成人周邊靜脈注射新思維

New Evidence-Based Practice in Peripheral Intravenous Therapy

周邊靜脈注射是急性住院病人最常見的治療，目前大多數醫療院皆依循美國疾病 管制局所發佈的導管相關血流感染之預防指引，規定成人周邊靜脈注射導管每72－96小時重新更換，最新的系統性文獻回顧指出，依臨床症狀更換周邊靜脈注射導管並不會增加周邊靜脈炎或導管相關血流感染率，澳洲之周邊靜脈導管臨床指引亦建議，各醫療機構可在靜脈炎及導管相關菌血症發生率低的情況下訂定每機構的靜脈導管更換時間頻率準則，因此，建議在充分的人員訓練下，臨床人員確實做好置入部位及注射管路系統之無菌，配合每班確實檢視注射部位並詳實記錄，當有靜脈炎的徵象，熱、痛、紅、可觸及的靜脈索狀硬化或出現相關合併症時，即刻更換周邊靜脈導管及全部的輸液給藥管路及連接管，以減少病人常規置入靜脈導管之疼痛，並減少醫療成本及人力成本之耗費。依據最新證據作為臨床照護之指引已成為目前趨勢，在使用新證據時併用相關組套措施才能為病人提供最適切又優質的照護品質。

Peripheral intravenous therapy is the most common therapy for acute hospitalized patients. Currently, most hospitals follow the Guidelines for the Prevention of Intravascular Catheter-Related Infections by Centers for Disease Control and Prevention of America. The guidelines state that peripheral intravenous catheters should be replaced every 72 to 96 hours in adults. The latest systemic literature reviews point out that replacing the peripheral intravenous catheter does not increase the occurrence rate of peripheral phlebitis or catheter-related bloodstream infection. Australia's clinical guidelines for prevention of peripheral intravenous catheter-associated infection also suggest that medical organizations set up their own standard for frequency of intravenous catheter change under the circumstance of low occurrence rate of phlebitis and catheter-associated sepsis. Therefore, recommended measures include sufficient skill training for staff, strict sterile procedures for intravenous catheter insertion, and ensured monitoring of the intravenous catheter-inserted sites with detailed recording. Once any sign of phlebitis (heat, pain, redness, touchable hardness of peripheral venous lines, and associated complications) presents, immediately replace the peripheral intravenous catheter and all intravenous infusion tubes and connectors. All these measures reduce the patient's pain due to routine insertion of the intravenous catheter and decrease medical and taskforce expenses. Using the latest evidence-based research to guide clinical practices has been a current trend that, combined with relevant bundled measures, offers patients the most adequate and highest quality of care.