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【更换外周中心静脉导管可仅根据临床指征】9月22日《柳叶刀》：一项澳大利亚随机对照等效性试验显示，仅根据临床指征更换外周中心静脉导管，与每3天一次常规更换的效果相当。前者将减少导管使用数量、节省医疗费用、减轻患者不适，并降低医务人员的工作量。http://t.cn/zlLcsMm
This article can be found in the following collection:
Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trialOriginal Text
Prof Claire M Rickard PhD a b c f , Prof Joan Webster BA a b c, Prof Marianne C Wallis PhD a b g, Nicole Marsh BN a b c, Matthew R McGrail PhD e, Venessa French RN f, Lynelle Foster MN g, Peter Gallagher MBA f, John R Gowardman FCICM/FRACP a d, Li Zhang PhD a, Alice McClymont RN c, Prof Michael Whitby PhD a f
SummaryBackgroundThe millions of peripheral intravenous catheters used each year are recommended for 72—96 h replacement in adults. This routine replacement increases health-care costs and staff workload and requires patients to undergo repeated invasive procedures. The effectiveness of the practice is not well established. Our hypothesis was that clinically indicated catheter replacement is of equal benefit to routine replacement.
MethodsThis multicentre, randomised, non-blinded equivalence trial recruited adults (≥18 years) with an intravenous catheter of expected use longer than 4 days from three hospitals in Queensland, Australia, between May 20, 2008, and Sept 9, 2009. Computer-generated random assignment (1:1 ratio, no blocking, stratified by hospital, concealed before allocation) was to clinically indicated replacement, or third daily routine replacement. Patients, clinical staff, and research nurses could not be masked after treatment allocation because of the nature of the intervention. The primary outcome was phlebitis during catheterisation or within 48 h after removal. The equivalence margin was set at 3%. Primary analysis was by intention to treat. Secondary endpoints were catheter-related bloodstream and local infections, all bloodstream infections, catheter tip colonisation, infusion failure, catheter numbers used, therapy duration, mortality, and costs. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12608000445370.
FindingsAll 3283 patients randomised (5907 catheters) were included in our analysis (1593 clinically indicated; 1690 routine replacement). Mean dwell time for catheters in situ on day 3 was 99 h (SD 54) when replaced as clinically indicated and 70 h (13) when routinely replaced. Phlebitis occurred in 114 of 1593 (7%) patients in the clinically indicated group and in 114 of 1690 (7%) patients in the routine replacement group, an absolute risk difference of 0·41% (95% CI −1·33 to 2·15%), which was within the prespecified 3% equivalence margin. No serious adverse events related to study interventions occurred.
InterpretationPeripheral intravenous catheters can be removed as clinically indicated; this policy will avoid millions of catheter insertions, associated discomfort, and substantial costs in both equipment and staff workload. Ongoing close monitoring should continue with timely treatment cessation and prompt removal for complications.
FundingAustralian National Health and Medical Research Council.
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发表于 2012-9-25 10:21
发表于 2012-9-25 10:38
