题名

超音波導引周邊靜脈注射之效應-系統性文獻回顧暨統合分析

并列篇名

Efficacy of Ultrasound-Guided Peripheral Intravenous Access: A Systematic Review and Meta-Analysis

DOI

10.6224/JN.63.6.89

作者

郭嘉琪(Chia-Chi Kuo);吳貞鋆(Chen-Yun Wu);馮已榕(I-Jung Feng);李維鈞(Wei-Jing Lee)

关键词

超音波導引 ; 周邊靜脈注射 ; 困難靜脈注射 ; 注射時間 ; ultrasound guide ; peripheral intravenous access ; difficult venous access ; procedure time

期刊名称

護理雜誌

卷期/出版年月

63卷6期(2016 / 12 / 01)

页次

89 - 101

内容语文

繁體中文

中文摘要

背景 周邊靜脈注射是臨床普遍的侵入性處置,當遭遇困難靜脈注射(以下簡稱困難靜注)問題時,將危及病人安全,增加護理人員壓力,耗用護理時數與衛材費用。目的 透過系統性文獻回顧暨統合分析,探討超音波導引於困難周邊靜脈注射病人之效應,及其在兒童與成人次族群的效應。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六個中英文資料庫,2016年4月以前之文獻,鍵入「超音波導引」與「周邊靜脈注射」等關鍵字,限制隨機控制試驗與臨床控制試驗的研究設計,共12篇文獻符合標準。依據Joanna BriggsInstitute嚴格評讀查核表,做研究方法之品質評估,並使用RevMan 5.3軟體進行統合分析。結果 超音波導引技術可顯著提升困難靜注病人的注射成功率(OR = 3.00, p < .0001)與減少注射次數(MD= -0.61, p = .03);次族群分析顯示,其可顯著提高困難靜注成人的注射成功率與減少注射次數,及顯著減少困難靜注兒童的注射時間。結論/實務應用 超音波導引技術可幫助健康照護專業人員透視周邊靜脈,提高靜脈注射成效。建議臨床可考量病人特性、超音波可近性、人員訓練可行性,適當運用超音波於提升周邊靜脈注射成效。

英文摘要

Background: Peripheral intravenous access is a common, invasive procedure that is performed in clinical practice. Difficult intravenous access may not only jeopardize patient safety but also increase staff stress, nursing hours, and material costs. Purpose: To explore the efficacy of ultrasound-guided peripheral intravenous access in difficult intravenous-access patients and in the two subgroups of adult patients and pediatric patients using systematic review and meta-analysis. Methods: Six Chinese and English databases, including 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 April 2016. The search was limited to studies that used randomized control trials (RCTs) or controlled clinical trials (CCTs) and the associated key words "ultrasound-guided" AND "peripheral intravenous access". The 12 articles that met these criteria were used in the analysis. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to assess methodological quality and RevMan 5.3 software was used to conduct the meta-analysis. Results: The ultrasound-guided technique was found to improve the success rate of intravenous access significantly (OR = 3.00, p < .0001) and to decrease the number of attempts (MD = -0.61, p = .03) in the overall group of difficult intravenous-access patients. The subgroup analysis found a significantly improved success rate and decreased number of attempts in difficult intravenous-access adult patients and significantly decreased procedural times in difficult intravenous-access pediatric patients. Conclusions / Implications for Practice: The ultrasound-guided technique may improve the efficacy of intravenous access by helping health care professionals visualize the peripheral veins. We suggest that patient characteristics, ultrasound accessibility, and the feasibility of staff training be assessed in order to provide ultrasound guidance that improves the efficacy of intravenous access.

