中心静脉导管留置患者导管接头维护的最佳证据应用
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摘要
目的将中心静脉导管(central venous catheter,CVC)留置患者导管接头维护的最佳证据应用于临床实践,提高护士对实践证据应用的依从性,从而降低CVC留置患者导管接头的堵塞率。方法遵循JBI循证护理中心的临床证据实践应用模式,包括证据应用前的基线审查、实践变革和证据应用后变革效果的再审查。采用现场观察法、查阅护理文献进行资料收集。证据应用时间为2017年5月至2018年1月,前后共纳入258例CVC留置患者及25名护士,进行2轮质量审查,分析证据应用过程中的障碍因素,寻找可利用的资源及解决方案。结果证据应用之后,10条循证依从性较差的审查标准有显著性提高(均P<0.05);护士对基于循证的CVC导管维护知识大大提高,应用前后比较差异有统计学意义(P<0.01);CVC留置患者导管堵塞率由45.9%降为29.3%。结论将中心静脉导管维护的最佳证据应用于临床,可规范护士行为,提高护士循证依从性,降低CVC留置患者导管堵塞率,节约患者经济成本。
Objective To apply the best evidence of catheter joint maintenance in patients with the central venous catheter(CVC)to clinical practice,to improve nurses' compliance with the application of practical evidence,in order to reduce the blockage rate of catheter joint in patients with CVC.Methods Following the clinical evidence practice application model of the JBI Evidence-based Care Center,it included baseline review before evidence application,practice changes,and re-examination of the effect of post-evidence application.The field observation method and nursing literature were used for data collection.The evidence application time was from May 2017 to January 2018.A total of 258 patients with CVC and 25 nurses were included in the study.Two rounds of quality reviews were conducted to analyze the obstacles in the application of evidence and find available resources and solutions.Results After the application of evidence,there was a significant improvement in the 10 review criteria with poor evidence-based compliance(all P<0.05).The knowledge of the CVC maintenance was improved in nurse(P<0.01).The blockage rate of catheters in patients with CVC retention decreased from 45.9% to 29.3%.Conclusions Applying the best evidence of CVC maintenance to clinical practice can standardize nurses' behavior,improve nurses' evidence-based compliance,reduce the rate of catheter blockage in patients with CVC,and save patients' financial costs.
Objective To apply the best evidence of catheter joint maintenance in patients with the central venous catheter(CVC)to clinical practice,to improve nurses' compliance with the application of practical evidence,in order to reduce the blockage rate of catheter joint in patients with CVC.Methods Following the clinical evidence practice application model of the JBI Evidence-based Care Center,it included baseline review before evidence application,practice changes,and re-examination of the effect of post-evidence application.The field observation method and nursing literature were used for data collection.The evidence application time was from May 2017 to January 2018.A total of 258 patients with CVC and 25 nurses were included in the study.Two rounds of quality reviews were conducted to analyze the obstacles in the application of evidence and find available resources and solutions.Results After the application of evidence,there was a significant improvement in the 10 review criteria with poor evidence-based compliance(all P<0.05).The knowledge of the CVC maintenance was improved in nurse(P<0.01).The blockage rate of catheters in patients with CVC retention decreased from 45.9% to 29.3%.Conclusions Applying the best evidence of CVC maintenance to clinical practice can standardize nurses' behavior,improve nurses' evidence-based compliance,reduce the rate of catheter blockage in patients with CVC,and save patients' financial costs.
引文
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[2]JACOB J T,CHERNETSKY T S,DENT R M,et a1.Comparison of a silver coated needleless connector and a standard needleless connector for the prevention of centralline-associated bloodstream infections[J].Infect Control Hosp Epidemiol,20l5,36(3):294-301.
[3]JARVIS W R,MURPHY C,HALL K K,et a1.Health care associated blood stream infections associated with negative or positive pressure or displacement mechanical valve needleless connectors[J].Clin Infect Dis,2009,49(12):1821-1827.
[4]LONG K D L.Needleless connectors:thrombotic occlusions[EB/OL].[2017-11-09].http://connect.jbiconnectplus.org/Search.aspx.
[5]MAFAKDA D.Needleless connectors:bloodstream infections[EB/OL].[2018-04-20].http://connect.jbiconnectplus.org/Search.aspx.
[6]LISA G,LYNN H,MARY E,et al.Infusion therapy standards of practice[S].MA:American Infusion Nurses Society,2016:1-75.
[7]顾莺,胡雁,张玉侠,等.儿科外周静脉留置针维护的最佳证据应用[J].护理学杂志,2014,29(15):52-55.