以质量求发展，以服务铸品牌

护理学报 ›› 2022, Vol. 29 ›› Issue (1): 41-46.doi: 10.16460/j.issn1008-9969.2022.01.041

• 循证护理 • 上一篇    下一篇

成年患者中线导管留置与维护的最佳证据总结

许志娟1a, 李秀轻1a, 孔晔宏1a, 史蕾1b, 乔秋阁1c, 凌冬兰2   

  1. 1.河北医科大学第二医院 a.肝胆外科;b.泌尿外科;c.普外一科,河北 石家庄 050000;
    2.广州医科大学附属第二医院 护理部,广东 广州 510260
  • 收稿日期:2021-06-02 出版日期:2022-01-10 发布日期:2022-02-14
  • 通讯作者: 凌冬兰（1981-）,女,广东梅州人,硕士,副主任护师,南方医院 JBI 循证护理合作中心导师库成员。E-mail：lingdonglan@gzhmu.edu.cn
  • 作者简介:许志娟（1981-）,女,河北石家庄人,硕士,副主任护师,南方医院JBI循证护理合作中心循证护理师,肝胆外科副护士长。
  • 基金资助:
    河北省医学科学研究课题计划项目（20211679）

Best Evidence Summary of Indwelling and Maintenance of Midline Catheters in Adult Patients

XU Zhi-juan1a, LI Xiu-qing1a, KONG Ye-hong1a, SHI Lei1b, QIAO Qiu-ge1c, LING Dong-lan2   

  1. 1a. Dept. of Hepatobiliary Surgery; 1b. Dept. of Urology; 1c. Dept. of General Surgery I,the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China;
    2. Dept. of Nursing Administration, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
  • Received:2021-06-02 Online:2022-01-10 Published:2022-02-14

PDF (PC)

770

赞

摘要： 目的 总结成年患者中线导管留置与维护的最佳证据,为临床护理工作提供证据支持。方法 采用PICO构建循证护理问题,按照“6S”证据金字塔系统检索建库至2021年2月在UpToDate、BMJ Best Practice、Cochrane Library、JBI循证卫生保健中心数据库、美国国立指南库（National Guideline Clearinghouse, NGC）、美国疾病预防与控制中心（Centers for Disease Control and Prevention,CDC）、英国国家临床医学研究所指南库（National Institute for Health and Care Excellence, NICE）、国际指南协作网（Guideline International Network,GIN）、加拿大安大略注册护士协会（The Registered Nurses' Association of Ontario,RNAO）、CINAHL、EMbase、PubMed、美国静脉输液护理学会（Intravenous Nurses Society,INS）、万方数据库、中国知网、医脉通数据库有关成年患者中线导管留置与维护的文献。由2名循证护理师独立进行文献质量评价及证据筛查,证据汇总后由项目团队归类综合。结果 共纳入文献6篇,包括指南4篇,系统评价2篇。从纳入的文献中共提取53条证据,最终综合成27条最佳证据共7个维度,分别是中线导管适应症及禁忌证、导管及穿刺部位选择、导管置入方法、管端位置、导管维护、拔除时机、培训与教育。结论 本研究为临床医护人员规范化管理成年患者中线导管提供了循证依据,建议在评估机构环境及利益相关者的意愿后选择性应用最佳证据,以提升护理质量,保证患者安全。

关键词: 成年人, 中线导管, 留置, 维护, 循证护理

Abstract: Objective To summarize the best evidence of indwelling and maintenance of midline catheter in adult patients, and to provide evidence for clinical nursing. Methods The PICO model was used to identify evidence-based nursing problems, and the literature related to the placement and maintenance of midline catheter in adult patients was searched according to the 6S hierarchy of?evidence-based resources in databases of Up To Date, BMJ Best Practice, Cochrane Library, JBI, NGC, CDC, NICE, GIN, RNAO, CINAHL, EMbase, PubMed, INS, Wanfang, CNKI and Yimaitong from the inception to February 2021. The literature was independently evaluated and screened by two evidence-based nurses with master degree, and the evidence were summarized and evaluated by the research team. Results Six articles were included, including 4 guidelines and 2 systematic evaluations. A total of 53 pieces of evidence were extracted from the included literature, and finally 27 pieces of best evidence were integrated into 7 dimensions, including indications and contraindications of midline catheter, selection of midline catheter and puncture site, catheter placement method, catheter end location, catheter maintenance, catheter removal timing, training and education. Conclusion This study provides evidence-based evidence for clinical staff to standardize the management of midline catheters in adult patients. It is recommended to selectively apply the best evidence after evaluating the institutional environment and the willingness of stakeholders to improve the quality of care and ensure patient safety.