主题分类 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
参考文献
  1. Hwu, Y. J.,Lin, F. Y.(2014).Effectiveness of propolis on oral health: A meta-analysis.The Journal of Nursing Research,22(4),221-230.
    連結:
  2. The Cochrane Collaboration. (2011). The Cochrane Collaboration's tool for assessing risk of bias. Retrieved from http://handbook.cochrane.org/chapter_8/8_5_the_cochrane_collaborations_tool_for_assessing_risk_of_bias.htm
  3. Aponte, H.,Acosta, S.,Rigamonti, D.,Sylvia, B.,Austin, P.,Samolitis, T.(2007).The use of ultrasound for placement of intravenous catheters.Journal of the American Association of Nurse Anesthetists,75(3),212-216.
  4. Avelar, A. F.,Peterlini, M. A.,da Pedreira, M. L.(2013).Assertiveness and peripheral intravenous catheters dwell time with ultrasonography-guided insertion in children and adolescents.Revista da Escola de Enfermagem da USP,47(3),539-546.
  5. Bair, A. E.,Rose, J. S.,Vance, C. W.,Andrada-Brown, E.,Kuppermann, N.(2008).Ultrasound-assisted peripheral venous access in young children: A randomized controlled trial and pilot feasibility study.The Western Journal of Emergency Medicine,9(4),219-224.
  6. Bauman, M.,Braude, D.,Crandall, C.(2009).Ultrasound-guidance vs. standard technique in difficult vascular access patients by ED technicians.The American Journal of Emergency Medicine,27(2),135-140.
  7. Benkhadra, M.,Collignon, M.,Fournel, I.,Oeuvrard, C.,Rollin, P.,Perrin, M.,Girard, C.(2012).Ultrasound guidance allows faster peripheral IV cannulation in children under 3 years of age with difficult venous access: A prospective randomized study.Pediatric Anesthesia,22(5),449-454.
  8. Costantino, T. G.,Parikh, A. K.,Satz, W. A.,Fojtik, J. P.(2005).Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access.Annals of Emergency Medicine,46(5),456-461.
  9. Curtis, S. J.,Craig, W. R.,Logue, E.,Vandermeer, B.,Hanson, A.,Klassen, T.(2015).Ultrasound or near-infrared vascular imaging to guide peripheral intravenous catheterization in children: A pragmatic randomized controlled trial.Canadian Medical Association Journal,187(8),563-570.
  10. Doniger, S. J.,Ishimine, P.,Fox, J. C.,Kanegaye, J. T.(2009).Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients.Pediatric Emergency Care,25(3),154-159.
  11. Egan, G.,Healy, D.,O'Neill, H.,Clarke-Moloney, M.,Grace, P. A.,Walsh, S. R.(2013).Ultrasound guidance for difficult peripheral venous access: Systematic review and meta-analysis.Emergency Medicine Journal,30(7),521-526.
  12. Fields, J. M.,Piela, N. E.,Au, A. K.,Ku, B. S.(2014).Risk factors associated with difficult venous access in adult ED patients.The American Journal of Emergency Medicine,32(10),1179-1182.
  13. Heinrichs, J.,Fritze, Z.,Vandermeer, B.,Klassen, T.,Curtis, S.(2013).Ultrasonographically guided peripheral intravenous cannulation of children and adults: A systematic review and meta-analysis.Annals of Emergency Medicine,61(4),444-454.
  14. Higgins, J. P.,Thompson, S. G.,Deeks, J. J.,Altman, D. G.(2003).Measuring inconsistency in meta-analyses.British Medical Journal,327(7414),557-560.
  15. İsmailoğlu, E. G.,Zaybak, A.,Akarca, F. K.,Kıyan, S.(2015).The effect of the use of ultrasound in the success of peripheral venous catheterisation.International Emergency Nursing,23(2),89-93.
