| Objective:Through systematic review,the current global clinical studies on the efficacy and safety of intravenous therapy in hospitalized children were combined in order to ob tain relevant evidence for the following issues:(1)Factors influencing the effectiveness of maintaining the static therapy access in pediatric patients(2)Factors influencing the safety of maintaining the static therapy access in pediatric patientsMethods:Following the principles of evidence-based medicine,the method of Cochrane systematic evaluation,computer and manual retrieval were employed to comprehensively and systematically search CNKI,VIP,CBM,Wanfang,PubMed,Cochrane Library,Web of Science,and Embase,supplemented by gray literature,network resources,and journal information search.The retrieval time is up to December 2019.studies on the factors in fluencing the effectiveness and safety of intravenous catheterization in hospitalized childr en were searched.General data were screened and extracted by two investigators(L,C),and the quality of included articles was evaluated in pairs according to different study types.Used Statal2.0 to quantitatively andcomprehensively analyze the results,and the s ubject headings were selected to summarize the literature for qualitative evaluation.The Cochrane systematic review was judged using the systematic review re-evaluation metho d.The extracted quantitative data were subjected to Q test and I2 statistical heterogeneit y test,Subgroup analysis and sensitivity analysis were used to investigate the sources of heterogeneity,and Subgroup analysis and sensitivity analysis were used to investigate th e sources of heterogeneityBegg rank correlation method and Egger regression method w ere employed to quantitatively identify publication bias.The systematic review protocol is registered with the PROSPERO International Prospective Register of Systematic Review(http://www.crd.york.ac.uk/PROSPERO).Registration number:CRD42020161239,and report ed by useing the PRISMA guidelines.Results:A total of 71 articles were included,including 16 RCTs in Chinese and 5 in Engli sh;10 CCTs in Chinese and 1 in English;1 case-control study in English;8 cohort stu dies in Chinese and 15 in English;1 cross-sectional study in English;and 14 Cochrane systematic reviews in Chinese and English.The kappa value between the two reviewer s was between 0.8 and 1.0,and there was strong agreement between the quality evaluat ion results.(1)Quantitative analysis results:The success rate of puncture 95%CI(2.85～5.48),i ndwelling time 95%CI(1.074～1.546),localization accuracy 95%CI(1.074～1.546),com plication rate 95%CI(0.202～0.326),catheter damage 95%CI(0.242～0.404),the differe nces were statistically significant.The above outcomes are all "key important outcomes."Except for localization accuracy,the GRADE recommendation level is strong recomme ndation(1).(2)Qualitative analysis results:Through thematic comprehensive result analysis comb ined with health social ecology theoretical model,the influencing factors are divided int o upstream factors,midstream factors and downstream factors.The quality of the three main influencing factors was:"MODERATE,MODERATE,MODERATE".The quality o f observational studies was positioned as low quality evidence at GRADE.Qualitative r esults are moderate,weak recommendation(2)(3)Overview of systematic reviews results:AMSTAR was used for quality evaluatio n,9 grade A,4 grade B and 1 grade C.All English studies were Cochrane studies,an d the overall quality of the included studies was moderate.The study had a mean over all reporting quality score of 23.6 points,overall reporting quality was high(A),and th e primary outcome measures were 4 key important outcomes,1 important non-key outco me,and 1 less important outcome,with a weak recommendation(2).Conclusion:(1)Quantitative analysis:Catheterization site,nursing management,use of drugs and vascular visualization techno logy are protective factors for the success rate of puncture;c atheter fixation method,type of new catheter are protective factors for indwelling time;positioning method and lower limb vein are protective factors for positioning accuracy;prefilled flushing tube,and family cooperation are protective factors for the incidence of complications.Transvenous and health education are protective factors for catheter injur y.(2)Qualitative analysis:patient factors selection of dorsal hand vein and noble vein in children with cancer or blood diseases aged 1～10 years is a protective factor for eff ectiveness;medical factors including good professional quality of medical care,high quali ty of treatment,strict hospital management,appropriate use of medical equipment,corre ct choice of infusion concentration,and the specialized medical environment are the effe ctive and safe protection factors.Standardization and promotion of guidelines are protecti ve factors for effectiveness and safety.(3)Overview of systematic reviews analysis:Infectious complications are safety risk f actors;puncture duration≤30 min,puncture times<2 times,catheter indwelling time≤7 points are protective factors for effectiveness and safety;premature infants,low birth we ight,Apgar score≤7 points are risk factors for effectiveness and safety. |
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