Evidence-based Practice Of Removal Strategy Of Peripheral Intravenous Catheters And The Effect Of Different Indwelling Sites In Hematopathy Patients

BACKGROUNDPeripheral intravenous catheter(PIVC)is a commonly used vascular access device in clinical because of its low price and simple operation.The removal strategy of PIVC has been controversial in clinical,the controversy about the removal of PIVC is mainly whether to removal it routinely or according to clinical indication.The routine replacement strategy is to remove the PIVC every 72 hours to 96 hours,and the clinical indicated strategy is based on the clinical indications,that is,to monitor the insertion site of the PIVC.When there are phlebitis,infiltrations,occlusions and other symptoms,the PIVC will be replaced.At present,there is no uniform standard for the removal of the PIVC in clinical practice,and there is no standardized record,and the patients who have complications or do not need infusion are still used continuously,which increases the risk of transfusion.There is also a lack of research on the relationship between the indwelling site and the effect of the different sites,which makes it difficult for the clinical nurses to choose the puncture site.OBJECTIVE1.The purpose of this study is to find the best evidence of removal of peripheral intravenous catheter(PIVC),to develop the removal strategies and apply these strategies to hematopathy patients,to improve nurses'complhance with the evidence and extend the indwelling time of PIVC.2.To investigate the indwelling time of different sites and the incidence of related complications in hematopathy patients when removing peripheral intravenous catheter according to clinical indications,to provide evidence for rational selection of puncture site for clinical nurses.METHODSThis study is divided into two sections.The first section is the evidence-based practice of removal of peripheral intravenous catheters in hematopathy patients.The second section is to observe the effect of peripheral intravenous catheter at different sites in hematopathy patients when removal the PIVCs by the clinical indicated strategy.1.The standard procedure supported by the JBI—PACES program was followed in section one,including three stages:baseline audit,evidence implementation,and re-audit.The best evidences of removal of PIVC were searched from Joanna Briggs Institute(JBI),Cochrane Library,Pubmed,National Institute for Health and Care Excellence(NICE),National Guideline Clearinghouse(NGC),China Biology Medicine disc(CBMdisc)and Wanfang Data Knowledge Service Platform.Evaluate the evidence and accepted a recommended evidence and translated evidence into clinical criteria.Investigated the current situation of removal of PIVCs and compared it with the best evidence.The information was collected through on-site review,questionnaires,and review of nursing records.A total of 390 patients and 43 nurses were included before and after the application of the evidence,barriers to evidence usage were analyzed and improved.Applyed the best evidence to clinical practice and evaluated the effection.2.The second section adopts the convenient sampling method,a total of 386 cases were included,including 190 cases with catheters on the back of hand and 196 cases with catheters in forearm.When the PIVCs was removed according to the best evidence,the patients with peripheral intravenous catheters were observed and recorded,and the indwelling time and the incidence of complications were analyzed.RESULTS1.Finally,in section one,we included an Evidence Summary,an Evidence Review,a Systematic Review,an Expert Consensus and two Guidelines,eleven pieces of evidence and four clinical audits have been developed in the project,including inspecting the insersion site of PIVCs on each shift change time,removing PIVCs when clinicaly indicated,PIVCs should be replaced when complications such as phlebitis,infiltration and occlusion occur in the puncture site,and assessing the need for PIVCs daily and removing the unused PIVCs for more than 24 hours.Nurses' adherence to 4 audits were improved significantly(P<0.05)after the best evidence was implemented.There was no significant difference in the complications included phlebitis,infiltration and occlusion before and after the implementation of best evidence(P>0.05),but the indwelling time was extended from(5.18±2.42)days to(6.21±3.41)days,the difference was statistically significant(P<0.05).2.The results of the second section of the study showed:Indwelling time more than 3 days of intravenous catheters were a total of 386 cases,including 190 cases with catheters on the back of hand and 196 cases with catheters in forearm.The indwelling time of the catheters on the back of hand and forearm was 5.22 ±2.45 days and 5.65 ±2.94 days respectively(P>0.05),the incidence of phlebitis was 46.8%and 29.6%respectively.6 cases(3.2%)of the peripheral intravenous catheters on the back of the hand had unplanned extubation,while none of the forearm cases had unplanned extubation.The difference was statistically significant(P<0.05).The incidence of occlusion was 25.8%and 29.6%,and the incidence of infiltration was 5.8%and 3.6%respectively(P>0.05).CONCLUSIONS1.The integration of best evidence of removal of PIVC in hematopathy patients can standardize nurses' behaviors,improve their compliance,and extend the indwelling time of PIVC without increasing the incidence of complications.2.There was no significant difference(P<0.05)in indwelling time between the catheters on the back of hand and forearm,but there were significant difference in the incidence of phlebitis and unplanned extubation.Forearm is preferred site for peripheral intravenous catheters,Clinical nurses should first choose forearm to indwell peripheral intravenous catheters according to the patient's condition,state of vascular and property of medicine.