Enfermeria Clinica最新文献_第5页

Gestión del cuidado y mantenimiento de los dispositivos de accesos vasculares: un reto para el cuidado enfermero 血管通路设备的护理管理和维护：对护理的挑战

IF 1.1 Q4 NURSING

Enfermeria Clinica

Pub Date : 2025-07-01 DOI: 10.1016/j.enfcli.2025.502284

Sonia Casanova-Vivas , Pablo López-Guardiola

The use of vascular access devices (VADs) is highly prevalent in patients in the hospital and out-of-hospital settings. Short peripheral venous catheters are the most common used devices. Use of DAVs is not without complications. The literature includes several studies on the prevalence and characteristics of VADs (location, device, fixation, etc.) in hospitalized patients, but few studies have assessed whether the status of this vascular access met the quality standard or not. Quality standards in this care can be obtained by evaluating compliance with the variables that define the adequate care and maintenance of vascular access through observation and daily monitoring of its condition and possible complications. The role of the nurse in this care is fundamental. Evaluating the management and maintenance of VADs to improve the quality of care and patient safety through training and monitoring of good practices for nursing professionals is the objective of the initiative of the nursing research group INCATIV® in the Valencian Community.

The implementation of this study has led to the evolution of the improvement of the results progressively. Ongoing training and monitoring significantly improve the quality and safety of VAD care. The success of the INCATIV® initiative in adult and paediatric populations underscores the importance of standardized practices and the critical role of nurses in the management of VADs.

血管通路装置（vad）的使用在医院和医院外的患者中非常普遍。短外周静脉导管是最常用的设备。使用dav并非没有并发症。文献中有一些关于住院患者vad的患病率和特征（位置、装置、固定等）的研究，但很少有研究评估该血管通路的状态是否符合质量标准。通过观察和日常监测血管通路的状况和可能的并发症，评估是否遵守定义血管通路适当护理和维持的变量，从而获得这种护理的质量标准。护士在这种护理中起着至关重要的作用。评估vad的管理和维护，通过培训和监测护理专业人员的良好做法来提高护理质量和患者安全，这是瓦伦西亚社区护理研究小组INCATIV®的倡议目标。本研究的实施导致了结果的逐步改进。持续的培训和监测显著提高了VAD护理的质量和安全性。INCATIV®倡议在成人和儿科人群中的成功强调了标准化实践的重要性以及护士在vad管理中的关键作用。

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引用次数: 0

Dolor y ansiedad debidos a punción venosa en población adulta 成人静脉穿刺引起的疼痛和焦虑

IF 1.1 Q4 NURSING

Enfermeria Clinica

Pub Date : 2025-07-01 DOI: 10.1016/j.enfcli.2024.07.007

Mario I. Ortiz , Juan de Dios Bautista-Montiel , Héctor Carreto-Díaz , Eduardo Fernández-Martínez , Carlo E. Medina-Solís

Objective

To evaluate anxiety and pain induced by venipuncture and its statistical association with sociodemographic variables and history of previous venipuncture in the adult population.

Method

An observational, cross-sectional, quantitative and analytical study was conducted. A questionnaire was used to collect data on sociodemographic variables and variables related to pain and anxiety induced by venipuncture in the adult population attending a Mexican ambulatory care center. A descriptive and inferential analysis of the variables studied was performed using the IBM program SPSS®.

Results

A total of 2,157 adults participated, of whom 1,464 (67.9%) were men. The mean age (± standard deviation) of the participants was 34.9 (12.7) years. Of the total venipunctures, 1592 (73.8%) were painful and 1,206 (55.9%) were classified as distressing. Age, gender, history of previous venipuncture and venipuncture anxiety were statistically significant risk factors for venipuncture pain. On the other hand, age, venipuncture pain and history of previous venipuncture were risk factors for anxiety during venipuncture.

Conclusions

A high incidence of pain and anxiety due to venipuncture was found, as well as several factors that may increase it in the Mexican adult population. Healthcare professionals should consider pharmacological and non-pharmacological interventions to reduce venipuncture anxiety and pain, which would facilitate patient self-management and outpatient visits for therapeutic, diagnostic, preventive, or rehabilitative care as needed.

