Clinical application of recommendations on adult central venous catheter fixation based on the infusion therapy standards of practice
基于《输液治疗实践标准》的成人中心静脉导管固定推荐意见的临床应用

摘要

目的 将基于21版《输液治疗实践标准》中的成人中心静脉导管固定推荐意见应用于临床。让科室护士更加注重中心静脉导管固定操作，减少错误，提升重症医学科护士中心静脉导管护理质量。方法 对《输液治疗实践标准》中的成人中心静脉导管固定推荐意见进行归纳证据16条，应用FAME评价对证据进行评价，筛选出12条最佳证据，并转化为14项可用于质量审查的观察指标，按照循证护理流程开展证据的临床转化应用。结果 基线审查显示8‑13号指标护士执行率不足60%；证据应用后各项指标执行率显著提升（P＜0.05），中心静脉导管固定装置留置时间延长至(5.73±0.91)d，患者未发生粘胶相关性皮肤损伤及机械性压力损伤。结论 在临床工作中，科学应用《输液治疗实践标准》中成人中心静脉导管固定推荐意见，可规范护士中心静脉固定的护理行为．延长中心静脉导管固定装置留置时间，降低相关并发症，提高重症医学科中心静脉导管护理质量。

Abstract

Objective To apply the recommendations on adult central venous catheter fixation from the 21st edition of the Infusion Therapy Standards of Practice in clinical practice. To standardize the dressing fixation and operation behaviors of central venous catheters by nurses in the intensive care unit (ICU) and improve the quality of central venous catheter care in the ICU.
Methods Sixteen pieces of evidence regarding the recommendations for adult central venous catheter fixation in the Practice Standards for Infusion Therapy were summarized. The FAME evaluation tool was adopted to assess the evidence, 12 best‑practice pieces of evidence were screened out and converted into 14 observation indicators for quality review. Clinical translation and application of the evidence were performed following the evidence‑based nursing procedure.
Results Baseline review showed that nurses’ implementation rate of indicators 8‑13 was less than 60%. After evidence application, the implementation rate of all indicators improved significantly (P＜0.05). The retention time of central venous catheter fixation devices was prolonged to (5.73±0.91) days. No adhesive‑related skin injury or mechanical pressure injury occurred in patients.
Conclusion   In clinical practice, the scientific application of the recommendations for adult central venous catheter fixation in the “Practice Standards for Infusion Therapy” can standardize the nursing behavior of nurses in central venous catheter fixation, prolong the retention time of central venous catheter fixation devices, reduce related complications, and improve the quality of central venous catheter nursing in critical care medicine.