摘要
目的检索和评价ICU成人患者中心静脉导管相关性血流感染预防的相关证据,并对证据进行总结。方法计算机依次检索BMJ最佳临床实践、Up To Date、G-I-N、NGC、NICE、SIGN、RNAO、医脉通、JBI、Cochrane Library、Web of Science、PubMed、CINAHL、EMBASE、SCCM、CDC、INS、SinoMed、CNKI、万方数据及VIP自建库至2019年3月关于综合ICU中心静脉导管相关性血流感染预防及管理的临床实践指南、证据总结、最佳实践、实践推荐、系统评价及原始研究。结果共纳入18篇文献,包括指南2篇、实践推荐1篇、指南更新意见1篇、实践标准1篇、系统评价11篇、原始研究2篇。最终形成38条最佳证据,整理综合为穿刺工具的选择、穿刺部位的选择、无菌操作、无菌维护、导管移除、质量改进6个维度。结论该证据总结可为医务人员预防ICU中心静脉导管相关性血流感染提供循证支持,但在证据应用时,用证者还需结合临床情境、分析障碍因素、制定干预方案、进行过程监测和效果评价,最终达到指导医务人员解决临床问题的目的。
Objective To retrieve and evaluate the evidence about prevention of central venous catheter associated bloodstream infection among adult patients in ICU and summarize the evidence.Methods We searched BMJ best practice,Up To Date,G-I-N,NGC,NICE,SIGN,RNAO,Yimaitong,JBI,Cochrane Library,Web of Science,PubMed,CINAHL,EMBASE,SCCM,CDC,INS,SinoMed,CNKI,Wanfang,VIP to collect literatures including guideline,evidence summary,best practice,recommended practice,systematic review and original research related to this study.Result A total of 18 references were adopted,including 2 guidelines,1 practice recommendation,1 updated recommendation,1 practice standard,11 systematic reviews and 2 original studies.Finally,38 pieces of best evidence were formed,which were combined into six dimensions:selection of puncture tools,selection of puncture sites,aseptic operation,aseptic maintenance,catheter removal and quality improvement.Conclusion This evidence summary provides evidence-based support for medical staff to prevent central venous catheter associated bloodstream infection in the ICU.When the evidence is applied,the examiner also needs to combine the clinical situation,analyze the obstacles,develop an intervention plan,and conduct process monitoring and effect evaluation.Ultimately,the goal of guiding medical staff to solve clinical problems can be achieved.
作者
刘云访
喻姣花
黄海燕
米元元
明耀辉
陈汉珍
吴为
晏蓉
李鑫
滕芬
Liu Yunfang;Yu Jiaohua;Huang Haiyan;Mi Yuanyuan;Ming Yaohui;Chen Hanzhen;Wu Wei;Yan Rong;Li Xin;Teng Fen(Affiliated Union Hospital of Tongji Medical College,Huazhong University of Science and Technology Department of Nursing;Affiliated Union Hospital of Tongji Medical College,Huazhong University of Science and Technology ICU,Wuhan Hubei 430022)
出处
《护士进修杂志》
2020年第4期319-325,333,共8页
Journal of Nurses Training
关键词
重症监护
中心静脉导管
血流感染
预防
循证护理
Intensive care
Central venous catheter
Bloodstream infection
Prevention
Evidence-based nursing
