外周静脉留置针不同拔管时机的随机对照研究  

A multicenter randomized controlled study on removal indication of peripheral venous indwelling needle

作　　者：李旭英[1] 孙红[2] 魏涛 王蕾[2] 郭彩霞[3] 赵改婷[4] 梅赣红[5] 陈英[6] 张敏 程文兰[8] 王一任 陈利芬[10] 钟卫兰[11] LI Xuying;SUN Hong;WEI Tao;WANG Lei;GUO Caixia;ZHAO Gaiting;MEI Ganhong;CHEN Ying;ZHANG Min;CHENG Wenlan;WANG Yiren;CHEN Lifen;ZHONG Weilan

机构地区：[1]湖南省肿瘤医院护理部,长沙市410013 [2]北京医院/国家老年医学中心/中国医学科学院老年医学研究院护理部 [3]吉林大学中日联谊医院护理部 [4]河北医科大学第二医院儿科 [5]南昌大学第二附属医院护理部 [6]广西医科大学附属肿瘤医院护理部 [7]西安国际医学中心医院护理部 [8]河南省人民医院神经外科 [9]中南大学公共卫生学院 [10]中山大学附属第一医院护理部 [11]贵阳市第一人民医院护理部

出　　处：《中华护理杂志》2020年第2期272-277,共6页Chinese Journal of Nursing

基　　金：湖南省卫生计生委项目(20180456)。

摘　　要：目的比较依据临床指征拔除留置针和常规拔除留置针的效果。方法2019年3月—7月,采用多中心随机对照研究,选取12所三级甲等综合医院的3669例患者作为研究对象,按照随机数字表法分为试验组和对照组,试验组依据临床指征拔除留置针,对照组常规拔除留置针,比较两组的外周静脉留置针留置时间、96 h内各导管相关并发症的发生率和整个留置期间各导管相关并发症(静脉炎、堵管、渗液、怀疑感染)发生的风险,其中静脉炎为主要结局指标,其他并发症为次要结局指标。结果共3642例患者纳入研究,其中试验组1803例,对照组1839例。试验组外周静脉留置针留置时间为(85±52)h,对照组留置时间为(71±30)h,两组留置时间比较,差异具有统计学意义(P<0.001);96 h内,主要结局指标静脉炎的发生率在两组之间的差异无统计学意义(P>0.05),次要结局指标中除堵管有统计学意义(P=0.005),其余指标的差异均无统计学意义(P>0.05);整个留置期间,两组主要结局指标静脉炎发生风险的差异无统计学意义(P>0.05),次要结局指标中除堵管外,其余指标的差异均无统计学意义(P>0.05)。结论依据临床指征更换外周静脉留置针,留置时间更长且不会增加静脉炎、渗液及怀疑感染的发生风险,但堵管的发生风险会增大,如根据临床指征拔管,需加强堵管的监测与评估。Objective To investigate the clinical safety of pulling peripheral venous indwelling needle according to clinical indications,and compare its effect with conventional indwelling needle extraction.Methods A multicenter randomized controlled trial was conducted with a total of 3,669 patients in 12 tertiary general hospitals from March 2019 to July 2019.The patients were randomly allocated into the observation group(group A)and the control group(group B)by the random number table.The puncture methods were consistent between the two groups.Researchers compared the indwelling time,the incidence of catheter-related complications within 96 hours,and the risk ratio of catheter-related complications during the entire indwelling period(phlebitis,occlusion,and infiltration,suspected infection)between two groups,among which phlebitis was the primary outcome indicator and other complications as secondary outcome measures.Results A total of 3,642 patients were enrolled in the study with 1,803 cases in group A and 1,839 cases in group B.The indwelling time of group A was(85±52)h and it was longer than that of(71±30)h in group B with a statistical difference(P<0.001).Within 96 h of indwelling time,there was no statistical differences in the risk of phlebitis,infiltration and suspected infection between two groups(P>0.05).During the entire indwelling period,the risk of occlusion in group A was higher than that in group B with a statistical difference(P<0.05).The other indicators showed no statistical difference.Conclusion The placement of indwelling needle based on clinical indications can prolong the indwelling time without increasing the risk of phlebitis,infiltration and suspected infection,but the risk of occlusion will increase.If the catheter is removed according to clinical indications,monitoring and evaluation of occlusion should be strengthened.

关 键 词：留置针 并发症 拔管指征 风险管理 导管插入术 外周 护理 

分 类 号：R472[医药卫生—护理学]