Systematic Reviews For Replacement Strategy And Efficacy In Blood Collection Of Peripheral Venous Catheter

BackgroundPeripheral venous catheter used in intravenous infusion,it can be left in vein for a longer period,re-used,reducing the pain because of repeated venipuncture,and be able to play a role in the protection of blood vessels,to ensure the exact time of medication administration,or to a large extent reduce the workload on the care at the same time.This study has two parts,the first part is comparison of two peripheral venous catheter replacement strategies:One is routine replacement strategy,generally 3 or 4 days to replace.The other is clinical indicated strategy,that is,not the regular replacement of catheter,but removing catheter when there is only to be replaced indications.So it need insertion site monitoring.Retention time of catheters with clinical indicated replacement are different.Many studies have reported retention time at more than seven days,the longest up to 29 days.If no additional complications such as catheter-related infection,clinical indicated replacement strategy is the better choice.Since such a replacement strategy for a longer retention time,reducing the suffering of patients with repeated puncture and nursing workload.Therefore this study intend to systematically compare the incidence of complications between the two strategies,with a view to identifying the better one. The second part is a systematic review for efficacy in blood collection of peripheral venous catheter:Whether or not peripheral venous catheter can be an alternative to traditional venipuncture method of collecting blood samples? Because there is no relevant standards and evidence-based research support,at present we can see two different clinical practices.One way is:Continue to use peripheral venous catheter for blood collection with the doubt attitude,especially for repeated blood sampling,poor blood vessels or infant and child patients.In this case there are significant differences in some key steps such as blood discarded,wait period and so on.The other way is:even if a existing peripheral venous catheter can be used, because there is no evidence to support,is still using the traditional venipuncture method collecting blood sample in order to ensure accurate results of laboratory tests.If the two methods no difference between the test results,the peripheral venous catheter is a better option.Because it can reduce pain,protect blood vessels,reduce the nursing workload,it also can get more precise sampling time.This study intented to conduct systematic review for efficacy in blood collection of peripheral venous catheter to provide better evidence for clinical practice.ObjectiveWith international Cochrane Collaboration methods,systematic review the present clinical trials all over the world regarding the replacement strategy and efficacy in blood collection of peripheral venous catheter to obtain evidence of the following questions:1 ) Whether or not,the incidence of catheter-related infection and other complications is different between routine replacement strategy and clinical indicated replacement strategy of peripheral venous catheter?2)Is the test results of blood collected by peripheral venous catheters accurate? Will it be affected by the different blood collection methods,lock solution or infusion ingredients? Do we need to discard a certain amount of blood or stop infusion for a period before sampling? How much is the best discarded volume? How long is the best wait period? MethodsGuided by the principles of evidence-based medicine and the methods of Cochrane systematic reviews,PUBMED(1966-2009.1),EMBASE(1966-2008.12), OVID,Coehrane library,CINAHL(1982-2008.12),CBMdisc(1979-2009.1), CNKI(1994-2008.11),VIP(1994-2008.11) and the reference lists of identified studies were searched.We identified randomized controlled trials or quasi-randomized control trials of replacement strategy and efficacy in blood collection of peripheral venous catheter,as well as self-concurrent control trials of efficacy in blood collection of peripheral venous catheter.The quality of included trials was evaluated by two reviewers.Meta-analysis was conducted including homogeneous studies and sensitivity analysis with RevMan 5.0.18.Results【Section one】1.Six studies(1241 Patients) were included.All included studies were graded in term of randomization,allocation concealment,and blinding.Two studies were graded A, two were graded B and the other two were graded C.2.Meta-analysis showed that the incidence of phlebitis of clinical indicated replacement of peripheral venous catheter group was higher than routine replacement group(RR:2.47,95%CI:1.48-4.13).3.The difference of catheter-related blood infection rate between two groups had no statistical significance(RR:0.96,95%CI:0.19-4.81).