超声引导成人外周静脉通路：一项随机交叉对照试验。

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing Pub Date : 2025-01-20 DOI:10.1016/j.ienj.2025.101571

Chia-Chi Kuo , Wei-Jing Lee , Ya-Ting Ke

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引用次数: 0

摘要

背景：外周静脉通路是一种常见的侵入性临床操作，外周静脉通路困难是急诊和危重患者护理中的常见问题。在临床实践中，静脉通路的困难影响了即时治疗的及时性，危及患者的安全。反复注射增加了护理人员的压力，消耗了更多的护理时间，并产生了更高的医疗费用。目的：本研究旨在建立循证超声引导下外周静脉通路方案，评估超声引导下外周静脉通路困难的有效性。方法：随机交叉研究。本研究采用方便抽样的方法，在台湾南部某医疗中心招募36名外周静脉注射困难的成人志愿者。随机区组设计生成随机序列。每个参与者都接受了超声引导和传统的盲外周静脉注射。超声引导下外周静脉通路采用高频12 mhz超声探头，采用二人动态纵向横向扫描方法定位外周静脉的位置、方向和深度。本研究采用卡方检验、Fisher精确检验和独立t检验比较两组的检验后差异。结果：超声引导可显著提高首次尝试成功率（优势比= 10.97,p）。结论/实践意义：本研究建立的超声引导外周静脉通路方案可显著提高静脉通路困难成人的注射有效性。临床实践中推荐采用二人动态纵横扫描方式，通过严格的超声操作训练进行静脉插管，解决静脉插管困难的临床问题，减轻护理人员的压力，提高临床护理质量。试验注册号：ISRCTN18025891。

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Ultrasound-guided peripheral intravenous access in adults: A randomized crossover controlled trial

Background

Peripheral intravenous access is a common invasive clinical procedure, and difficult peripheral intravenous access is a common problem in the care of emergency and critically ill patients. The timeliness of immediate treatment is affected by the difficulty of intravenous access in clinical practice, which endangers patient safety. Repeated injections increase the pressure on nursing staff, consume more nursing hours, and incur higher medical costs.

Purpose

This study aimed to develop an evidence-based ultrasound-guided peripheral intravenous access protocol and evaluate the effectiveness of ultrasound guidance on difficult peripheral intravenous access.

Methods

This was a randomized crossover study. This study enrolled 36 adult volunteers with difficult peripheral intravenous access at a medical center in southern Taiwan via convenience sampling. A randomized block design was used to generate random sequences. Each participant underwent ultrasound-guided and traditionally blind peripheral intravenous access. Ultrasound-guided peripheral intravenous access was performed using a high-frequency 12-MHz-ultrasound probe, and a two-person, dynamic, longitudinal, and transverse scanning method was adopted to help locate the position, direction, and depth of the peripheral veins. In this study, the chi-square test, Fisher’s exact test, and independent t-test were used to compare post-test differences between the two groups.

Results

Ultrasound guidance significantly improved the first attempt success rate (odds ratio = 10.97, p < 0.0001) and overall success rate (odds ratio = 49.67, p < 0.0001) and reduced the number of attempts (mean difference = −0.50 attempts, p < 0.0001) in difficult peripheral intravenous access.

Conclusions/implications for practice

The ultrasound-guided peripheral intravenous access protocol developed in this study can significantly improve injection effectiveness in adults for whom intravenous access is difficult. A two-person, dynamic, longitudinal, and transverse scanning method is recommended in clinical practice to perform intravenous cannulation through rigorous ultrasound operation training to resolve the clinical problem of difficult intravenous access, reduce pressure on nursing staff, and improve the quality of clinical care.

Trial registration: ISRCTN18025891.

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来源期刊

International Emergency Nursing NURSING-

CiteScore

3.20

自引率

11.10%

发文量

期刊介绍： International Emergency Nursing is a peer-reviewed journal devoted to nurses and other professionals involved in emergency care. It aims to promote excellence through dissemination of high quality research findings, specialist knowledge and discussion of professional issues that reflect the diversity of this field. With an international readership and authorship, it provides a platform for practitioners worldwide to communicate and enhance the evidence-base of emergency care. The journal publishes a broad range of papers, from personal reflection to primary research findings, created by first-time through to reputable authors from a number of disciplines. It brings together research from practice, education, theory, and operational management, relevant to all levels of staff working in emergency care settings worldwide.