| Objective:To design an early warning and precontrol scheme for the risk of catheter occlusion with intravenous indwelling needles,so as to provide specialized nursing tools for clinical nurses and provide reference basis for further scientific early warning and evaluation of the risk and precontrol nursing of catheter occlusion with intravenous indwelling needles.Methods:This study is divided into three parts:The first part is the intravenous indwelling needle occlusion pipe risk early warning assessment programe of study,through keywords “peripheral venous/ peripheral intravenous/peripheral intravascular/peripheral vein/peripheral vascular” and“catheter*/ needle/ cannula? OR device OR line” and “blockage/occlusion/ obstruction/complications” and “risk/factor/influence”retrieval Scopus platform,CNKI,Pub Med and so on six big database,according to the important related factors affecting the intravenous indwelling needle tube jam occurrence frequency,screening of summarizing risk early warning assessment item pool formation,design experts consultation questionnaire.The indicators were screened through two rounds of expert consultation,the weight of indicators was determined by the analytic hierarchy process,and the early warning threshold was determined by the ROC curve drawn in a retrospective study.The early warning level was determined by percentile method for the actual patients with blocked catheter according to the early warning threshold,and the early warning scheme for the risk of occlusioned catheter with intravenous anlays was formed.The second part is the research on the precontrol scheme of intravenous catheter occlusion.Relevant literatures on prevention and nursing of intravenous catheter occlusion were systematically searched,and the literature was evaluated with the quality evaluation tool launched by Australian(JBI)evidence-based health care center in 2016.The standard and intensity of evidence classification refer to the practice standard of American society of intravenous infusion nursing(INS)in 2016.The literature was sorted out and analyzed.Consensus was reached through expert meetings to form the precontrol scheme for risk classification.The third part is a type of experimental study.218 inpatients in some departments of a third-class hospital in Jilin province were selected as the control group from may to June 2017,and 236 patients in corresponding departments from may to June 2018 were selected as the intervention group.The control group was given routine nursing,and the intervention group was given early warning and precontrol programs.The incidence rate,duration and satisfaction of patients with intravenous catheter blockage were compared between the two groups.Excel2010 and SPSS19.0 were used for data entry,proofreading and analysis.Measurement data conforming to normal distribution were analyzed by t test.The 2 test was used to compare the counting data,and the difference was considered statistically significant when P < 0.05.Results:1.30 experts(including clinical nursing,nursing education,nursing management and clinical medicine)were consulted for 2 rounds.The recovery rate of the second round of questionnaire was 100%,and the authority coefficient of experts was 0.860.The risk factors of the formation of pipe blockage included 2 first-level indicators,9 second-level indicators and 18 third-level indicators,and the warning range of the third-level indicators was assigned 14 points.According to the results of retrospective evaluation,the ROC curve was made with an AUC of 0.812,a standard error of 0.011,and a 95% confidence interval of 0.791 to 0.834(P < 0.001).When the score was 6.5,the Youden index was the largest,and the prediction degree of blockage was 88.2% and the specificity was 67.4%.Early warning classification results:(1)the total score of 7 to 10 points,low risk early warning occurred in patients with blocked tube;(2)the total score of 11 to 16 points,the patient blockage occurred in the early warning of intermediate risk;(3)total score > 16 points,the patient blocked tube high risk warning.2.According to the literature search results,a total of 28 literatures were screened and evaluated,which were summarized,extracted,sorted out,summarized and summarized.The intervention program was composed of 5 first-level indicators and 17 second-level indicators,among which the first-level indicators included five aspects: puncture,fixation,nursing,flushing and sealing,and health education.Of 16 experts(clinical nursing,nursing management,nursing education experts)meeting discussion,expert authority coefficient is 0.932,and eventually form three levels of control counter plan,the low risk precontrol measures 6 items,the crisis precontrol solutions in low risk precontrol add 3 measures,risk precontrol solutions in crisis precontrol increase on the basis of the five measures.3.Observe the early warning and control counter plan implementation effect,results show that the intervention group compared the control group,a significant reduction in the incidence of blocking pipe from 11.76% to 5.65%(P < 0.01),while the needle indwelling time by average 4.14 days to 5.17 days(P < 0.01),patients with indwelling needle satisfaction from 78.05% to 92.95%(P < 0.01),the difference is statistically significant.Conclusion:This study by using the theory of risk management and forward-looking thinking in nursing,the expert consultation,hierarchical analysis and retrospective study and so on scientific methods,contains 2 first-level indicators,9 second-level indicators and 18 third-level indicators of early warning assessment program,to determine the low risk,moderate and high risk three warning level,according to different alert level to form the three levels of control counter plan.The research has realized the whole process of identification,comprehensive evaluation,precontrol and treatment of the risk factors.The establishment of the early warning program realizes the systematic risk assessment of blockage pipes,and the division of the early warning level highlights the key intervention objects of blockage pipes.The establishment of precontrol program has realized the systematic and continuous precontrol intervention covering all links and standardized every link of nursing.Early warning scheme combined with control counter plan,improved the nurses intravenous indwelling needle tube jam the ability of risk identification and control counter,effectively reduce the incidence of intravenous indwelling needle tube jam,extend the intravenous indwelling needle indwelling time,improve the satisfaction degree of the patients with intravenous indwelling needle,for further science in intravenous indwelling needle blocking pipe risk early warning and assessment and precontrol care provides reference basis. |
PDF Full Text Request