周回静脈カテーターの常規的対臨床的に示された置換:ランダム化対照同等性試験
Claire M Rickard1, Joan Webster, Marianne C Wallis
1Research Centre for Clinical and Community Practice Innovation, Griffith Health Institute, Griffith University, Nathan, QLD, Australia. c.rickard@griffith.edu.au
Lancet (London, England)
|September 25, 2012
まとめ
外周静脈カテーターの臨床的に示された置換は,通常の置換と同じくらい効果的です. このアプローチは,不必要な手順を回避することによって,患者の不快感,医療費,およびスタッフの作業負荷を軽減します.
科学分野:
- 医療介入 医療介入について
- クリニカル・プラクティスのガイドライン
- 患者の安全性について
背景:
- 周周静脈カテーテル (PIVC) は年間数百万個使用されており,成人の場合72~96時間毎に定期的に交換することが推奨されています.
- この標準的な慣行は,医療費,スタッフの労働負担を増加させ,患者に対する繰り返し侵襲的な処置を必要とします.
- ルーティン PIVC 置換の臨床効果は十分に確立されていません.
研究 の 目的:
- 臨床的に示されたPIVC置換は,通常の置換と利益が等しいという仮説を検証するために.
- PIVCの代替戦略が患者のアウトカムや医療資源の利用に与える影響を評価する.
主な方法:
- PIVCを使用している成人 (≥18歳) が,4日以上使用されると予想される多センター,ランダム化,非ブラインド等価試験.
- 参加者はランダムに (1:1) 臨床的に示されたか,または日常的な (毎3日) PIVC 置換に割り当てられました.
- プライマリアウトカムはフレビティスで,同値差は3%と設定されました.
主要な成果:
- フレビティスは,臨床的に示された (114/1593) グループと,通常の置換 (114/1690) グループの両方で,患者の7%に発生しました.
- フレビティスの絶対リスクの差は0.41%で,3%の同値範囲内であった.
- 経管の平均停留時間は,臨床的に示されたグループ (99時間) で,ルーティングループ (70時間) に比べて長かった.
結論:
- 外周静脈カテーターの臨床的に示された置換は,通常の置換の効果的な代替手段です.
- 臨床的に示された置換方針を採用することで,カテーテル挿入,患者の不快感,および関連する費用を大幅に削減することができます.
- 継続的な綿密なモニタリングと,合併症が発生した際のキャセターの迅速な除去は不可欠です.
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