Application of the best evidence for preventing central venous catheter-related thrombosis in patients undergoing...

This study aimed to implement evidence-based practice (EBP) for the prevention and management of catheter-related thrombosis (CRT) in patients undergoing continuous renal replacement therapy (CRRT) and to evaluate its clinical effectiveness in enhancing nurses' knowledge and reducing CRT incidence rates.

A systematic approach was employed to retrieve, screen, evaluate, and synthesize literature, identifying best evidence for CRT prevention and management in CRRT patients. From August 1, 2023 to February 29, 2024, the Ottawa Model of Clinical Application guided the development of audit criteria based on best evidence. Clinical audits were conducted to identify barriers and facilitators to the implementation of evidence, refining the EBP content for CRRT patient CRT prevention and management. Subsequently, from March 1, 2024 to September 30, 2024, this EBP was implemented in the ICU of a tertiary hospital in Zhejiang Province. A comparative analysis was conducted to assess the implementation rates of audit criteria, nurses' knowledge scores on CRRT patient CRT prevention and management, and patient CRT incidence rates before and after the EBP intervention.

A total of 51 nurses and 247 patients were enrolled in this study, with 123 patients assigned to the pre-EBP phase and 124 patients to the post-EBP phase. Compliance rates for all 16 established review indicators demonstrated a significant upward trend following EBP implementation; however, four key indicators failed to meet the 90 % compliance threshold: nurse-conducted risk factor assessment, ultrasound-guided venipuncture, X-ray imaging for catheter dysfunction, and administration of thrombolytic therapy. Nurses' knowledge regarding CRT prevention and management was significantly enhanced, with questionnaire scores increasing from (77.72 ± 4.96) to (87.02 ± 6.17) (t = -12.180, P < 0.001). Notably, the incidence of CRT decreased substantially from 28.46 % to 15.32 %, with the difference reaching statistical significance (t = 10.257, P < 0.001).

Evidence-based nursing practice tailored to prevent CRT in patients undergoing CRRT significantly enhances nurses' specialized knowledge in CRT prevention and management, effectively reduces the incidence of CRT, and further fortifies safeguards for patient safety by optimizing clinical nursing quality.