Design Improvement And Intervention Evaluation Of Securing Devices In Supporting Indwelling Catheters

[Objective] This study is aimed to clarify the tools,methods,location and evaluation indexes of securing urinary devices for design improvement,and to evaluate effect of clinical application of improved securing urinary devices.This will provide reference basis for clinical practice and standardized management of urinary catheter external fixation in China.[Methods](1)First,the items of the questionnaire were preliminarily established by literature analysis.Then,the relevance of the items of the questionnaire was evaluated and the weak or irrelevant items were excluded by expert group discussion,and the content validity index(CVI)was measured.Finally,the "questionnaire on Clinical practice of external Catheter Fixation in Hospital" was formed.A questionnaire survey was conducted among 246 clinical nurses in the tertiary hospital in Wuhan,Hubei province by convenience sampling.(2)Chi-square test,nonparametric test and binary logistic regression analysis were used to screen the factors affecting the outcome of external catheter fixation.Fully evaluate the impact of this factor on the improvement of securing urinary devices design,by comparing the cost of securing urinary devices,the occurrence of catheter-related adverse events in different positions of securing urinary devices,design and improve the way of securing urinary devices.(3)Using the historical control method,patients in the intervention group were treated with improved securing urinary devices,and a supervision group was set up to ensure the effect of intervention,while patients in the control group maintained the original mode of securing urinary devices.A total of 450 patients with indwelling catheter were enrolled according to certain inclusion criteria to compare the incidence of catheter-related adverse events between the two groups,and then evaluate the effect of clinical application of the improved securing urinary devices.[Results] (1) Clinical practice of securing urinary devices in hospital:①87.4% of the nurses used securing urinary devices of catheter when patients with indwelling catheter,butthe tools,positions and methods of external fixation of catheter were different.78.9% of the nurses chose 3M adhesive tape as a tool for securing urinary devices,and 8.5% of the nurses chose a disposable catheter fixation device.The position of securing urinary devices was 72% in the inner thigh,8.9% in the outer one of the umbilical cord connected with the anterior superior iliac spine,and 6.5% in the lateral thigh.Among the methods of securing urinary devices,the "I" type fixation method accounted for 47.6%,and the "I" type fixation method accounted for 32.9%②The incidence of catheter-related adverse events was 28.5%,and the incidence of catheter-related adverse events with or without securing urinary devices was 27.9% and 32.6%,respectively.Among them,urinary tract pain,urinary tract infection,poor drainage,unplanned extubation and urine leakage accounted for 42.9%,35.7%,12.9%,7.1% and 2.9%,respectively.③T-test and chi-square test showed that there were three significant factors affecting the occurrence of catheter-related adverse events:the position of securing urinary devices,gender and state of consciousness.However,only10.2% of nurses chose different fixed positions according to gender in the clinical practice of securing urinary devices.(2)Design of securing urinary devices Securing urinary devices includes three parts:①tool: cost-effective 3M adhesive tape;②position: different fixed positions according to gender,such as male patients was fixted at 3 locations outside the line between the navel and the anterior superior iliac spine,and female patients was fixed at3 locations outside the inner and outer thighs;③method: "E" type fixation method.(3)Evaluation of clinical intervention effect of securing urinary devices: the incidence of catheter-related adverse events in the intervention group(10.6%)was significantly lower than that in the control group(27.9%),and the difference was statistically significant.[conclusions and suggestions] (1)The operation of securing urinary devices in hospital is not standard and lack of relevant nursing training and operation standards.Therefore,hospital and department managers should pay attention to the management of securing urinary devices,strengthen the training of related knowledge of securing urinary devices,update the design of securing urinary devices combined with clinical practiceand relevant guidelines,and standardize the management of catheter externalfixation.(2)The design of securing urinary devices was improved: the cost-effective 3M adhesive tape was used for the fixation tools.The fixation positions of male and female patients were 3outside the line between the umbilical cord and the anterior superior iliac spine,and 3outside the medial and outer thigh.The "E" type fixation method was used for securing urinary devices.(3) The design of securing urinary devices in this study can effectively reduce the incidence of catheter-related adverse events,reduce the cost of medical services,ensure the safety and comfort of patients,and can be widely used in clinic.The purpose of this study is to provide reference for improving and updating the guidelines related to catheter externalization.