SCI晨读：产科外周静脉导管管理 (PICMIC)：多中心前瞻性队列研究
产科外周静脉导管管理 (PICMIC)：多中心前瞻性队列研究
摘要
背景
分娩是一个正常的生理过程，但各种干预很常见。最常见的干预措施是插入外周静脉导管。然而，指导最佳实践的研究很少。本研究旨在描述当前的静脉导管插入实践，探索插入过程中的临床医生决策和女性的看法。
方法
这项前瞻性、观察性队列研究招募了来自澳大利亚两家地区医院的 101 名女性和临床医生。数据收集包括非参与者观察、简短访谈和图表审查。测量的变量包括疼痛评分、插入尝试、导管规格和停留时间。
结果
生育妇女平均年龄为 31 岁，体重指数 (BMI) 高于 28。妇女报告导管插入 24 小时的平均疼痛评分为 3.3/10，12% 报告有瘀伤。18 号导管被认为比 16 号导管更痛，多次尝试并没有增加感知的平均疼痛评分。未建立首次尝试失败与较高 BMI 之间的关联。参与的临床人员主要是助产士，他们选择和放置 18 号导管主要在手或手腕 (66%)。关于部位、导管规格、敷料和尝试的决策各不相同。尽管经常练习，仍有 34% 的人尝试了 2 到 3 次。
结论
当使用延长管放置在手的小静脉中时，常规使用大规格导管是难以想象的。需要更多的研究来推广围绕导管选择、穿刺点和女性体验的最佳实践。
Abstract
Background
Childbirth is a normal, physiological process, yet intervention is common. Arguably the most common intervention is the insertion of a peripheral intravenous catheter; however, there are few studies guiding best practice. This study aimed to describe current intravenous catheter insertion practice, explore clinician decision-making during insertion and perceptions of women.
Methods
This prospective, observational cohort study recruited 101 women and clinicians from two Australian regional hospitals. Data collection incorporated non-participant observation, brief interview and chart review. Variables measured included pain score, insertion attempts, catheter gauge and dwell time.
Results
Childbearing women were, on average, aged 31 with body mass index (BMI) above 28. Women reported a mean pain score of 3.3/10 at 24 h for catheter insertion and 12% reported bruising. An 18-gauge catheter was considered more painful than a 16-gauge, and multiple attempts did not increase perceived average pain score. Association between failed first attempts and higher BMI was not established. Participant clinicians were predominantly midwives, who selected and placed 18-gauge catheters mostly in hand or wrist (66%). Decision-making about site, catheter gauge, dressing and attempts varied. Thirty-four per cent attempted two to three times, despite regular practise. Confidence to reliably insert determined catheter gauge and almost half clinician participants cited hospital policy and preferred non-dominant arm as key reasons for the location of PIVC.
Conclusions
Regular use of a large-gauge catheter is counter intuitive when placed in the small veins of the hand with extension tubing. More research is needed to promote best practice around gauge selection, site and women's experience.
原文链接：
https://doi.org/10.1111/jan.14933
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