人员进行文献质量评价,证据提取、分析与整合。结果共纳入16篇文献,其中指南8篇、专家共识5篇、系统评价3篇。最终形成包括危险因素、制度管理、无菌屏障、导管留置、导管评估、导管维护、冲封管7个类别共41条的最佳证据。结论医护人员在证据转化过程中应根据导管留置时间和患者个体差异应用证据,并及时更新相关证据,以降低血液净化用中心静脉导管相关血流感染发生率。

Objective To retrieve,evaluate and summarize the evidence of prevention and control management of bloodstream infection related to central venous catheter for blood purification,and provide evidence-based basis for hemodialysis care.Methods According to the"6S"evidence model,clinical practice guidelines,expert consensus,systematic review,evidence summary and best clinical practice for the prevention and control of bloodstream infections related to central venous catheters for blood purification were systematically searched in databases and websites.The search period was up to July 25,2023.Literature quality evaluation,evidence extraction,analysis and integration were conducted by two researchers.Results A total of 16 studies were included,including 8 guidelines,5 expert consensus,and 3 systematic reviews.Forty-one pieces of best evidence were summarized from 7 aspects of risk factors and system management,sterile barrier,catheter indwelling,catheter assessment,catheter maintenance,and flushing and sealing tube management.Conclusion In the process of evidence transformation,medical staff should apply the evidence according to the catheter retention time and individual differences of patients,and timely update the relevant evidence to reduce the incidence of bloodstream infections associated with central venous catheters for blood purification.