Construction Of Evidence-based Nursing Practice Of Program For Prevention Of Unplanned Extubation Of Peripherally Inserted Central Catheter(PICC)

Objective:Based on the method of evidence-based medicine,this study aimed at evaluating and synthesizing the evidence of risk factors and prevention of unplanned extubation of PICC,in order to develop a standardized,systematic and realistic evidence-based nursing practice of program for prevention of unplanned extubation of PICC.Thus to provide best practice information for the prevention of unplanned extubation of PICC,providing evidence-based security for PICC patients.Methods:1.Systematic Review: Cochrane Library,PubMed,EMbase,CINAHL,CBM,WanFang Data,CNKI and VIP were searched from the time of their data building to Oct 2016.The literatures about the risk factors for unplanned extubation in PICC were collected.The quality of included studies was evaluated by using the Newcas tle? Ottawa?Scale(NOS).Meta-analysis was conducted by using Rev Man 5.3.2.Literature research:Cochrane Library,PubMed,EMbase,CINAHL,CBM,WanFang Data,CNKI and VIP were searched from the time of their data building to Oct 2016.The literatures about the prevention of unplanned extubation of PICC were acquired.The quality of included studies was evaluated by using the Quality Evaluation Criteria of Australia JBI Evidence-Based Health Care Center(2008).The health education,hospital maintenance,quality improvement and other aspects of the content were analyzed.3.Guidelines Analysis: Scottish Academy Guide Network,US National Guideline Clearinghouse,the Canadian Ontario Registered Nurse Association Evidence-based Care Network were searched at the same time.Analyze the contents of the guidelines included.4.Delphi method: Taking two rounds of expert correspondence and carry out a statistical analysis.Results:1.After systematic retrieval of the literature,and the strict quality assessment of the literature,the final inclusion:(1)11 articles on risk factors for unplanned extubation in PICC.Including 3 cohort studies and 8 case-control studies.The sample size was 4454 with330 cases in unplanned extubation group and 4124 cases in planned extubation group.Meta-analysis showed that the relevant factors are phlebitis,infection,thrombosis,drug and delirium;(2)a total of 20 articles on the prevention of unplanned extubation in PICC were included,including 5 randomized controlled studies,3 semi-randomized controlled trials and 11 experimental studies.As the content of the study vary widely,only descriptive analysis,the health education,hospital maintenance,quality improvement,infusion team and other aspects of evidence integration,in order to further develop the prevention of PICC unplanned extubation of evidence-based nursing practice to provide a reference.2.8 guidelines were included in total,including 2 in Chinese and 6 in English.It containing 11 themes and 14 items to prevent PICC unplanned extubation.Such as infusion team,the operating points,the health education and quality improvement.It offer evidence support and content reference for further building systematic,complete evidence based care practices for the prevention of unplanned extubation of PICC.3.According to the evidence collected by the American Association of Intravenous Infusion Care(INS)2011 Clinical Practice Guidelines,the evidence level of each recommendation was given to establish an evidence-based nursing practice for the prevention of unplanned extubation of PICC.Using Delphi method for two rounds of expert correspondence,according to expert advice and ultimately the formation of China's care for the actual practice.The contents include: the scope of application,the best practice,the level of evidence standards,the program construction process and application recommendations.Conclusion:On the basis of evidence-based thinking,then formed the "evidence-based" program,that is,evidence-based nursing practice of program for prevention of unplanned extubation of PICC.The program is based on the existing best evidence and expert consensus,from the risk factors,operating points,health education,hospital maintenance and quality improvement in several aspects of clinical nurses to provide evidence support,but also tobe further clinical trial application.