儿童外周静脉留置针使用的循证护理实践

Evidence based practice on the use of peripheral venous indwelling needles in children based on the 2021 edition of infusion therapy practice standards

目的 :将第8版《输液治疗实践标准》中儿童外周静脉留置针相关证据用于临床实践并评价其效果。方法 :选取2022年7月至2023年3月北京市某三级儿童专科医院风湿免疫科收治的需要进行留置针输液治疗的患儿及科室24名护士作为研究对象。遵循复旦大学循证护理中心的证据转化模式,结合临床现状制订对策。使用调查问卷调查护士对最佳证据的知晓情况,采用现场观察和自我报告评估护士对最佳证据实施的依从性。结果 :证据的应用提高了护士穿刺和维护最佳证据知晓率和依从性(P<0.05);证据的应用可在未增加留置针静脉炎发生的前提下(P=0.205),有效延长留置时长(P<0.001),明显减少了静脉治疗相关费用(P<0.001)。结论 :证据的应用可以提升留置针的护理质量。在不增加并发症的前提下,使留置针的留置时间得到延长,减少了患儿穿刺次数和住院费用,从而减少护士工作量,节省人力。

Objective:To apply the evidence related to children's peripheral venous indwelling needles in the 8th edition of the"Practice Standards for Infusion Therapy"to clinical practice and evaluate its effectiveness.Methods:From July 2022 to March 2023,totally 24 department nurses and pediatric patients who were admitted to the Rheumatology and Immunology Department of a tertiary children's specialty hospital in Beijing and required indwelling needle infusion treatment were recruited.We adopted the evidence conversion model of Fudan University's Evidence Based Nursing Center and formulate policies based on clinical conditions.A survey questionnaire was used to investigate the awareness of nurses towards the evidence,and on-site observation and self-report were used to evaluate their compliance with the implementation of the evidence.Results:Application of evidence improved the awareness and compliance of nurses in puncture and maintenance of the evidence.Evidence was applied,which effectively prolonged the indwelling time(P<0.001)without increasing the incidence of indwelling needle phlebitis(P=0.205),significantly reduced venous treatment related costs(P<0.001),and thus reduced hospitalization costs.Conclusion:The application of evidence can improve the nursing quality of indwelling needles.Without increasing complications,the retention time of the indwelling needle can be prolonged,the number of punctures and hospitalization costs for the patient can be reduced,thereby reducing the workload of nurses and saving manpower.