目的探讨成人静脉穿刺引起的焦虑和疼痛及其与社会人口学变量和既往静脉穿刺史的统计学关系。方法采用观察性、横断面性、定量分析研究。本研究采用问卷调查的方法收集了在墨西哥一家门诊护理中心就诊的成年患者的社会人口学变量和静脉穿刺引起的疼痛和焦虑相关变量的数据。使用IBM程序SPSS®对所研究的变量进行描述性和推断性分析。结果共调查成人2157人，其中男性1464人，占67.9%。参与者的平均年龄（±标准差）为34.9（12.7）岁。其中疼痛1592例（73.8%），痛苦1206例（55.9%）。年龄、性别、静脉穿刺史和静脉穿刺焦虑是引起静脉穿刺疼痛的有统计学意义的危险因素。另一方面，年龄、静脉穿刺疼痛和既往静脉穿刺史是静脉穿刺时焦虑的危险因素。结论在墨西哥成年人中，静脉穿刺引起的疼痛和焦虑的发生率较高，并有几个因素可能使其增加。医疗保健专业人员应考虑药物和非药物干预，以减少静脉穿刺的焦虑和疼痛，这将促进患者的自我管理和门诊就诊治疗，诊断，预防，或康复护理的需要。

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引用次数: 0

Ensayo clínico: comparación de sistemas presurizados de infusión con suero salino con y sin heparina para el mantenimiento de accesos vasculares en el paciente crítico 临床试验：比较加压盐水输注系统加肝素和不加肝素维持危重病人血管通路

IF 1.1 Q4 NURSING

Enfermeria Clinica

Pub Date : 2025-07-01 DOI: 10.1016/j.enfcli.2024.502187

Mònica Maqueda-Palau , Jaime González-Sánchez

Aim

To evaluate the efficacy of 0.9% saline solution versus heparinized solution for maintaining the patency of intravascular catheters.

Method

Single-center, randomized, controlled, single-blind clinical trial. Population: patients with intravascular arterial and/or central venous catheters. Variables: age, sex, admission diagnosis, catheter type and location, duration of catheter placement, catheter functionality, reason for removal, antiplatelet treatment, Activated Partial Thromboplastin Time (APTT), and International Normalized Ratio (INR) values. Data collection was carried out using an ad hoc questionnaire. SPSS v.26 software was used for statistical analysis, including descriptive analysis (median and IQR), Mann-Whitney U test, variable association (chi-square test), and logistic regression. A p-value <.05 was considered the indicator of a significant difference.

Results

Data were collected from 373 patients, of whom 68,4% were male. Heparin was administered to 202 patients (54,2%) and 0.9% saline to 171 patients (45,8%). A total of 595 catheters were analyzed: 221 (37,1%) arterial catheters, 229 (38,5%) centrally inserted central venous catheters, and 145 (24,4%) peripherally inserted central venous catheters. A total of 51 complications (8,6%) were detected, with a higher incidence in the heparin group (10,4% versus 6,3%). Among all complications, significant differences were observed by catheter type, with an incidence of 11,8% in arterial catheters, compared to 7,4% in centrally inserted central venous catheters and 5,5% in peripherally inserted central venous catheters.

Conclusions

No significant differences were observed in maintaining catheter patency between systems using heparinized pressurization and those using 0.9% saline solution.

目的评价0.9%生理盐水与肝素化溶液维持血管内导管通畅的疗效。方法单中心、随机、对照、单盲临床试验。人群：血管内动脉和/或中心静脉导管患者。变量：年龄、性别、入院诊断、导管类型及位置、置管时间、导管功能、拔除原因、抗血小板治疗、活化部分凝血活素时间（APTT）、国际标准化比值（INR）值。数据收集采用一份特别问卷进行。采用SPSS v.26软件进行统计分析，包括描述性分析（中位数和IQR）、Mann-Whitney U检验、变量关联（卡方检验）和logistic回归。p值<；0.05被认为是显著差异的指标。结果共收集373例患者资料，其中男性68.4%。202例患者给予肝素（54.2%），171例患者给予0.9%生理盐水（45.8%）。共分析595根导管：221根（37.1%）动脉导管，229根（38.5%）中心静脉导管，145根（24.4%）外周中心静脉导管。共发现51例并发症（8.6%），肝素组发生率较高（10.4%比6.3%）。在所有并发症中，导管类型差异有统计学意义，动脉导管的发生率为11.8%，中心静脉导管为7.4%，中心静脉导管为5.5%。结论肝素加压与0.9%生理盐水在维持导管通畅方面无显著差异。

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引用次数: 0

Instrumentos para medir la calidad de vida de los pacientes que portan dispositivos de acceso vascular de inserción periférica: una revisión de alcance 佩戴外周血管通路装置的患者的生活质量测量仪器：范围回顾

IF 1.1 Q4 NURSING

Enfermeria Clinica

Pub Date : 2025-07-01 DOI: 10.1016/j.enfcli.2024.08.005

Saloa Unanue-Arza , Orlaith Hernon , Selene Lurueña-Rodríguez , Caitriona Duggan , Victoria Armenteros-Yeguas , Peter J. Carr

Objective

To identify studies that assess the quality of life of people with a peripheral intravenous catheter (PIVC), a midline catheter (MC) and a peripheral insertion central catheter (PICC).

