常规与临床指示的外周静脉导管更换:一个随机对照的等效性试验
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
概括
临床上表明的外周静脉导管更换与常规更换一样有效. 这种方法通过避免不必要的程序来减少患者的不适,医疗费用和员工的工作负担.
科学领域:
- 医疗干预 医疗干预
- 临床实践指南 临床实践指南
- 患者安全 患者安全
背景情况:
- 每年使用数以百万计的外周静脉导管 (PIVC),建议成年人每72-96小时进行例行更换.
- 这种标准做法增加了医疗保健费用,增加了员工的工作量,并需要对患者进行重复的侵入性手术.
- 常规PIVC替代剂的临床有效性尚未得到充分证实.
研究的目的:
- 为了测试临床指示PIVC替换与常规替换的益处等同的假设.
- 评估PIVC替代策略对患者结果和医疗保健资源利用的影响.
主要方法:
- 一个多中心的,随机的,非盲目的等效性试验,涉及成年人 (≥18岁) 预计使用PIVC超过4天.
- 参与者被随机分配 (1:1) 接受临床指示或例行 (每三天) PIVC 替代.
- 首要结局结果是炎,相当率为3%.
主要成果:
- 在临床指示 (114/1593) 和常规替代 (114/1690) 组中,炎发生在7%的患者中.
- 炎的绝对风险差异为0.41%,在3%的等效率范围内.
- 与常规组 (70小时) 相比,临床指示组 (99小时) 的平均导管停留时间更长.
结论:
- 临床上表明的外周静脉导管更换是常规更换的有效替代方案.
- 采用临床指示的替换政策可以显著减少导管插入,患者的不适以及相关成本.
- 持续密切监测和在出现并发症时迅速移除导管是必不可少的.
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