近紅外線設備輔助兒童周邊靜脈注射之效應──系統性文獻回顧與次族群統合分析

The Efficacy of Near-Infrared Devices in Facilitating Peripheral Intravenous Access in Children: A Systematic Review and Subgroup Meta-Analysis

背景：周邊靜脈注射是兒科常見的侵入性處置。兒童普遍有困難靜脈注射問題，常造成護理人員注射壓力，影響立即性治療時效。目的：透過系統性文獻回顧暨統合分析，探討近紅外線設備於輔助兒童周邊靜脈注射之效應。方法：搜尋台灣期刊論文索引、華藝線上圖書館、CINAHL、Cochrane Library、PubMed/MEDLINE、ProQuest資料庫，2017年2月以前之文獻，鍵入「近紅外線」與「周邊靜脈注射」等關鍵字，限制兒童族群，及隨機控制試驗或臨床控制試驗，共12篇文獻符合標準。依據Cochrane偏差風險評估文獻品質，並使用RevMan 5.3.5軟體進行統合分析。結果：近紅外線設備並未顯著改善兒童周邊靜脈注射之第一次注射成功率、注射次數與注射時間。然而，困難靜脈注射因素之次族群分析顯示近紅外線設備可顯著提升評分為困難靜脈注射兒童的第一次注射成功率（OR = 1.83, p = .03）。結論／實務應用：近紅外線設備可幫助健康照護專業人員透視困難靜脈注射兒童的周邊靜脈，提高第一次注射成功率。建議臨床善用困難靜脈注射評估量表，以適當篩選與運用近紅外線設備於困難靜脈注射兒童的周邊靜脈注射。

Background: Peripheral intravenous access is a common and invasive procedure that is performed in pediatric clinical settings. Children often have difficult intravenous-access problems that may not only increase staff stress but also affect the timeliness of immediate treatments. Purpose: To determine the efficacy of near-infrared devices in facilitating peripheral intravenous access in children, using a systematic review and meta-analysis. Methods: Six databases, namely the Index to Taiwan Periodical Literature System, Airiti Library, CINAHL, Cochrane Library, PubMed/MEDLINE, and ProQuest were searched for related articles that were published between the earliest year available and February 2017. The search was limited to studies on populations of children that used either a randomized controlled trial or controlled clinical trial approach and used the key words “near-infrared devices” AND “peripheral intravenous access.” The 12 articles that met these criteria were included in the analysis. The Cochrane Collaboration bias assessment tool was used to assess the methodological quality. In addition, RevMan 5.3.5 software was used to conduct the meta-analysis. Results: The near-infrared devices did not significantly improve the first-attempt success rate, number of attempts, or the procedural time of peripheral intravenous access in children. However, the subgroup analysis of difficult intravenous-access factors revealed a significant improvement in the first-attempt success rate of children with difficult intravenous access scores （OR = 1.83, p = .03）. Conclusions/Implications for Practice: Near-infrared devices may improve the first-attempt success rate in children with difficult intravenous access by allowing healthcare professionals to visualize the peripheral veins. Therefore, we suggest that the difficult intravenous-access score be used as a screening tool to suggest when to apply near-infrared devices to children with difficult peripheral intravenous access in order to maximize efficacy of treatment.