PICC导管相关性血流感染风险因素与防护措施研究进展

本文综述了外周静脉置入中心静脉导管(PICC)发生导管相关性血流感染的风险因素及防护对策的研究现状,为护理人员针对相关风险因素进行有效的预防和处理提供指导,从而降低PICC的血流感染率。     

抗感染中心静脉导管预防导管相关性血流感染的效果

目的评价抗感染中心静脉导管在预防导管相关性血流感染（CRBSI）中的临床价值。方法采用随机数字法,将850例肿瘤患者随机分为实验组420例（采用抗感染中心静脉导管）和对照组430例（采用普通中心静脉导管）,比较两组CRBSI发生率,分析导管相关性血流感染病原菌的种类与特点。结果发生CRBS166例,其中实验组25例,对照组41例,两组导管留置7d前CRBSI感染牢差异无统计学意义（χ2=0．06,P〉0．05）,7d后实验组CRBSI感染率较对照组低,差异有统计学意义（χ2分别为3．91,4．30,P〈0．05）。实验组减少导管相关性血流感染的病原体主要为革兰阳性菌。结论抗感染中心静脉导管可明显减少导管相关性血流感染的发生,有很大的临床价值。     

中心静脉导管相关性血流感染病原学及危险因素分析

正中心静脉置管是将中心静脉导管(central venous catheter,CVC)经皮穿刺置入颈内静脉、锁骨下静脉或股静脉等管径较粗、血流速度快且流量大的中心静脉,以减少药物刺激所致化学性静脉炎的发生;同时还可减少长期输液反复穿刺给患者带来的痛苦,有助于降低患者由于反复穿刺而发生机械性静脉炎的几率,对外周静脉可起到良好的保护作用,在重症监护病房中已被广泛应用~([1])。但与其相关的感染问题也随之日渐     

维持性血液透析患者中心静脉导管相关性血流感染及预防的研究进展

<正>中心静脉导管(central venous catheter,CVC)作为首选血路,包括隧道套囊导管、非隧道导管和移植物,适用于原有血路废用、首次血液透析、动静脉瘘(arteriovenous fistulas,AVF)未成熟或有严重外周血管疾病无法建立血路的患者。导     

国外预防中心静脉导管相关性血流感染的研究进展

结合2011年美国疾病控制和预防中心出版的预防中心静脉导管相关性血流感染(CRBSI)的最新指南,从皮肤消毒液的选择、持续护理质量改进措施、浸渍敷料和浸渍导管的选择方面综述了预防中心静脉导管相关性血行感染的研究现状。     

血液透析256例中心静脉导管相关性血流感染预防及护理

目的:探讨减少血液透析患者发生中心静脉导管相关性血流感染(CRBSI)的预防与护理措施。方法:选取行血液透析治疗的256例留置中心静脉导管(CVC)的患者作为研究对象,通过制定标准化中心静脉导管上下机操作流程,并对护士进行严格、规范的操作培训,注重无菌观念及加强健康宣教等方法,减少导管相关血流感染的发生。开始监测时中心静脉导管均无细菌定植,计算2013年CRBSI发生率。结果:1~6月监测100例有3例患者存在导管相关血流感染,总导管使用天数6 721 d,导管相关血流感染发病率为0.446‰;7~12月监测156例总导管使用天数7 334 d,导管相关血流感染发病率为0.0%;全年导管相关血流感染发病率为0.213‰,明显低于全国平均水平(2.5‰~5.5‰)。结论:通过严格的无菌操作,规范导管护理操作流程,加强健康宣教,可明显降低导管相关性血流感染(CRBSI)发病率。     

留置经外周静脉置入中心静脉导管肿瘤病人发生导管相关性血流感染的护理

经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）具有创伤小、操作简单、维护方便、并发症小等优点,可以为肿瘤病人提供一条无痛、安全、可长期使用的静脉通路。但随之伴发的导管相关性血流感染（CRBSI）的发生率也越来越高,如今已成为最常见的院内获得性感染之一,在医院感染中占第3位,占所有感染的19%[1]。我科自2008年开展PICC以来,已置管354例,随着置管例数的增多,导管相关性感染也日益突出,我室2009年12月—2011年6月对100例发生CRBSI的原因进行分析总结,并提出了相关的护理措施。     

建立导管日志控制呼吸ICU中心静脉导管相关性血流感染的效果

目的 了解ICU中心静脉置管患者中心静脉导管感染现状,探讨建立导管日志控制中心静脉导管相关性血流感染(CRBSI)的效果.方法 采用类实验性研究方法,便利选取北京市某三甲医院呼吸监护室留置中心静脉导管的患者.对照组51例患者采取常规的护理措施,干预组43例患者采取以建立导管日志为主的一系列护理干预措施.比较两组患者CRBSI的发生率.结果 对照组发生感染5例(9.8％),干预组发生感染0例,两组比较差异有统计学意义(x2 =4.453,P＜0.05).干预组导管的千日感染率为0.00,对照组为4.36‰.干预组记录完整的日志为31条(72％)导管,记录不完整的12条(28％).结论 建立导管日志,切实做好无菌操作、管路观察及维护等一系列护理干预措施能够降低CRBSI的发生率.     