Method

Using a scoping review design we included studies that reported the quality of life of adult patients with the aforementioned vascular access devices. With a specific keyword search strategy performed in December 2023 we searched, CINAHL, Embase, Cochrane, Scopus and ProQuest databases. There were no restrictions on the date of publication and studies in English, Spanish or Portuguese were included. Following our inclusion an exclusion criteria, extracted findings reported with the patterns, advances, gaps, evidence for practice and research framework.

Results

Of 6317 sources we included 151 papers for full text screening and included 21 studies for data extraction and interpretation. PICCs were the primary catheter reported in seven studies. All remaining studies included more than one device. The most frequently used questionnaire was European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (eight studies) followed by the Short Form Health Survey, the Karnofsky scale, Functional Living Index-Cancer questionnaire, Palliative Care Outcome Scale FACT-B questionnaire. In eight studies a researcher developed without validated questions were used alone or combined with other validated instruments.

Conclusion

There are no validated questionnaires measuring patient quality of life with specifically for three of the most commonly inserted vascular access devices used in healthcare to date. Opportunities exist to develop and validate a patient related and catheter device specific quality of life instrument.

目的评价外周静脉导管（PIVC）、中线导管（MC）和外周插入中心导管（PICC）患者的生活质量。方法采用范围回顾设计，我们纳入了报道使用上述血管通路装置的成年患者生活质量的研究。通过2023年12月执行的特定关键字搜索策略，我们检索了CINAHL， Embase, Cochrane， Scopus和ProQuest数据库。对出版日期没有限制，包括英文、西班牙文或葡萄牙文的研究报告。根据我们的纳入和排除标准，提取的研究结果报告了模式、进展、差距、实践证据和研究框架。结果在6317个来源中，我们纳入了151篇论文进行全文筛选，21篇研究用于数据提取和解释。在7项研究中，PICCs是首选导管。所有剩余的研究都包括不止一种设备。最常用的问卷是欧洲癌症研究和治疗组织生活质量问卷核心30（8项研究），其次是简短健康调查，Karnofsky量表，功能生活指数-癌症问卷，姑息治疗结果量表FACT-B问卷。在8项研究中，研究人员开发的未验证问题单独使用或与其他验证工具结合使用。结论目前还没有有效的问卷来衡量患者的生活质量，特别是针对医疗保健中最常用的三种血管通路插入装置。存在开发和验证与患者相关和导管装置特定的生活质量仪器的机会。

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引用次数: 0

Transición a la práctica. Experiencia de estudiantes de enfermería en el aprendizaje de la venopunción y la canulación intravenosa periférica 过渡到实践。护理专业学生学习静脉穿刺和外周静脉抽吸的经验

IF 1.1 Q4 NURSING

Enfermeria Clinica

Pub Date : 2025-07-01 DOI: 10.1016/j.enfcli.2025.502256

Orlaith Hernon , Edel McSharry , Caitríona Duggan , Iain MacLaren , Peter J. Carr

Objective

This study explores final-year nursing students’ experiences with venepuncture and peripheral intravenous cannulation, focusing on both educational and clinical practice settings.

Methods

This study is qualitative descriptive design. Data were collected from three focus group sessions using a semi-structured interview approach. Interviews were transcribed verbatim, and data analysis was guided by Braun and Clarke's six-step model for thematic analysis.

Results

Eight final-year nursing students participated, with each student attending one focus group session. Data analysis resulted in four main themes 1) Practice, practice, practice 2) Not the way it's done here 3) Luck of the draw and 4) Experiential learning. The results highlight what hindered and helped students learn these skills in both the educational and clinical environment.

Conclusion

Improvements are recommended which can be made to the teaching of nursing students on these skills. The findings of this study can inform educational programmes which incorporate these types of skills.

