Construction And Application Of Control Scheme For Central Venous Catheter Blockage Risk

Objective:1.To construct a pre-control scheme for the risk of central venous catheter blockage based on evidence-based and expert meeting method.2.In order to reduce the incidence of central venous catheter blockage,the pre-control scheme was applied to clinical practice and the effect was evaluated.Methods:The first part: : through literature study and expert meeting method to build the central venous catheter blockage risk control scheme.Based on the "6S" evidence model,this study searched all domestic and foreign evidences related to the prevention of central venous catheter blockage from top to bottom,including clinical practice guidelines,evidence summary,systematic evaluation,etc.After quality evaluation,standardized integration and summary of the evidence finally included in the literature were carried out.Expert meeting method was adopted to organize experts engaged in venous therapy to evaluate,revise and improve the initial plan formed by evidence,and finally form the central venous catheter blockage risk control plan.The second part : to evaluate the effectiveness and feasibility of the pre-control scheme for the risk of central venous catheter blockage by using the historical control design in the quasi-experimental study.A total of 300 inpatients requiring CVC implantation from June 2021 to January 2022 were selected as the study subjects in some departments of central venous catheters in a grade III,Grade A hospital in Shanxi Province.Among them,149 patients from June to September 2021 were the control group,receiving routine placement,fixation and maintenance of central venous catheter,and 151 patients from October 2021 to January 2022 were the intervention group.Based on the evaluation of the risk prediction model of central venous catheter blockage,the corresponding pre-control plan was implemented according to the risk grade.The incidence of catheter blockage,the duration of indwelling and the awareness rate of nurses’ knowledge of prevention and maintenance of catheter blockage were compared between the two groups before and after intervention.Results:1.Central venous catheter blockage risk control plan: Central venous catheter jam prevention based on the literature summary of the best evidence,participants included 12 articles,including system evaluation 1 piece,1 piece of Meta analysis,expert consensus3 article,summarize the evidence 4,3,guide parts including intravenous treatment team,and the method,the wash pipe tools and operating,blockage prevention strategies,education of five dimensions,20 patients with evidence.After discussion among 13 venous therapy experts,expert authority coefficient(Cr)= 0.930,a central venous catheter blockage risk pre-warning and control plan was finally formed,including 10low-risk pre-control measures,6 medium-risk pre-control measures added to the low-risk,and 4 high-risk pre-control measures added to the medium-risk.2.To evaluate the application effect of the pre-control scheme for the risk of central venous catheter blockage: The results showed that there were no statistical differences between the two groups in age,number of catheter lumens,catheterization site,disease type,gender,education and drug type(P > 0.05).After the application of the scheme,the incidence of catheter blockage in the intervention group(11.26%)was lower than that in the control group(19.46%)(P < 0.05).The catheter indent time of patients in the intervention group(22.74±3.80)d was higher than that in the control group(17.82±4.09)d(P < 0.001),and the knowledge rate of nurses based on evidence-based prevention of central venous catheter blockage was significantly improved.The average score increased from(74.24±7.19)points to(95.50±2.88)points(P < 0.001),with statistical differences.Conclusion:1.Based on evidence-based and expert meeting methods,this study constructed a pre-control scheme for the risk of central venous catheter blockage,realizing the continuous pre-control intervention for the whole process from catheter assessment,placement to maintenance,and providing evidence-based basis for medical institutions to improve the management scheme.2.The application of pre-control scheme for the risk of central venous catheter blockage can reduce the incidence of catheter blockage,prolong the time of patients with catheter,and provide a guarantee for the safe indwelling of catheter in inpatients.