血液透析中心静脉导管相关性血流感染的危险因素分析及风险预测模型的构建与验证

目的:分析血液透析中心静脉导管相关性血流感染现状及危险因素,构建风险预测模型并探究应用效果。方法:选取医院2020年6月—2021年12月留置中心静脉导管接受维持性血液透析的194例病人作为风险预测模型组,另选取2022年1月—12月收治的110例维持性血液透析病人作为验证组,通过回顾分析法收集病人一般资料,统计风险预测模型组中心静脉导管相关性血流感染发生例数,经多因素Logistic回归分析法确定中心静脉导管相关性血流感染危险因素,构建风险预测模型并进行验证,确定护理干预对策。结果:单因素分析显示,血液透析中心静脉导管相关性血流感染的影响因素有基础疾病、导管留置时间、留置部位及白蛋白水平(P<0.05)。多因素Logistic回归分析结果显示,基础疾病、导管留置时间、留置部位是维持性血液透析病人发生导管相关性血流感染的独立危险因素(P<0.05)。ROC曲线结果显示,导管相关性血流感染风险预测模型的ROC曲线下面积为0.783,灵敏度为91.8%,特异度为73.6%,95%CI为[0.643,0.897],最佳截断值为2.147;预测准确率为91.82%(101/110)...     

集束干预策略预防中心静脉导管相关性血流感染的效果观察

目的探讨集束干预策略预防中心静脉导管相关性血流感染(catheter related blood stream infection,CRBSI)的效果。方法将实施集束干预策略之前(2011年1～10月)留置中心静脉导管186例患者设为对照组,在实施集束干预策略之后(2012年1～10月)留置中心静脉导管193例患者设为集束组。比较实施集束干预措施前后两组患者CRBSI发生率及时间,置管情况。结果采用集束干预策略后CRBSI发生率由实施前8.31‰下降至1.67‰,前后比较,差异具有统计学意义(P<0.001);CRBSI发生时间由(7.47±2.44)d延长至(13.75±1.92)d,前后比较,差异具有统计学意义(P<0.05);锁骨下静脉置管率从39.78%上升至71.50%,股静脉置管率从45.70%下降至18.65%,前后比较,差异具有统计学意义(均P<0.05)。结论集束干预策略可有效降低中心静脉置管患者CRBSI发生率。     

ICU 导管相关性血流感染风险评估的研究

目的：探讨预防导管相关性血流感染（CRBSI）的风险评估方法,并根据评估结果进行临床干预的效果。方法：以我院SICU病区2011年4月至2012年3月留置中心静脉导管的774例患者为对照组,以2012年4月至2013年3月留置中心静脉导管的883例患者为观察组,由预防CRBSI护理专科小组利用风险评估表对观察组进行质量控制和干预,比较两组CRBSI的发生率。结果：对照组CRBSI的发生率为6.79/千导管留置日,而观察组的发生率为2.34/千导管留置日,差异有统计学意义（P〈0.05）。结论：对ICU留置中心静脉导管的患者进行CRBSI的专项风险评估并及时干预,能有效降低危重症患者CRBSI的发生率。     

Hospital fall risk assessment tools: a critique of the literature

There are numerous fall risk assessment tools developed for use by nurses in hospitals; however, few of them have established validity and reliability. This article will examine the current state of knowledge in regard to fall risk assessment tools through review and critique of the literature on the topic. Recommendations for future research on fall risk assessment tools will be made and a conceptual framework detailing the relationship between the variables involved in assessing the accuracy of fall risk assessment tools will be presented.     

