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Elective replacement of peripheral intravenous cannulas in neonates.

新生儿外周静脉插管的选择性置换。

  • 影响因子:1.12
  • DOI:10.1177/1129729820927235
  • 作者列表:"Liew DD","Zhou L","Chin LY","Davies-Tuck M","Malhotra A
  • 发表时间:2021-01-01
Abstract

BACKGROUND:Newborns admitted to neonatal units often require vascular access. Peripheral intravenous cannulas allow essential medication, fluids, and/or parenteral nutrition to be delivered. Peripheral intravenous cannulas are often associated with complications, such as extravasation, infiltration, phlebitis, leakage, spontaneous dislodgement, and catheter-associated blood stream infection. METHODS:A secondary analysis of a randomized controlled trial evaluating standard replacement versus elective replacement (72-96 h) of peripheral intravenous cannula was conducted in a tertiary-level neonatal unit in Melbourne, Australia. The main outcome of this analysis was to assess the risk of combined adverse events associated with elective replacement of peripheral intravenous cannula. A cost analysis of the intervention was also conducted. RESULTS:Combined adverse outcomes noted per infant were 48 (87.27%) in the standard replacement group versus 44 (75.86%) in the elective replacement group (RR 0.87; 95% CI 0.71-1.04, p = 0.15). In terms of combined adverse outcome per 1000 intravenous hours, there was a significant risk ratio of 0.81 in the elective group compared with the standard group (95% CI 0.65-0.98, p = 0.04). Gestation (adjusted odds ratio (AOR) 0.58; 95% CI 0.35-0.96, p = 0.03), male gender (AOR 4.65; 95% CI 1.07-20.28, p = 0.04), elective replacement (AOR 0.12; 95% CI 0.03-0.68, p = 0.01), and the total number of re-sites (AOR 27.84; 95% CI 4.61-168.18, p < 0.001) were significant risk factors associated with adverse events. There were also significantly higher costs involved with elective replacement. CONCLUSION:Elective replacement of peripheral intravenous cannulas was not shown to reduce the risk of combined adverse events. Elective peripheral intravenous cannula replacement also incurred a higher cost.

摘要

背景: 新生儿科收治的新生儿通常需要血管通路。外周静脉插管允许递送必需的药物、液体和/或肠外营养。外周静脉插管常常伴有并发症,如外渗、浸润、静脉炎、渗漏、自发脱落和导管相关血流感染。 方法: 在澳大利亚墨尔本的三级新生儿病房中进行了一项随机对照试验的二次分析,评估了外周静脉插管的标准置换与选择性置换 (72-96 h)。该分析的主要结果是评估与选择性更换外周静脉插管相关的合并不良事件的风险。还进行了干预的成本分析。 结果: 在标准替代组中,每个婴儿的综合不良结局为48例 (87.27%),而在选择性替代组中为44例 (75.86%) (RR 0.87; 95% CI 0.71-1.04,p = 0.15)。就每1000小时静脉内联合不良结局而言,与标准组相比,选择性组的显著风险比为0.81 (95% CI 0.65-0.98,p = 0.04)。妊娠 (校正比值比 (AOR) 0.58; 95% CI 0.35-0.96,p = 0.03),男性 (AOR 4.65; 95% CI 1.07-20.28,p = 0.04),选择性替代 (AOR 0.12; 95% CI 0.03-0.68,p = 0.01),和re-site的总数 (AOR 27.84; 95% CI 4.61-168.18,p <0.001) 为与不良事件相关的显著危险因素。选择性替代也有显著较高的费用。 结论: 选择性更换外周静脉插管未显示可降低合并不良事件的风险。选择性外周静脉插管替换术也招致较高的费用。

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