目的探讨护理专业毕业班学生静脉穿刺和外周静脉置管的经验，从教学和临床两方面进行探讨。方法本研究采用定性描述设计。使用半结构化访谈方法从三个焦点小组会议中收集数据。访谈逐字记录，数据分析以Braun和Clarke的六步主题分析模型为指导。结果8名护理专业毕业班学生参加，每个学生参加一次焦点小组会议。数据分析产生了四个主要主题1)练习，练习，再练习2)不是这里的方式3)运气和4)体验式学习。结果突出了在教育和临床环境中阻碍和帮助学生学习这些技能的因素。结论护生在这些技能的教学中需要改进。这项研究的结果可以为纳入这些技能的教育计划提供信息。

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引用次数: 0

Repensar el mundo del manejo del acceso vascular, poniendo un foco en la colaboración 以合作为重点，重新思考血管获取管理

IF 1.1 Q4 NURSING

Enfermeria Clinica

Pub Date : 2025-07-01 DOI: 10.1016/j.enfcli.2025.502334

Sally M. Havers , Claire M. Rickard

引用次数: 0

Reflexiones y experiencias de la realización de una encuesta europea con relación a las prácticas clínicas sobre dispositivos de acceso vascular para terapia sistémica contra el cáncer 关于全欧洲血管通路癌症治疗装置临床实践调查的反思和经验

IF 1.1 Q4 NURSING

Enfermeria Clinica

Pub Date : 2025-07-01 DOI: 10.1016/j.enfcli.2025.502248

Caitriona Duggan , Martha Killilea , Veronica McInerney , Onagh O’Grady , Jacqueline Daly , Aoife Lowery

Background

Intravenous infusion is the principal way of providing systemic anti-cancer therapy (SACT) for the vast majority of malignant diseases with approximately one million infusions conducted worldwide each day. A recent scoping review discovered a significant deficit in the literature covering clinical aspects of vascular access device (VAD) selection, insertion, and, in particular, training and education. To answer some of these questions, we are conducting a quantitative survey throughout Europe to investigate healthcare professionals’ current practices surrounding vascular access devices used for systemic anti-cancer therapy.

Methods

This methods paper describes the actions that a research team studying vascular access took to carry out a comprehensive survey across Europe. The purpose of this paper is to share some reflections regarding the survey design. It also covers the steps involved in creating a high-quality questionnaire, the extent, quality, and impact of Public Patient Involvement (PPI) in survey design, the methodologies used to measure the questionnaire's face and content validity, and the experiences gained about stakeholder engagement and dissemination.

Conclusion

This paper summarizes some of the findings acquired from integrating and interacting with PPI during different stages of clinical research. It also provides practical tactics for managing a large global team of collaborators, as well as an explanation of the many methodologies used to increase the survey's validity and accuracy.

背景静脉输注是为绝大多数恶性疾病提供全身抗癌治疗（SACT）的主要方式，全世界每天大约进行100万次静脉输注。最近的一项范围审查发现，在涉及血管通路装置（VAD）的选择、插入，特别是培训和教育的临床方面的文献中存在重大缺陷。为了回答其中的一些问题，我们正在整个欧洲进行一项定量调查，调查医疗保健专业人员目前在用于全身抗癌治疗的血管通路装置方面的做法。方法本文描述了一个研究血管通路的研究小组在整个欧洲开展的一项全面调查。本文的目的是分享一些关于调查设计的思考。它还涵盖了创建高质量问卷所涉及的步骤，公众患者参与（PPI）在调查设计中的程度、质量和影响，用于测量问卷外观和内容有效性的方法，以及在利益相关者参与和传播方面获得的经验。结论总结了在不同临床研究阶段与PPI结合及相互作用的一些发现。它还提供了管理大型全球合作者团队的实用策略，以及用于提高调查有效性和准确性的许多方法的解释。

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引用次数: 0

CuidaVen®, una app para el cuidado de las personas con accesos vasculares. Proyecto de innovación en cuidados CuidaVen®，一款护理血管通路患者的应用程序。护理创新项目

IF 1.1 Q4 NURSING

Enfermeria Clinica

Pub Date : 2025-07-01 DOI: 10.1016/j.enfcli.2025.502297

Jesús Bujalance-Hoyos , Margarita Enríquez de Luna-Rodríguez , Ana Carmen González-Escobosa , Ana María Oña-González , María José Fernández Álvarez , Raquel López Suárez

Venous catheters are the most common invasive devices used in hospitals. There are multiple complications associated with its use, such as phlebitis and bacteremia, with clinical variability in care and poor patient involvement in their own self-care being the main reasons that justify these complications.