Presentation and impact of catheter-associated thrombosis in patients with infected long-term central venous catheters: a prospective bicentric observational study

Background: Catheter-associated thrombosis (CAT) in patients with infected long-term central venous catheter (LTCVC) has been poorly studied. Methods: We prospectively included patients with infected LTCVC and collected clinical data. Doppler ultrasound was systematically performed to screen for CAT. Outcome (death or infection relapse) was evaluated 12 weeks after infection diagnosis. Results: 90 patients were included and CAT was diagnosed in 27 (30%). Local signs suggesting infection were more frequent in patients with CAT than without (11/27 versus 8/63, p?=?0.03). Outcome was similar in patients with and without CAT. However, median duration of antimicrobials was longer (18 versus 14 days, p?=?0.02), catheter removal tended to be more frequent (24/27 versus 46/63, p?=?0.08), and anticoagulant therapy more often prescribed (17/27 versus 6/63, p?Staphylococcus aureus infections (4/7 versus 1/17, p?=?0.02) and prolonged positivity of blood-cultures (3/7 versus 1/15, p?=?0.02), than patients with non-occlusive thrombosis. Conclusion: CAT is associated with local signs suggesting infection. A more aggressive treatment in CAT cases allowed a similar outcome at 12 weeks between patients with and without CAT. Occlusive thrombosis represented a subgroup of patients at risk of delayed clearance of bacteremia.

• KEY MESSAGES

• 30% of patients with infected long-term central venous catheter had catheter-associated thrombosis (CAT) and 89% of patients with CAT had no symptom specifically suggestive of thrombosis.

• More aggressive treatment (catheter removal, anticoagulant therapy and prolonged antimicrobial therapy) in patients with CAT allowed a similar outcome at 12 weeks than in patients without CAT.

• Occlusive thrombosis represented a subgroup of patients at risk of delayed bacteremia clearance.

     

Nutritional screening and assessment tools for older adults: literature review

AIM: This paper reports a literature review to examine the range of published tools available for use by nurses to screen or assess nutritional status of older adults, and the extent to which validity, reliability, sensitivity, specificity and acceptability of the tools has been addressed. BACKGROUND: The incidence of malnutrition in older adults is high. One method by which malnutrition or risk of malnutrition can be detected is by the use of nutritional screening or assessment tools. METHODS: A comprehensive literature review methodology was employed. A variety of electronic databases were searched for the period 1982-2002. Search terms incorporating nutrition, screening, validity, reliability and sensitivity and specificity were combined to retrieve relevant literature. In addition, manual searches were conducted and articles retrieved from those listed in key papers. In this paper, nutritional screening or assessment tools are described as tools which use a questionnaire-type format containing more than one risk factor for malnutrition, and give a quantitative or categorical assessment of risk. RESULTS: Seventy-one nutritional tools were located, 21 of which were identified as designated for use with an older population. A wide variety of risk factors for malnutrition are used with the tools, ranging from objective measurements to subjective assessment. Some tools identify an action plan based on the score obtained. Many tools appear not to have been subjected to validity and/or reliability testing but are used clinically. CONCLUSIONS: As malnutrition is present in the older adult population, nutritional assessment and screening tools can be useful to highlight those in need of a nutritional care plan. However, many have not been subjected to evaluation and consequently may not demonstrate sensitivity and/or specificity in clinical use. The decision to use a particular tool should therefore be considered carefully.     

Central venous catheter dressings: a systematic review

BACKGROUND: Gauze and tape or transparent polyurethane film dressings such as Tegaderm, Opsite or Opsite IV3000 are the most common types of dressing used to secure central venous catheters (CVCs). Currently, there are no clear guidelines as to which type of dressing is the most appropriate. AIMS: To identify whether there are any differences between gauze and tape and/or transparent polyurethane film dressings in the incidence of CVC-related infection, catheter-related sepsis, catheter security, tolerance to dressing material, dressing condition and ease of application in hospitalized patients. METHODS: The Cochrane Controlled Trials Register and Medline, Embase and CancerLit databases were searched to identify any controlled trials comparing the effects of gauze and tape and/or transparent polyurethane dressings on CVCs. Additional references were sought from published and non-published literature. Twenty-three studies were reviewed. Data were extracted independently from each paper by two members of the review team and results compared. Differences were resolved either by consensus or referral to a third person. Authors were contacted for missing information. RESULTS: Of the 23 studies reviewed, 15 were excluded. Of the remaining eight, data were available for meta-analysis from six studies. Of the six included studies, two compared gauze and tape with Opsite IV3000, two compared Opsite with Opsite IV3000, one compared Tegaderm with Opsite IV3000, and one compared Tegaderm with Opsite. CONCLUSIONS: There was no evidence of any difference in the incidence of infectious complications between any of the dressing types compared in this review. Each of these comparisons was based on no more than two studies and all of these studies reported data from a small patient sample. Therefore it is unlikely that any of these comparisons would have had sufficient power to detect any differences between groups.     

