- 期刊
比較內科病人72小時與96小時更換靜脈導管其靜脈炎發生率：前瞻型研究
Comparison of the Incidence of Peripheral Venous Catheter-Related Phlebitis Between 72- and 96- Hour Insertion in Medical Inpatients: A Cohort Observational Study
摘要
周邊靜脈注射是醫院最常見的治療之一，研究指出依臨床表徵或96小時更換週邊靜脈導管，不會增加靜脈炎及血流感染等合併症，但浸潤發生率較高；也有研究發現置針後48小時相關合併症即出現。本研究目的係發展以實證為基礎之周邊靜脈導管靜脈炎相關危險因子調查表，並比較72小時及96小時更換靜脈導管之靜脈炎發生率，與其導致靜脈導管相關合併症危險因子之差異。為兩組前瞻性觀察型研究設計，對台北某醫學中心八個內科屬性病房住院成年病人，分72小時與96小時更換靜脈導管組，放置留置針大於或預期大於24小時的病人。使用輸液靜脈炎視覺量表（Visual Infusion Phlebitis Scale）與觀察合併症如靜脈浸潤、紅、腫等發生情形。統計方法採卡方檢定、存活分析與邏輯斯迴歸分析比較靜脈炎發生率之差異。依收案條件共收案839人，依周邊靜脈留置針更換時間分為72與96小時兩組，72小時組收案429人，96小時組收案410人。主要結果：一、整體靜脈炎發生率，72小時與96小時兩組病人分別為43.8%與41.0%；二、72小時組病人24、48、72、96小時區間無靜脈炎發生率分別為98%、85%、53%、26%；96小時組病人24、48、72、96小時區間無靜脈炎發生率分別為98%、87%、72%、50%；三、兩組病人靜脈炎之共同危險因子為注射時間、持續滴注、給藥後封存輸液管路等三項；四、預測病人靜脈炎發生時間之危險因子為組別、年齡、初始注射地點、持續滴注、給藥後封存輸液管路、注射部位潮濕、需靜脈幫浦給藥等7項。本研究期望提供臨床護理同仁辨識與預估靜脈炎之線索，預防更嚴重的靜脈炎或血流感染發生、減少住院天數，進而提供病人全人照護，提升照護品質且減少醫療浪費。
並列摘要
Background: Peripheral intravenous cannula insertion is a universal intervention for inpatients and is associated with multiple complications. Objective: The purposes of this study were to establish an evidence-based checklist for detecting peripheral intravenous catheter-related complications in adult acute medical inpatients, compare the incidence of phlebitis between 72- and 96-hour replacement groups, and explore the risk factors in these groups. Methods: A two-group cohort observational design was used to investigate the complications. Adult acute medical inpatients aged 20 years or older from eight medical wards were assessed. The research instruments were the Visual Infusion Phlebitis Scale and other catheter-related complication indices. Survival analysis, the relative ratio of the incidence of peripheral intravenous catheter-related complications in the two groups, and logistic regression were also used. Results: Of the 839 patients, 429 were in the 72-hour group, and 410 were in the 96-hour group. The groups did not differ in terms of demographics. No statistically significant difference in the prevalence of phlebitis was observed between the groups. Duration of continuous injection, continuous intravenous (IV) drip, and IV lock for medication were risk factors for phlebitis in the groups. Group, age, site of initial injection, continuous IV drip, IV lock for medication, moisture around the IV site, and the pumping of medication affected time to incidence of phlebitis in the groups. Conclusions: The results can provide reference for comprehensive nursing care for patients with peripheral intravenous therapy and reduce the incidence and duration of infiltration, extravasation, phlebitis, infection, and peripheral intravenous cannula-related bloodstream infection. The peripheral intravenous care guidelines should be applied in other institutions.