Key words: adult, midline catheters, indwelling, maintenance, evidence-based nursing

中图分类号: 

  • R472
[1] 喻婷,刘文文.改良型中等长度导管在肠外营养患者中的应用[J].中国处方药,2019,17(1):137-138.DOI:10.3969/j.issn.1671-945X.2019.01.092
[2] Moureau N, Chopra V.Indications for Peripheral, Midline and Central Catheters: Summary of the MAGIC Recommendations[J]. Br J Nurs, 2016,25(8):S15-24. DOI:10.12968/bjon.2016.25.8.S15.
[3] Debra L.Wiegand.AACN Procedure Manual for High Acuity, Progressive,and Critical Care[M]. Seventh Edition. St Louis, MO:Elsevier:2017.
[4] Hagle ME,Mikell M.Peripheral venous access.In:Weinstein S,Hagle ME,eds. Plumer's Principles and Practice of Infnsion Therapy[M]. 9thed. Philadelphia, PA:Wolters Kluwer/Lippincott Williams & Wilkins:2014.
[5] 邹晓春,何金爱,宋燕伶.252例留置静脉中长导管患者调查分析[J].护理学报,2016,23(20):48-50.DOI:10.16460/j.issn1008-9969.2016.20.048
[6] Gorski LA, Hadaway L, Hagle ME, et al.Infusion Therapy Standards of Practice, 8th ed[J]. J Infus Nurs, 2021,44(1S Suppl 1):S1-S224.
[7] Gorski LA.Fast Facts for Nurses about Home Infusion Therapy: The Expert's Best Practice Guide in a Nutshell[M].New York, NY: Springer Publishing Company:2017.
[8] 朱政,胡雁,邢唯杰,等.不同类型循证问题的构建[J].护士进修杂志,2017,32(21):1991-1994.
[9] Dicenso A, Bayley L, Haynes RB. Accessing Pre-appraised Evidence: Fine-tuning the 5s Model into a 6s Model[J]. Evid Based Nurs,2009,12(4):99-101. DOI:10.1136/ebn.12.4.99-b.[10] AGREE Project Office. The AGREE II Instrument[EB/OL]. (2009-05-01)[2021-12-8].http://www.agreetrust.org.
[11] 熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AMSTAR[J]. 中国循证医学杂志,2011,11(9):1084-1089.DOI:10.3969/j.issn.1672-2531.2011.09.017.
[12] The Joanna Briggs Institute. Critical Appraisal Tools [EB/OL].(2017-11-24)[2021-12-08].http://joannabriggs.org/research/critical-appraisal-tool.
[13] 刘巧艳,朱力群,周英凤,等 .外周静脉短导管选择与置入的最佳证据分析[J].护士进修杂志, 2020, 3(35):550-555.DOI:10.16821/j.cnki.hsjx.2020.06.014.
[14] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[15] O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the Prevention of Intravascular Catheter-related Infections[J]. Clin Infect Dis,2011,52(9):e162-e193.
[16] Chopra V, Flanders SA, Saint S, et al.The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method[J]. Ann Intern Med, 2015,163(6 Suppl):S1-S40. DOI:10.7326/M15-0744.
[17] 傅麒宁,吴洲鹏,孙文彦,等.《输液导管相关静脉血栓形成中国专家共识》临床实践推荐[J].中国普外基础与临床杂志,2020, 27(4):412-418.DOI:10.7507/1007-9424.202001030.
[18] Cawcutt KA, Hankins RJ, Micheels TA, et al.Optimizing Vascular-access Device Decision-making in the Era of Midline Catheters[J]. Infect Control Hosp Epidemiol, 2019,40(6):674-680.DOI:10.1017/ice.2019.49.
[19] Moureau N, Chopra V.Indications for Peripheral, Midline and Central Catheters: Summary of the MAGIC Recommendations[J]. Br J Nurs, 2016,25(8):S15-24.DOI:10.12968/bjon.2016.25.8.s15.
[20] Caparas JV, Hu JP.Safe Administration of Vancomycin through A Novel Midline Catheter: A Randomized, Prospective Clinical Trial[J].J Vasc Access, 2014,15(4):251-256. DOI:10.5301/jva.5000220.
