Construction Of Evidence-based Nursing Practice For Prevention Of Catheter-related Infections Of Peripherally Inserted Central Catheter

ObjectsIn order to bridge the gap between foreign clinical guidelines and nursing practice in China and promote the implementation of PICC-Catheter Related Infection(PICC-CRI)clinical nursing practice in China,the purpose of this study is to build a localized evidence-based nursing practice plan to prevent PICC catheter related infection(PICC-CRI).The specific contents are as follows:1.Through the use of evidence-based nursing research methods,summarize the relevant risk factors of PICC-CRI,preventive interventions and domestic and foreign clinical practice guidelines and other research evidence.2.Based on the above evidence,the evidence-based nursing practice plan to prevent PICC-CRI was preliminarily formed.3.Delphi method was used to carry out further expert inquiry,and finally formed a localized evidence-based nursing practice plan for prevention of PICC-CRI applicable to the current situation of clinical nursing of PICC in China,in order to provide evidence-based evidence for the prevention of PICC-CRI localization for nursing staff in China,and ensure the safety of patients with management.MethodsThis study strictly follows the development method of the practice plan of card nursing,and the steps are as follows:1.Set up an expert group,draw up the research theme and design the research plan.2.Evaluate and summarize the evidence of prevention of PICC-CRI by using the research method of evidence-based nursing.(1)Meta analysis was used to summarize the risk factors of PICC-CRI.Case control studies or cohort studies on risk factors of PICC-CRI were retrieved from Cochrane Library,Pub Med,EMBASE,web of science,sinomed,CNKI,Wanfang and other databases.The retrieval time was from the establishment of the database toJanuary 2019.The quality of PICC-CRI was evaluated by NOS scale,and the risk factors of PICC-CRI were analyzed by Revman 5.3 software.(2)The preventive interventions of PICC-CRI were summarized through systematic evaluation.Search Cochrane Library,Pub Med,EMBASE,webofscience,sinomed,CNKI,Wanfang and other databases to find randomized controlled trials to prevent PICC-CRI.The search time limit is from the establishment of the database to January 2019.The quality evaluation standard of JBI randomized controlled trial2016 was used to evaluate the quality of the included literature,and the included preventive interventions were analyzed.(3)To evaluate the quality of the domestic and foreign practical guidelines and summarize the recommendations.At the same time,we searched the guide websites such as the international guide collaboration network(GIN),the National Institute of health and Clinical Excellence(NICE),the Scottish Intercollegiate guides network(SIGN),the national guide clearing house(NGC),etc.Using ageii system(2009 Edition)to evaluate the quality of the guidelines and summarize the items of clinical practice guidelines on PICC-CRI prevention.3.Summarize the above evidence,and preliminarily form the evidence-based nursing practice plan to prevent PICC-CRI.JBI 2014 evidence classification was used to classify the evidence items of the preliminary nursing practice plan,and Johns Hopkins quality evaluation standard was used to establish the quality level of evidence items.4.Delphi method was used to carry out expert inquiry,and finally formed a localized evidence-based nursing practice plan to prevent PICC-CRI.Through two rounds of expert consultation,the experts scored according to the importance and operability of the items,and put forward the adjustment opinions of the items,so as to realize the localization of evidence-based nursing practice program.Result:1.Meta-analysis included 18 literatures,including 1228 cases of infection and7346 cases of non-infection.Meta-analysis showed that diabetes mellitus,history of chemotherapy,number of catheter lumens≥2,delay of catheter maintenance cycle(>7 days),indwelling season(summer),catheter indwelling time,leukopenia,puncture times ≥2,puncture experience <50 times were risk factors for PICC-CRI.2.A total of 12 randomized controlled trials were included in the systematice valuation.Through descriptive analysis,it was found that the methods of quality improvement,PICC dressing(maintenance)method,and training of PICC maintenance personnel could effectively prevent the occurrence of PICC-CRI.3.A total of 18 clinical practice guidelines were included,including 12 in English and 6 in Chinese.Using the AGREE II system to evaluate the quality of the guidelines,the results show that the quality of the guidelines is good overall.The recommendations for prevention of PICC-CRI mainly include five aspects: education and training,quality control,assessment before catheterization,nursing during catheterization and nursing after catheterization.4.Summarize the relevant risk factors of PICC-CRI,preventive interventions and recommendations of domestic and foreign clinical practice guidelines,and form the first draft of evidence-based nursing practice plan for prevention of PICC-CRI.5.After two rounds of expert correspondence,we finally built a localized evidence-based nursing practice plan to prevent PICC-CRI.Among them,there are 5first level items,14 second level items and 51 third level items.The recovery rate of two rounds of expert inquiry forms was 93.75% and 100% respectively.In the first round,CV variation coefficient of all indicators fluctuated from 0.00 to 0.30,coordination coefficient W of importance and operability was 0.20 and 0.27 respectively,CV variation coefficient of all indicators fluctuated from 0.00 to 0.26 in the second round,coordination coefficient W of importance and operability was 0.26 and 0.28 respectively.The difference was statistically significant(P < 0.05).Conclusion:1.Risk factors for PICC catheter-related infections include both patients and catheterizers.patient risk factors include diabetes,history of chemotherapy,number of catheter lumens≥2,catheter maintenance cycle delay(>7 days),indwelling season(summer),catheter indwelling time ≥ 30 d,leukopenia;risk factors for catheterization include puncture times ≥ 2,operator puncture experience <50times.This conclusion suggests that in PICC-CRI preventive care,we should pay more attention to the above risk factors and actively take preventive measures.2.In this study,evidence-based nursing practice plan for prevention of PICC-CRI was constructed,which is suitable for the current situation of clinical nursing in China.The plan consists of five aspects: education and training,assessment before catheterization,nursing during catheterization,nursing after catheterization and quality control.The result of expert inquiry shows that the scheme has better objectivity and accuracy,and has certain clinical significance and reference value.