成年患者中线导管留置与维护的最佳证据总结

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。

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

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.