[21] Caparas JV, Hung HS.Vancomycin Administration through a Novel Midline Catheter: Summary of a 5-year,1086-patient Experience in an Urban Community Hospital[J]. Assoc Vasc Access,2017,22:38-41. DOI:10.1016/j.java.2016.10.092.
[22] Cawcutt KA, Hankins RJ, Micheels TA, et al.Optimizing Vascular-access Device Decision-making in the Era of Midline Catheters[J].Infect Control Hosp Epidemiol, 2019,40(6):674-680.DOI:10.1017/ice.2019.49.
[23] Dickson HG, Flynn O, West D, et al.A cluster of Failures of Midline Catheters in a Hospital in the Home Program: A Retrospective Analysis[J]. Infus Nurs, 2019,42(4):203-208.DOI:10.1097/NAN.0000000000000330.
[24] Ullman AJ, Cooke ML, Mitchell M, et al.Dressing and Securement for Central Venous Access Devices (CVADs): A Cochrane Systematic Review[J].Int J Nurs Stud, 2016(59):177-196.DOI:10.1016/j.ijnurstu.2016.04.003.
[25] Marsh N, Webster J, Mihala G, et al.Devices and Dressings to Secure Peripheral Venous Catheters: A Cochrane Systematic Review and Meta-analysis[J]. Int J Nurs Stud, 2017(67):12-19.DOI:10.1016/j.ijnurstu.2016.11.007.
[26] Schiffer CA, Mangu PB, Wade JC, et al.Central Venous Catheter Care for the Patient with Cancer: American Society of Clinical Oncology Clinical Practice Guideline[J]. Clin Oncol, 2013,31(10):1357-1370.DOI:10.1200/JCO.2012.45.5733.
[27] 周英凤,胡雁,顾莺,等.基于证据的持续质量改进模式图的构建[J].中国循证医学杂志,2017,17(5):603-606.DOI:10.7507/1672-2531.201611090.
[1] 张静, 彭焕椽, 陈佳, 鲁永锦, 刘克玄, 侯晓敏. 成人体外循环心脏手术患者预防手术部位感染的最佳证据总结[J]. 护理学报, 2025, 32(4): 41-47.
[2] 李若雨, 刘鑫, 林萍, 陈丹, 林桦. 出院患者用药安全管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 50-55.
[3] 杨小娟, 毛孝容, 王静, 江华, 李蓉, 樊宇, 文青, 李林章, 陈晓容. 成人重度烧伤患者早期肠内营养管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 56-61.
[4] 刘硕怡, 熊莉娟, 李凌, 王玉梅, 何嘉, 李鑫, 袁淑蕾, 郭雪琴, 王暘婧, 张慧娟. 老年住院患者衰弱预防及管理临床实践指南的质量评价及内容分析[J]. 护理学报, 2025, 32(2): 50-55.
[5] 闫亚铃, 乐美妮, 姚桃琴, 王雪莲, 姜建玲, 辛艺. 老年胃肠肿瘤患者围手术期衰弱管理方案的构建[J]. 护理学报, 2025, 32(2): 74-78.
[6] 陈洁, 孟庆童, 刘惊今, 吴艳妮. 基于指南的慢性心力衰竭患者运动康复科普手册研制[J]. 护理学报, 2024, 31(9): 36-41.
[7] 符路路, 解艺璇, 王玥, 魏巍, 张传英, 朱宇. 新生儿操作性疼痛听觉刺激干预的证据总结[J]. 护理学报, 2024, 31(9): 42-47.
[8] 纪锐婷, 林丹娜, 刘小成, 李婷婷, 谢映梅, 胡冰, 应文娟. 早产儿初乳口腔免疫疗法的最佳证据总结[J]. 护理学报, 2024, 31(8): 37-42.
[9] 张小莉, 杨鑫玉, 肖宇, 刘春燕, 张璐, 伍晓琴, 黄月霖, 傅静. 晚期癌症患者代理决策者安宁疗护决策后悔研究的范围综述[J]. 护理学报, 2024, 31(8): 49-54.
[10] 周毅峰, 杨继平, 胡正中, 袁浩. 肝癌切除手术患者目标导向性血糖监测的证据总结[J]. 护理学报, 2024, 31(7): 46-50.
[11] 莫选菊, 吴远, 张曼, 刘章来, 申铁梅. 共患慢性失眠症住院患者实施睡眠限制疗法的证据总结[J]. 护理学报, 2024, 31(6): 62-66.
[12] 杨建国, 何细飞, 鄢建军, 张梦, 杨纯子, 徐蓉, 王艳芳. 局部枸橼酸抗凝在连续性肾脏替代治疗中的应用及管理的最佳证据总结[J]. 护理学报, 2024, 31(4): 48-53.
[13] 刘璇, 蓝玉清, 李梦如, 王小惠, 钟雪梅, 周文. 住院老年性痴呆患者跌倒预防的最佳证据总结[J]. 护理学报, 2024, 31(4): 54-59.
[14] 祁水林, 林桦, 邓锐颖, 李荣杰, 李若雨, 王凤廷. 老年皮肤瘙痒症患者非药物管理的最佳证据总结[J]. 护理学报, 2024, 31(3): 46-50.
[15] 杨丽娜, 黄蓉, 姚梅琦, 王竹青, 徐怡婷, 谢佩敏. 产后母乳喂养行为中断风险预测模型的系统评价[J]. 护理学报, 2024, 31(23): 59-65.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!