成人中心静脉导管堵塞处置及预防的证据总结

Evidence Summary of the Prevention and Management of Adult Central Venous Catheter Occlusion

目的检索、评价并总结成人中心静脉导管(central venous catheter,CVC)堵塞处置及预防措施的相关循证证据,为临床护理实践提供循证依据。方法计算机检索2012年1月—2023年7月共19个中英文文献数据库、临床指南数据库及相关协会网站中关于成人CVC管理、堵塞预防及处置的所有证据,包括指南、专家共识、证据总结、证据实践、系统评价和Meta分析。采用临床指南研究与评价系统Ⅱ(appraisal of guidelines for research and evaluationⅡ,AGREEⅡ)、系统综述评价工具2(a measurement tool to assess systematic reviews 2,AMSTAR 2)及澳大利亚循证卫生保健中心专家意见与专家共识质量评价工具(joanna briggs institute text and expert opinion critical appraisal tool,JBI TEOCAT)进行文献质量评定,采用澳大利亚循证卫生保健中心(joanna briggs institute,JBI)证据分级和推荐系统进行证据质量评定。结果初步检索共获得文献891篇,最终纳入文献15篇,汇总了26条最佳证据。结论CVC的堵塞可从导管的全生命周期和全程管理入手进行有效预防,堵塞发生后应根据堵塞性质尽快处理。临床护士可以应用证据总结,结合实际情况制定护理策略进行CVC管理,降低CVC堵塞发生率。

Objective To identify,evaluate and summarize the best evidence of the prevention and management of central venous catheter(CVC)occlusion,and provide evidence for clinical nursing.Methods From January 2012 to July 2023,a total of 19 Chinese and English literature databases,clinical guidelines databases and related association websites were searched for all evidence on adult CVC management,blockage prevention and disposal,including guidelines,expert consensus,evidence summary,evidence practice,systematic review and meta-analysis.Appraisal of guidelines for research and evaluation 2(AGREEⅡ),a measurement tool to assess systematic reviews 2(AMSTAR 2)and joanna briggs institute text and expert opinion critical appraisal tool(JBI TEOCAT)were used to evaluate literature quality,and joanna briggs institute(JBI)evidence grading and recommendation system was used to evaluate evidence quality.Results A total of 891 references were obtained by the initial retrieval,and 15 were finally included.Twenty-six pieces of best evidence were summarized.Conclusion The occlusion of CVC can be effectively prevented from the whole life cycle and whole process management of the catheter,and the occlusion should be dealt with as soon as possible according to the nature of the occlusion.Clinical nurses can summarize the evidence,formulate nursing strategies based on the actual situation,and carry out CVC management to reduce the incidence of CVC occlusion.