【Section two】1.Twenty seven studies were included.Three studies were graded A,Fourteen were graded B and the other ten were graded C.2.Hemolysis rate of blood samples of peripheral venous catheter group was higher than venipuncture group in adult patients(RR:7.06,95%CI.2.77-18.01 );and was lower than venipuncture group in children(RR:0.18,95%CI:0.07-0.49); 3.Success rate of blood sampling of venipuncture method group was higher than drawing method group in children(RR:0.88,95%CI:0.81-0.96);and was lower than flowing method group in children(RR:1.26,95%CI.1.14-1.39);4.Contamination rate of blood culture samples of peripheral venous catheter group was higher than venipuncture group(RR:2.75,95%CI:2.15-3.53);5.Test value of blood samples of peripheral venous catheter group(no blood discarded )was lower than venipuncture group(SMD:-0.75,95%CI: -1.31-0.19);The difference of test values between various blood discarded group and venipuncture group had no statistical significance;6.Detecting ingredients included in the infusion solution,test value of blood samples of peripheral venous catheter group(no wait period)was higher than venipuncture group(SMD.6.88,95%CI:-3.24-10.52);and was lower than venipuncture group as detecting ingredients not included in the infusion solution(SMD:-2.70,95%CI: -2.70,-1.30);7.The total combined result showed that the difference of test values of blood samples between 1min wait period group and venipuncture group had no statistical significance.Yet subgroup analysis indicated,after 1 min wait period,haematocrit of peripheral venous catheter group was still lower than venipuncture group(SMD: -0.74,95%CI:-1.17-0.32);and blood glucose value of peripheral venous catheter group was still higher than venipuncture group as dextrose soltion used(SMD: 9.40,95%CI:7.36-11.44);8.After 2 min wait period,the difference of haematocrit value of blood samples between peripheral venous catheter group and venipuncture group had no statistical significance(SMD:-0.74,95%CI:-2.07-0.58);9.Even though after 3 min wait period,blood glucose value of peripheral venous catheter group was still higher than venipuncture group as dextrose soltion used (SMD:1.18,95%CI:0.77-1.59)。10.As screening of documents we found that many studies analyze the three different states of peripheral venous catheter at the same time,and therefore be excluded. Because different states there are different impact factors,it should not be confused with:①As blood sampling with a saline lock(no infusion,the catheters standby with a saline lock),the impact of blood discarded volume is main problem;②As blood sampling through peripheral venous catheter with a ongoing infusion,the impact of wait period is main problem;③Researching on the first two states,it is important to rule out the blood sampling immediately after catheter insertion.Conclusions:【Section one】1.Compared with routine replacement strategy,clinical indicated replacement strategy of peripheral venous catheter may increase the incidence of phlebitis;2.Clinical indicated replacement strategy doesn't affect Catheter-related blood infection rate;3.Still not sure whether clinical indicated replacement strategy will affect the incidences of swelling,infiltration or occlusion;4.As uesd for TPN including lipid,retention time of peripheral venous catheter should not be more than 24h.Does not recommend clinical indicated replacement strategy.At present,the practice of reserving more than 24h in most Chinese hospitals deserves our attention;5.Although in recent years,many studies indicated that the clinical indicated replacement strategy of peripheral venous catheter will not increase catheter-related infections and other complications.However,the meta-analysis results of this study do not support this view.In clinical Cautious attitude should be held about the clinical indicated replacement strategy of peripheral venous catheter;6.After strict quality evaluation,consider the possibility of a higher measurement bias and publication bias.More relevant RCT studies should be carry out to provide solid and reliable evidences.On the methodology,we must pay attention to the use of the blindness,as far as possible to avoid measurement bias. 【Section two】1.Hemolysis rate of blood samples of peripheral venous catheter group was higher than venipuncture group in adult patients;and was lower than venipuncture group in children;2.Compared with drawing method,flowing method approaches a higher success rate in children blood collection;3.Contamination rate of blood culture samples of peripheral venous catheter group was higher than venipuncture group.Blood culture specimens using the traditional venipuncture method are better;4.Impact on the results of the lock solution can not be ignored.A certain amount of blood including lock solution should be discarded before blood sampling through a peripheral venous catheter;5.1ml is the best blood discarded volume as collecting blood samples through a peripheral venous catheter;6.Intravenous infusion side arm can't be used for direct blood collection;7.During intravenous infusion,detecting ingredients not included in the infusion solution,blood samples can be collect through peripheral venous catheter after 1min stop period;8.During intravenous infusion,detecting HCT,blood samples can be collect through peripheral venous catheter after 2min stop period;9.During intravenous infusion,detecting ingredients included in the infusion solution,if it's low concentration in infusion solution and small molecular weight(such as the detection of sodium and chloride When input normal saline), blood samples can be collect through peripheral venous catheter after 1min stop period;10.During intravenous infusion,detecting ingredients included in the infusion solution,if it's higher concentration in infusion solution and bigger molecular weight(such as the detection of glucose when input dextrose solution),blood sampling is not recommended in the infusion side arm.Contralateral arm blood is better for precise test results.11.It is important to make a clear distinction between three states of peripheral venous catheter during studies.In addition we must pay attention to the strict training and quality control of operator.Quality controls of preservation and submission of blood specimens are also very important.