PICC尖端心腔内电图定位操作准确性与安全性的最佳证据总结

Best evidence summary on the accuracy and safety of PICC tip positioning in intracardiac ECG

目的检索、评价并整合经外周静脉置入中心静脉置管(peripherally inserted central catheter,PICC)尖端心腔内电图定位技术(intracardiac electrocardiogram,IC-ECG)安全性及准确性的的最佳证据,为临床实践提供循证依据。方法按照“6S”证据资源金字塔模型,自上而下系统检索证据。数据库包括BMJ最佳临床实践,UpToDate,英国国家卫生与临床优化研究所,国际指南协作网,苏格兰院际指南网,加拿大安大略注册护士协会,JBI(Joanna Briggs Institute)循证卫生保健数据库,PubMed,Embase,Cochrane Library,中国知网,万方数据库,SinoMed,维普数据库。检索时限为建库至2024年2月1日。由2名研究者独立评价文献质量,提取符合标准的文献证据。结果共纳入12篇文献,包括2篇指南、1篇团体标准、1篇专家共识、1篇Meta分析、1篇系统评价、3篇随机对照试验、1篇诊断性研究、2篇队列研究,针对置管前的评估与准备、成人最佳尖端位置及波形、新生儿最佳尖端位置及波形、房颤患者最佳尖端位置及波形、置管时维持波形稳定和记录置管过程中相关信息等6个方面,汇总成22条证据。结论本研究总结PICC尖端心腔内电图定位技术安全性及准确性的最佳证据,可为临床医护人员循证护理实践提供依据。

Objective To search,evaluate,and integrate the best evidence on the safety and accuracy of peripherally inserted central catheter(PICC)tip positioning in intracardiac ECG so as to provide evidence-based support for clinical practice.Methods Following the"6S"evidence resource pyramid model,evidence was systematically searched from top to bottom across databases,such as BMJ Best Practice,UpToDate,National Institute for Health and Care Excellence,Guidelines International Network,Scottish Intercollegiate Guidelines Network,Registered Nurses'Association of Ontario,JBI(Joanna Briggs Institute)Evidence-Based Healthcare Database,PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure,Wanfang Data,SinoMed and VIP Database.The search period was from the inception the database to 1st February,2024.Two researchers independently evaluated the quality of the literature and extracted evidence that met the criteria.Results A total of 12 articles were retrieved including 2 guidelines,1 group standard,1 expert consensus,1 Meta-analysis,1 systematic review,3 randomised controlled trials,1 diagnostic study and 2 cohort studies.They covered 6 themes such as pre-catheterisation assessment and preparation,the best tip position and waveform for adults,the best tip position and waveform for neonates,the best tip position and waveform for patients with atrial fibrillation,maintaining waveform stability during catheterisation and relevant information recording during the catheterisation process.A total of 22 pieces of evidence were summarised from the documents.Conclusion This study summarises the best evidence in the safety and accuracy of PICC tip positioning techniques of intracardiac ECG,which can provide a basis for nursing staff to practice evidence-based nursing.