Preventing peripheral intravenous catheter failure by reducing mechanical irritation
Preventing peripheral intravenous catheter failure by reducing mechanical irritation
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DOI：
10.1038/s41598-019-56873-2
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发表时间：
2020-01-31
影响因子：
4.6
通讯作者：
Sanada, Hiromi
中科院分区：
文献类型：
--
作者：
Takahashi, Toshiaki;Murayama, Ryoko;Sanada, Hiromi
外周静脉导管失败是一个重要的关注在临床设置。我们研究了护理方案的有效性，包括在置管前进行超声“预扫描”以选择大直径静脉，在置管后进行超声“后扫描”以确认导管尖端位置，以及使用柔性聚氨酯导管以减少导致导管失效的机械刺激。本干预研究是一项非随机对照试验，旨在探讨上述护理方案的有效性，并将其效果与对照组接受常规护理的结果进行比较。两组参与者都是从2017年7月至11月期间日本东京大学两个病房的患者中挑选出来的。采用倾向评分的基于逆概率评分的加权方法（IPW）来评估护理方案的有效性。主要结局是导管失效，定义为意外和计划外的导管拔除。我们使用KaplanMeier生存曲线来比较导管失效前的时间比率。我们分别分析干预组和对照组189根和233根导管。在对照组中，68根导管（29.2%）被确定为失效，而在干预组中，只有21根导管（11.1%）被确定为失效。两组间根据IPW调整的导管失效率差异有统计学意义（p = 0.003）。干预导致导管失效的相对风险降低为0.60 （95% CI: 0.47-0.71）。护理方案，包括评估静脉直径、静脉深度和导管尖端位置，利用超声检查减少机械刺激，是一种有希望减少导管失效发生率的方法。
Peripheral intravenous catheter failure is a significant concern in the clinical setting. We investigated the effectiveness of care protocols, including an ultrasonographic "pre-scan" for selecting a largediameter vein before catheterization, a "post-scan" for confirming the catheter tip position after catheterization with ultrasonography, and the use of a flexible polyurethane catheter to reduce the mechanical irritation that contributes to the incidence of catheter failure. This intervention study was a non-randomized controlled trial to investigate the effectiveness of the abovementioned care protocols, the effects of which were compared to the outcomes in the control group, which received conventional care. For both groups, participants were selected from patients in two wards at the University of Tokyo in Japan between July and November 2017. Inverse probability score-based weighted methods (IPW) using propensity score were used to estimate the effectiveness of care protocols. The primary outcome was catheter failure, which was defined as accidental and unplanned catheter removal. We used KaplanMeier survival curves to compare rates of time until catheter failure. We analysed 189 and 233 catheters in the intervention and control groups, respectively. In the control group, 68 catheters (29.2%) were determined to have failed, whereas, in the intervention group, only 21 catheters (11.1%) failed. There was a significant difference between each group regarding the ratio of catheter failure adjusted according to IPW (p = 0.003). The relative risk reduction of the intervention for catheter failure was 0.60 (95% CI: 0.47-0.71). Care protocols, including assessment of vein diameter, vein depth, and catheter tip location using ultrasound examination for reducing mechanical irritation is a promising method to reduce catheter failure incidence.