  16. Joanna Briggs Institute(2014).Joanna Briggs Institute reviewers' manual: 2014 edition.
  17. Johns, C. M.,Sumkin, J. H.(1991).US-guided venipuncture for venography in the edematous leg.Radiology,180(2),573.
  18. Kerforne, T.,Petitpas, F.,Frasca, D.,Goudet, V.,Robert, R.,Mimoz, O.(2012).Ultrasound-guided peripheral venousaccess in severely ill patients with suspected difficult vascular puncture.Chest,141(1),279-280.
  19. Laksonen, R. P. Jr.,Gasiewicz, N. K.(2015).Implementing a program for ultrasound-guided peripheral venous access: Training, policy and procedure development, protocol use, competency, and skill tracking.Nursing Clinics of North America,50(4),771-785.
  20. Lamperti, M.,Bodenham, A. R.,Pittiruti, M.,Blaivas, M.,Augoustides, J. G.,Elbarbary, M.,Verghese, S. T.(2012).International evidence-based recommendations on ultrasound-guided vascular access.Intensive Care Medicine,38(7),1105-1117.
  21. Liu, Y. T.,Alsaawi, A.,Bjornsson, H. M.(2014).Ultrasound-guided peripheral venous access: A systematic review of randomized-controlled trials.European Journal of Emergency Medicine,21(1),18-23.
  22. Pappas, N. L.,Michaud, T. E.,Wolbers, R. M.,Steward, J. C.,Fevurly, T. A.,Samolitis, T. J.,Watts, D. D.(2006).Ultrasound guidance as a rescue technique for peripheral intravenous cannulation.AANA Journal: Journal of the American Association of Nurse Anesthetists,74(6),464-464.
  23. Sebbane, M.,Claret, P. G.,Lefebvre, S.,Mercier, G.,Rubenovitch, J.,Jreige, R.,de La Coussaye, J. E.(2013).Predicting peripheral venous access difficulty in the emergency department using body mass index and a clinical evaluation of venous accessibility.The Journal of Emergency Medicine,44(2),299-305.
  24. Stein, J.,George, B.,River, G.,Hebig, A.,McDermott, D.(2009).Ultrasonographically guided peripheral intravenous cannulation in emergency department patients with difficult intravenous access: A randomized trial.Annals of Emergency Medicine,54(1),33-40.
  25. Stolz, L. A.,Stolz, U.,Howe, C.,Farrell, I. J.,Adhikari, S.(2015).Ultrasound-guided peripheral venous access: A meta-analysis and systematic review.The Journal of Vascular Access,16(4),321-326.
  26. Weiner, S. G.,Sarff, A. R.,Esener, D. E.,Shroff, S. D.,Budhram, G. R.,Switkowski, K. M.,Darvish, A. H.(2013).Single-operator ultrasound-guided intravenous line placement by emergency nurses reduces the need for physician intervention in patients with difficult-to-establish intravenous access.The Journal of Emergency Medicine,44(3),653-660.
  27. Witting, M. D.,Schenkel, S. M.,Lawner, B. J.,Euerle, B. D.(2010).Effects of vein width and depth on ultrasound-guided peripheral intravenous success rates.The Journal of Emergency Medicine,39(1),70-75.
  28. 莊其穆(2011)。臨床醫師如何閱讀統合分析(Meta-analysis)的論文。臺灣醫界,54(12),74-82。
  29. 黃如萍、葉美玲(2011)。統合分析的出版誤差。源遠護理,5(2),51-55。
被引用次数
  1. 方景林,方莉,方淑慧(2020)。以系統性文獻回顧及統合分析法探討運動對於老人憂鬱的療效。台灣公共衛生雜誌,39(3),278-291。
  2. 方景林,方莉,方淑慧(2023)。以系統性文獻回顧及統合分析法探討芳香療法對於緩解護理人員工作壓力的效果。台灣公共衛生雜誌,42(4),409-422。
  3. 馮已榕、郭嘉琪、李維鈞(2017)。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。護理雜誌,64(5),69-80。
  4. 郭嘉琪,唐心如,王維那(2019)。實證知識轉譯經驗分享:以周邊靜脈導管重置為例。源遠護理,13(3),18-23。
  5. (2023)。POCUS—急診專科護理師臨床照護、評估與輔助鑑別診斷的新利器。台灣專科護理師學刊,10(2),16-24。