股静脉置入PICC术后预防导管相关性血流感染的循证护理研究  

Evidence-based nursing practice of preventing line-associated bloodstream infection post operation of implanting PICC in femoral vein

作　　者：许立薇[1] 赵心阳 张晓春[1] XU Li-wei;ZHAO Xin-yang;ZHANG Xiao-chun(Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang 110001, China)

机构地区：[1]中国医科大学附属第一医院呼吸与危重症医学科,辽宁沈阳110001

出　　处：《中国医学装备》2019年第5期94-97,共4页China Medical Equipment

基　　金：辽宁省自然科学基金资助课题(2013021014)"基于风险管理的重症心血管监护病房护理资源规划研究"

摘　　要：目的:制定中央导管相关血流感染(CLABSI)的循证护理方案,以预防导管相关性血流感染。方法:选取1例上腔静脉综合征(SVCS)患者,依据循证问题的研究人群(P)、干预措施(I)、对照(C)和结局(O)4要素和患者情况,提出临床问题;计算机检索美国国立指南库(NGC)、考克兰图书馆的CDSR与DARE数据库、加拿大安大略护理学会指南网(RNAO)、PubMed和中国生物医学文献数据库(CBM),检索时限为2000-2017年;选择证据类型为指南、系统评价(SR)、Meta分析和多中心大样本随机对照试验(RCT);最终纳入3篇临床实践指南、4篇系统评价、2篇Meta分析、1篇随机对照实验;根据最终检索结果、患者病情和患者及家属意愿,为患者制定护理方案。结果:患者留置PICC的67 d期间未发生导管相关性血流感染。结论:使用循证护理方法,可有效预防股静脉置入PICC发生导管相关性血流感染。Objective: To formulate the evidence-based nursing scheme for central line-associated bloodstream infections (CLABSI) so as to prevent line-associated bloodstream infection. Methods: According to the principle of Population(P), Intervention(I), Control(C), Outcome(O) and the conditions of patient, clinical problems of 1 selected patient with superior vena cava syndrome (SVCS) were proposed. The following databases included NGC, CDSR and DARE of the Cochrane Library, RNAO, PubMed and CBM were searched from 2000 year to 2017 year. The kinds of chosen evidences included clinical guidelines, systematic reviews (SR), meta-analysis and multicenter large randomized controlled trials (RCTs). And finally, a total of 3 clinical practice guidelines, 4 SRs, 2 meta-analyzes and 1 RCT were included. According to the finally retrieval outcomes, the conditions of patients and the willingness of patient and his family members, the nursing plan was formulated for patients. Results: The patient was catheterized with peripherally inserted central catheter (PICC) for 67 days without CLABSI. Conclusion: Evidence-based nursing approach can effectively prevent CLABSI when PICC is implanted in femoral vein.

关 键 词：上腔静脉综合征 股静脉置管 经皮中心静脉置管 导管相关性血流感染 循证护理实践 

分 类 号：R197.39[医药卫生—卫生事业管理]