| Objective:By investigating the use of peripheral venous catheters(PIVC)in patients with total parenteral nutrition support,analyzing the influencing factors of drug extravasation,constructing and validating a nomograph model to predict the risk of drug extravasation related to peripheral venous catheters in patients with total parenteral nutrition support,and providing scientific basis for clinical nursing staff to predict and early intervene in the risk of drug extravasation related to PIVC in patients with total parenteral nutrition support.Methods:1.A preliminary questionnaire on the risk of drug extravasation from peripheral venous catheters in patients undergoing total parenteral nutrition support was developed using two rounds of Delphi letter expert inquiry.2.Using the convenient sampling method,177 patients from a Class III hospital in Heilongjiang Province from July 2 0 2 1 to December 2 0 2 2 were selected as the study subj ects.Relevant information was collected using the Peripheral Venous Catheter Related Drug Extravasation Risk Questionnaire for Patients with Total Parenteral Nutrition Support,and the data obtained were input into SPSS 24.0 for statistical analysis.Single factor analysis and logistic stepwise regression analysis were used to analyze the influencing factors of PIVC related drug extravasation in patients with total parenteral nutrition support,and a nomogram was constructed to predict the risk of PIV C related drug extravasation in patients.The evaluation and prediction model uses C-index,correction curve,and decision curve for internal verification of discrimination,consistency,and clinical usefulness.Results:1.Expert consultation results:The content includes three primary indicators(patient factor,nurse factor,and peripheral venous catheter use factor),and 26 secondary indicators.The effective recovery rates of the two rounds of expert correspondence questionnaires were 9 5.2%and 90%,respectively.The expert authority coefficients were 0.902 and 0.901,and the Kendall harmony coefficients were 0.495 and 0.373,respectively(P<0.01).2.The factors related to PIVC related drug extravasation in patients with total parenteral nutrition support were analyzed by single factor and multiple factor Logistic analysis.The results showed th at:ag e(P=0.0 0 7,OR =1.053,95%CI:1.0 14-1.094),complication(P=0.037,OR=0.348,95%CI:0.129-0.94 1),compliance(P=0.007,OR=0.24 1,95%CI:0.086-0.674),history of target vein puncture in the past week(P<0.001,OR = 0.151,95%CI:0.05 5-0.415),number of vein punctures(P<0.001,OR = 5.004,95%CI:2.20511.359)is an independent risk factor for PI VC related drug extravasation in patients undergoing total parenteral nutrition support.3.The constructed nomograph model for evaluating the risk of PIVC related drug extravasation in patients with total parenteral nutrition support:the C-index value was 0.895,with a 95%confidence interval(95%CI:0.8450.945),and a moderate degree of differentiation;The consistency test conducted on the correction curve shows that the predicted probability is consistent with the actual occurrence probability;At the same time,the decision curve shows that the clinical net benefit of the nomograph model is higher than the net benefit predicted by selecting any one indicator alone.Conclusions:1.The risk assessment index for PIVC related drug extravasation in patients with total parenteral nutrition support ultimately constructed in this study can provide reference for clinical nursing personnel to assess and prevent the risk of PIVC related drug extravasation in patients with total parenteral nutrition support.2.The PIVC related drug extravasation risk nomograph model for patients with total parenteral nutrition support based on five risk factors has good predictive efficacy.This model helps clinical nursing personnel identify highrisk groups of drug extravasation in the early stage,and provides reference for targeted intervention measures to prevent the occurrence of drug extravasation. |
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