成人中线导管堵塞预防的最佳证据总结

目的 检索成人中线导管堵塞预防的相关证据，并对最佳证据进行总结，为临床护士实施中线导管护理提供参考。方法计算机检索UpToDate、BMJ、JBI、Cochrane Library、NICE、GIN、SIGN、NGC、RNAO、INS、Embase、Web of Science、PubMed、CINAHL、SinoMed、医脉通、中国知网、万方数据库，根据纳入与排除标准对文献进行筛选。由2名研究员独立评价文献质量，提取和汇总证据。结果 共纳入文献11篇，包括5篇指南、4篇专家共识、2篇系统评价，从导管堵塞识别、风险评估、导管置入、导管及附件、尖端位置、导管固定、冲管和封管、患者教育、组织政策9个方面汇总48条最佳证据。结论 基于证据构建成人中线导管堵塞预防策略，可为护理人员规范中线导管的使用提供循证依据。在应用证据时需综合考虑证据级别、临床情境及患者意愿等，降低中线导管堵塞的发生风险。

Best Evidence Summary for Prevention of Midline Catheter Blockage in Adults

Objective To retrieve evidence of prevention of midline catheter blockage in adults, and summarize the best evidence, and to provide reference for clinical nurses to implement midline catheter nursing. Methods Computer search was carried out on Up ToDate, BMJ, JBI, Cochrane Library, NICE, GIN, SIGN, NGC, RNAO, INS, Embase, Web of Science, PubMed, CINAHL, SinoMed, Medical Pulse, CNKI and Wanfang Database. Two researchers evaluated the quality of the literature, extracted and summarized the evidence independently. Results Eleven pieces of literature were included, including 5 guidelines, 4 expert consensus and 2 systematic evaluations. Forty-eight pieces of best evidence were collected from 9 dimensions: catheter blockage identification, risk assessment, catheter placement, catheter and accessories, tip location, catheter fixation, flushing and sealing, patient education and organizational policy. Conclusion The prevention of midline catheter blockage in adults based on evidence can provide evidence-based reference for nursing staff to standardize the use of midline catheter. The risk of middle line catheter blockage could be reduced by considering the level of evidence, clinical situation and patient’s willingness when applying evidence.