Evidence-based Study On Prevention Of Mechanical Phlebitis Caused By PICC Catheterization In Premature Infants

ObjectiveTo investigate and analyze the main nursing problems of mechanical phlebitis caused by indwelling PICC catheter in the neonatal intensive care unit(NICU)of Ningxia Medical University General hospital;through retrieving Chinese and foreign databases to obtain research literature,after literature quality evaluation,extract relevant evidence needed for research,formulate the first draft of evidence-based strategy for prevention of mechanical phlebitis caused by indwelling PICC catheter in preterm infants,and adopt clinical gap analysis method to build prevention strategy for mechanical phlebitis caused by indwelling PICC catheter in preterm infants The evidence-based strategy of mechanical phlebitis was applied in the process of PICC catheterization in preterm infants to explore the effect of evidence-based strategy on the success rate of PICC catheterization,the occurrence,severity and the duration of PICC catheterization in preterm infants.Method1.The data of 367 premature infants with PICC catheters successfully placed in NICU of Ningxia Medical University General hospital were retrospectively investigated.The main nursing problems and influencing factors of mechanical phlebitis caused by PICC catheters were analyzed and summarized,and the main evidence-based nursing problems were determined;2.Develop a search strategy,search the Chinese and English databases to obtain the published literature on mechanical phlebitis and related preventive measures after PICC catheterization in preterm infants at home and abroad.Two researchers screened the literature according to the inclusion exclusion criteria,evaluated the quality of the literature and extracted the data.Use Revman 5.3 software to carry out meta analysis on randomized controlled studies and cohort studies,for clinical guidelines and evidence summary,relevant research evidence is obtained through content analysis,According to the results of literature quality evaluation,the decision-making group integrated the preparation before catheterization,the operation during catheterization and the maintenance after catheterization to form the first draft of an evidence-based strategy for prevention of mechanical phlebitis caused by PICC catheterization in preterm infants;3.By using the method of on-the-spot questionnaire survey,the evaluation and modification opinions of clinical experts on the clinical applicability of the first draft of an evidence-based strategy for prevention of mechanical phlebitis caused by PICC catheterization of premature infants were collected.The decision-making group discussed,modified and summarized the evidence-based strategy according to the guidance and suggestions of clinical experts,and then formed the prevention of mechanical phlebitis caused by PICC catheterization of premature infants after confirmed by clinical experts The final version of the card strategy was changed into the operation process by the PICC management specialist nurses in the decision-making group through repeated operation drills;4.82 preterm infants who were admitted to NICU of Ningxia Medical University General hospital from January to August 2019 and were ready to put a PICC catheter were selected as the study objects,According to the random number table method,they were randomly divided into control group and intervention group.The control group implemented the standardized operation and nursing measures of PICC catheter,and the intervention group was given evidence-based strategies to prevent mechanical phlebitis caused by PICC catheter,and the comparison was made The difference of the success rate of catheterization,the incidence and degree of mechanical phlebitis and the duration of PICC between the two groups.Result1.Retrospective survey results1.1 the incidence of complications of PICC in preterm infants was 27.52%.According to the order of incidence,they were:mechanical phlebitis(20.44%),catheter blockage(3.40%),blood/fluid infiltration(1.63%),lymphadenopathy(1.09%),catheter-related bloodstream infection(0.54%),pleural effusion(0.54%)and catheter removal(0.27%).1.2 the results of single factor analysis showed that the length of body,the number of catheterization and the number of punctures entered the equation,which were the influencing factors of mechanical phlebitis caused by PICC catheterization in preterm infants(P<0.05);the multiple factor Logistic regression analysis showed that the number of catheterization and catheterization of cephalic vein>2 times were the independent risk factors of mechanical phlebitis caused by PICC catheterization in preterm infants(P<0.05).2.Results of evidence-based strategy construction2.1 Literature analysis resultsIn this study,730 literatures were searched,and 40 literatures were included,including 23randomized controlled studies,10 cohort studies,4 clinical guidelines,and 3 evidence summaries,after the literature quality evaluation,21 grade a literatures and 16 grade B literatures.The meta-analysis results of 17 articles included:selection of puncture vein,hot compress before puncture,0.08mg·ml~-11 dexamethasone solution pretreatment catheter,ultrasound-guided technique to assist puncture,and covering puncture site with hydrocolloid dressing;The results of content analysis and extraction of 23 articles included include:selection of tube placement position,warm salt water injection and delivery tube,positioning mode of the tube tip,position of the tube tip,preventive treatment measures.2.2 The results of evidence integration and the formation of the first draft of an evidence-based strategyAccording to the research evidence of meta analysis and analysis,extraction and integration of literature content,5 items of meta analysis and 34 pieces of literature content extraction.The maximum number of research evidence extracted from a single document is 18,and the maximum number of single research evidence is 8;The research evidence was integrated according to the three links of PICC catheterization preparation,catheterization operation,and catheterization maintenance,forming 18 items and 39 pieces of evidence-based strategy draft for prevention of mechanical phlebitis caused by PICC catheterization of premature infants,It includes 8 items and 18 pieces of preparation before catheterization,including 3 pieces of meta analysis and 15 pieces of literature content extraction;6 items and12 pieces of catheterization operation come from 1 piece of meta analysis and 11 pieces of literature content extraction;4 items and 9 pieces of conduit maintenance after catheterization consist of 1 piece of meta analysis and 8 pieces of literature content extraction.2.3 Results of clinical gap analysis and confirmation of an evidence-based strategyA total of 23 clinical experts were included in this study,all female,aged 30-60 years old,all of them had PICC catheterization experience,all of them had PICC catheterization experience for 5-10 years.According to the opinion of the clinical gap analysis of experts,3pieces of evidence that can not be applied due to the limitation of environment and facilities are deleted,including 1 piece of preparation before catheterization and 2 pieces of catheterization operation;2 pieces of evidence were revised,1 of which were adjusted from the tube operation to the preparation before catheterization.1 of catheter positioning methods were modified due to the limitation of facilities,After the modification,36 pieces of evidence were integrated and finally confirmed by clinical experts to form the final version of evidence-based strategy for prevention of mechanical phlebitis caused by PICC catheterization of premature infants,including 9 items and 19 pieces of preparation before catheterization,5items and 8 pieces of catheterization operation,4 items and 9 pieces of conduit maintenance,a total of 18 items and 36 pieces.3.Empirical research results of evidence-based strategy3.1 The incidence of mechanical phlebitis was 5.56%,which was significantly lower than the previous retrospective survey(20.44%);3.2 The times of PICC puncture and the time of catheterization in the intervention group were significantly lower than those in the control group(P<0.05);3.3 The incidence of mechanical phlebitis in the intervention group was 5.56%,which was significantly lower than that in the control group(21.62%)(P<0.05);3.4 The severity of mechanical phlebitis in the intervention group was significantly lower than that in the control group(P<0.05).Conclusion1.Mechanical phlebitis caused by PICC is the most common in premature infants;The main risk factors of mechanical phlebitis were catheterization of cephalic vein and more than 2times of puncture;2.The establishment of evidence-based strategy for prevention of mechanical phlebitis caused by PICC catheterization in preterm infants is based on the existing clinical problems,clinical needs as the starting point,evidence-based evidence and the guidance and suggestions of clinical experts.It is a comprehensive prevention strategy including preparation before catheterization,operation during catheterization and maintenance after catheterization,which not only shortens the difference between clinical application research and clinical practice Distance,more conducive to guide clinical practice;3.The evidence-based strategy of prevention of mechanical phlebitis caused by PICC catheterization in preterm infants can effectively reduce the occurrence and severity of mechanical phlebitis.