Nonpharmacologic interventions for prevention of catheter-related thrombosis: A systematic review

Purpose

The aim of this study was to summarize randomized controlled trials (RCTs) of nonpharmacologic interventions for prevention of catheter-related thromboses (CRTs).

Methods

MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were systematically searched for RCTs examining any nonpharmacologic intervention to prevent symptomatic or asymptomatic CRT. Titles and abstracts were screened by a single reviewer, followed by full-text screening by 2 independent reviewers. Data were extracted and quality assessed by a single analyst and audited by a second analyst. Strength of the evidence for each intervention was assessed using the Grading of Recommendations Assessment, Development and Evaluation.

Results

Ten RCTs enrolling 1,378 patients were included. Moderate- to high-quality evidence suggested peripherally inserted central catheters and insertion of central venous catheters (CVCs) at the femoral site increased CRT when compared with other catheter types or insertion sites, respectively. Evidence comparing CRT in CVCs inserted at the jugular vs the subclavian site as well as the placement of the CVC tip was of low quality and inconclusive. Low-quality evidence suggested that valved ports and silver-coated catheters had no effect on CRT. No RCT evidence was identified for other interventions.

Conclusions

Peripherally inserted central catheters and femoral insertion of CVCs should be avoided if possible. Randomized controlled trials are needed to ascertain the effects of other nonpharmacologic interventions to prevent CRT.     

Postoperative pain assessment tools in day surgery: literature review

BACKGROUND: Postoperative pain is an expected phenomenon. However, its passage beyond acceptable limits is a common and costly experience. This is particularly the case in day surgery, partly because of the increasing demand to reduce waiting lists for elective surgery, and partly because of lack of knowledge about patients' experiences of postoperative pain and relevant published research. The latter is mainly concerned with different interpretations of the phenomenon of pain that appear to have led to a variety of often inappropriate pain measurement tools. AIM: This paper critically reviews some of the available objective and subjective measures of pain and establishes the suitability of a Visual Analogue Scale (VAS) for measuring the intensity of pain after day surgery. METHOD: Nursing and health care papers published since 1983 were sought using the keywords: postoperative pain, day surgery, ambulatory surgery, rating scales, VAS, severity, assessment, tool, nursing, validity, sensitivity, reliability and their various combinations. The databases used were Medline, CINAHL, Nursing Collection, Embase, Healthstar, BMJ and several on-line Internet journals, specifically Ambulatory Surgery. The search included only papers published in the English language. FINDINGS: A range of interpretations of pain have led to the development of various measurement tools that address different components of pain. This inconsistency has led to ineffective pain management. Based on established criteria, the VAS was found to be methodologically sound, conceptually simple, easy to administer and unobtrusive to the respondent. On these grounds, the VAS seems to be most suitable for measuring intensity of pain after day surgery. CONCLUSIONS: Common guidelines on the definition and measurement of pain are needed. In day surgery, the availability of a unified and reliable measure of pain that can address its sensory component, such as the VAS, will provide more reliable information about the pain experience and, hence, improve its overall management.     

Nutritional screening and assessment tools for use by nurses: literature review

AIM: This paper reports a literature review describing the range of published tools available for use by nurses to screen or assess nutritional status of patients/clients, and to examine whether the validity, reliability, sensitivity, specificity and acceptability of the tool have been investigated. Tools developed specifically for use with older adults are not considered in this review. A screening/assessment tool is described as a tool that uses a questionnaire-type format, contains more than one risk factor for malnutrition and gives an assessment of risk. BACKGROUND: The incidence of malnutrition in people cared for by nurses is high and screening or assessment tools are often used to identify those with, or at risk of, malnutrition. METHODS: A comprehensive literature review methodology was employed. A range of electronic databases was searched from 1982 to 2002. Search terms incorporating "nutrition", "screening", assessment, feeding, instrument, tool, validity, reliability, sensitivity and specificity were combined. Manual searches were also conducted. RESULTS: Seventy-one nutritional screening/assessment tools were identified of which 35 were reviewed. Tools not reviewed included those which incorporated significant use of biochemical measures (8), included complex anthropometric measures (3), were concerned specifically with ingestion (4) or were designated for use with an older population (21). The tools reviewed use a wide variety of risk factors for malnutrition, varying from anthropometric measurements to socio-cultural aspects of eating behaviour. Some identify an action plan based on the score obtained. Many have not been subjected to validity and/or reliability testing and yet appear to be in use in clinical practice. The sensitivity, specificity and acceptability of the tools are often not investigated. CONCLUSION: There are many published nutritional screening/assessment tools available for use by nurses to screen or assess the nutritional status of patients/clients. Many have not been subject to rigorous testing. Future work should consider a more standardized approach to the use of these tools.