改變週邊靜脈導管留置天數是否會增加靜脈炎之風險

The Effect of Duration of Peripheral Intravenous Catheter(PIC) Placement on Peripheral Thrombophlebitis

留置週邊靜脈導管是住院病人常見的侵入性治療，但最常見之併發症為靜脈炎。本文旨在依據實證研究結果，驗證於台灣住院外科病人之適用性，目的在於建立一個協助病人週邊靜脈導管留置時間可依據臨床表徵更換之適切性，故採前瞻性研究設計，自收案對象放置導管起，每班追蹤注射部位情形至移除導管止。本文應用實證資料庫進行檢索查詢成人之週邊靜脈導管依臨床表徵更換，對靜脈炎發生率及留置時間之影響並檢視臨床應用之成效。從8個資料庫中搜尋系統性回顧之統合分析文獻兩篇，並以CASP十項評析文章、CEBM證據等級去研究品質及GRADE證據品質去評析證據強度。本文收案場所為北區某區域醫院，並採信封抽籤之簡單隨機取樣方式收案，於2014/1/1至2014/4/30共收案58人，對象為住院中有注射週邊靜脈導管的外科病人，實驗組為依臨床表徵更換導管、控制組為依常規每72小時更換導管。基於有效暨安全性的考量下，採Lundgren & Wahren （1999）靜脈炎評估表，利用Stomaguide - Coloplast評估工具來監測注射部位。本案之靜脈炎發生率實驗組6.7％ （n=2） 、控制組17.9％ （n=5），P=0.205；留置時間以實驗組109.4小時、控制組66小時，P=0.000；實驗組比控制組平均延長留置43.4小時，結果發現依臨床表徵更換導管不會增加靜脈炎的發生率。

Peripheral intravenous catheter (PIC) insertion is an often performed invasive procedure in hospitals. Peripheral catheter thrombophlebitis is a common complication secondary to PIC insertion. This article is an evidence-based study to verify the appropriate use of PIC for the surgical patients in Taiwan, with an intention to establish a guideline or appropriate PIC replacement based on clinical exhibitions. Through systematic review of literature, two articles were searched from eight databases. They were examined and evaluated with the CASP systematic review appraisal tool, the CEBM level of evidence system, and the GRADE Working Group. A prospective study design was conducted in the general surgical unit of a regional hospital in Northern Taiwan. 58 subjects with PIC insertion were assigned to either the experimental group or the control groups by random drawing from January 1 to April 30, 2014. The PIC in the experimental group was replaced according to clinical exhibitions, and the PIC in the controlled group was replaced every 72 hours routinely. Considering the research’s effectiveness and safety, Lundgren & Wahren (1999) thrombophlebitis scale and Stomaguide-Coloplast assessment tool were adopted to monitor insertion sites. The results showed that the incidence rate of thrombophlebitis was 6.7%(n=2) in the experimental group and 17.9%(n=5) in the control group with a p value of 0.205, which indicated no significant change. However, the duration of placement was 109.4 hours in the experimental group and 66 hours in the control group. A 43.4 hour variance with p=0.0000 between the two groups was significantly different statistically. In conclusion, PIC replacement based on clinical exhibition will not increase the incidence rate of thrombophlebitis.