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热点丨静脉注射感染风险的最新研究
检索：刘金淑 翻译：周超群 审核: 刘金淑、陈志锦 静脉注射感染风险的最新研究 美国每年需要进行医疗干预的成年人约2亿人次，通过手臂静脉注射输送生命所必需的液体、营养和药品。这些外周静脉导管在患者的治疗中起着至关重要的作用，但是一小部分患者会因此继发严重的血流感染。一名罗德岛医生对外周静脉导管引发的血流感染及需采取的最佳预防措施的最新研究正引起人们的关注。 传染病医师、罗德岛州生命健康系统研究员、骨科医学博士Leonard Mermel称：外周静脉注射器是“医疗机构中最常用的医疗器械”，它们却可能“在美国每年造成数千例血液感染”。 Mermel最近对许多有关外周静脉导管感染的研究进行了系统评价。他了解到过去几十年来，人们的注意力一直集中在中心静脉导管(中心导管)的风险上，中心静脉导管通常注射患者的颈部或胸部，将药物输送到心脏附近的静脉。对于这类感染，当前美国和其他许多国家都在进行密切监测。 但是Mermel认为，更需要从现有研究中收集外周静脉注射的风险数据，这些外周静脉注射通常注射手臂皮肤表面的静脉中。他发现，在美国每年成人患者植入的大约2亿个外周静脉导管中，血流感染的发生率约为0.18 %，即每注射1000个外周静脉导管出现近2例这样的感染病例。因此他表示：“有可能许多患者因使用这些装置而发生血流感染，即败血症”。 Mermel发现，虽然中心导管感染的风险是外周导管的2到64倍。不过，美国每年购买的外周静脉注射器达到3.3亿个，尽管其中五分之一的注射失败，需要连续尝试，但实际使用的外周静脉注射器的数目仍然发人深省。 他希望他的研究在2017年8月9日的《临床传染病》发表的研究报告能提高人们对这一问题的认识，并能鼓励医疗机构采取措施更好地监测和预防这种感染。 Mermel总结道：“希望发表文章中提供的数据终将成为唤醒呼吁，促使国家和国际多方努力，旨在实施已知的预防策略，以降低未来患者的血流感染风险，并减少注射和留置外周静脉导管的操作变动性”。 Mermel建议医疗机构： · 更换在紧急情况下注射的外周静脉注射器。 · 力求限制成年患者外周静脉留置时间不超过三至四天。 · 对外周静脉注射部位进行日常检查。 · 评估继续留置导管的必要性，及时拔除闲置导管。 来源: 罗德岛州医院 原文: New Research on IV Infection Risk Each year, about 200 million adults needingmedical intervention in the United States have an IV inserted into their arm todeliver vital fluids, nutrients and medicines. These peripheral intravenouscatheters play a critical role in a patient's care, but a small percentage ofpatients can acquire serious bloodstream infections. New research by a RhodeIsland physician is putting a spotlight on such complications as well as theneed to follow best practice for prevention. Peripheral IVs "are some of the mostcommonly utilized medical devices in healthcare settings" and they couldbe responsible for "several thousand bloodstream infections each year inthe United States," said Leonard Mermel, DO, an infectious diseasephysician and researcher with the Lifespan health system in Rhode Island. Mermel recently conducted a systematicreview of numerous studies on infections relating to peripheral intravenouscatheters. He knew that a great deal of attention hasbeen focused over the past couple of decades on the risks of central venouscatheters (central lines), which are typically inserted into the neck or chestof a patient to deliver medicine into a vein near the heart. Infections fromthese are now monitored closely in the United States and many other countries. But Mermel thought more needed to begleaned from existing research on the risks of peripheral IVs, which areinserted into a vein near the surface of the skin, typically in the arm.Hefound that of the approximately 200 million peripheral venous cathetersinserted into adult patients in the United States every year, the incidence ofbloodstream infection is about 0.18 percent (i.e., close to two such infectionsfor every 1,000 of these catheters inserted).As a result, he said, "Thereare likely many patients who develop bloodstream infections (i.e. bloodpoisoning) from these devices."Mermel found that the risk of infectionfrom central lines is 2 to 64 times greater than for peripheral catheters.Still, with 330 million peripheral IVs purchased in the United States each year– and one-fifth of their insertions failing and requiring successive attempts –the numbers are still sobering. He hopes that his study, published August9, 2017 online ahead of print in Clinical Infectious Diseases, will raiseawareness of the problem and encourage medical institutions to take steps to bettermonitor and prevent such infections. "It is hoped that the data presentedin the published article will serve as a wake-up call leading to national andinternational efforts aimed at implementing preventive strategies known toreduce such risk in future patients and to reduce the variability of practiceregarding insertion and maintenance of peripheralIVs," Mermel concluded. Mermel suggests that medical institutions: • Replace peripheral IVs inserted underemergent conditions • Strive to limit how long peripheral IVsremain inserted to no more than three to four days in adult patients • Conduct daily inspections of the IVinsertion site • Justify continued need for catheterizationand to remove idle catheters Source: Rhode Island Hospital
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发表于 2017-11-6 08:24:37
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