Clinical apps, as innovation tools, can be a tool that helps professionals access reliable information for care and patients in their own self-care. CuidaVen® is an app designed specifically to improve adherence to best practices in the care of people with venous catheters, and to increase health education and involvement of patients in their own clinical safety and self-care. The implementation of CuidaVen® has led to an improvement in nurses’ adherence to good practices, a decrease in complications associated with the use of venous devices and an increase in patient knowledge through NOC indicators.

静脉导管是医院中最常用的侵入性设备。与使用该药相关的多种并发症，如静脉炎和菌血症，临床护理的差异和患者自我护理的不良参与是导致这些并发症的主要原因。临床应用程序作为创新工具，可以帮助专业人员获得可靠的护理信息，也可以帮助患者进行自我护理。CuidaVen®是一款专门设计的应用程序，旨在提高对静脉导管患者护理的最佳实践的依从性，并增加健康教育和患者参与自己的临床安全和自我护理。CuidaVen®的实施提高了护士对良好做法的依从性，减少了与静脉装置使用相关的并发症，并通过NOC指标增加了患者的知识。

引用次数: 0

La ciencia de la implementación: potencial transformador para el avance de las enfermeras en el cuidado del acceso vascular 实施科学：护士在血管通路护理方面的变革潜力

IF 1.1 Q4 NURSING

Enfermeria Clinica

Pub Date : 2025-07-01 DOI: 10.1016/j.enfcli.2025.502306

Enrique Castro-Sánchez , Ismael Fernández-Fernández , Ian Blanco-Mavillard

This special article addresses the complexity of vascular access care and explores how implementation science can act as a catalyst to optimize vascular nursing practice. Although vascular access care is crucial, its quality is often unsatisfactory due to the diversity of procedures, technologies, and the need to adapt to each patient. Despite numerous improvement interventions, high complication rates and suboptimal use of these vascular devices persist.

Implementation science can be a crucial strategy to overcome these identified challenges, recognizing the behaviors of healthcare professionals, especially nurses, and their relevance to ensure quality care within the local and organizational context. In this sense, it is challenging to integrate implementation science into the nursing practice of vascular care, such as resistance to change and resource constraints, but it also offers opportunities for innovation and interdisciplinary collaboration. We suggest reevaluating specialized nursing roles to focus on implementation of interventions and optimizing care decisions related to vascular access. This integration requires the development of new competencies and an understanding of the organizational context, key elements to ensure the sustainability and effectiveness of interventions.

这篇特别的文章解决了血管通路护理的复杂性，并探讨了如何实施科学可以作为催化剂，以优化血管护理实践。虽然血管通路护理是至关重要的，其质量往往是不令人满意的，由于多样性的程序，技术，并需要适应每个病人。尽管有许多改善措施，这些血管装置的高并发症发生率和不理想的使用仍然存在。实施科学可以成为克服这些已确定挑战的关键策略，认识到医疗保健专业人员，特别是护士的行为，以及它们在当地和组织环境中确保高质量护理的相关性。从这个意义上说，将实施科学整合到血管护理的护理实践中是具有挑战性的，例如抗拒变革和资源限制，但它也为创新和跨学科合作提供了机会。我们建议重新评估专业护理角色，重点关注干预措施的实施和优化与血管通路相关的护理决策。这种整合需要发展新的能力和对组织环境的理解，这是确保干预措施的可持续性和有效性的关键要素。

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引用次数: 0

Equipos de infusión y acceso vascular como estrategia para afrontar los desafíos futuros de la terapia intravenosa 输液设备和血管通路作为应对未来静脉注射治疗挑战的战略

IF 1.1 Q4 NURSING

Enfermeria Clinica

Pub Date : 2025-07-01 DOI: 10.1016/j.enfcli.2025.502217

Miguel Ángel Rodríguez-Calero , Peter J. Carr , Paulo Santos-Costa , Ian Blanco-Mavillard

This special article addresses a highly relevant issue in healthcare, where the demand for care and attention has significantly increased, coinciding with a progressively aging population and the prevalence of multiple chronic conditions. These factors pose considerable challenges for contemporary healthcare systems. Vascular access devices, including peripheral intravenous catheters, are widely utilized for intravenous therapy in hospitals; however, they are associated with risks and complications. Nearly 50% of these catheters are removed in an unplanned manner, which exacerbates the problem of catheter-associated bloodstream infections, leading to serious consequences such as increased mortality and higher hospital costs.

Despite the interventions proposed by governmental organizations aimed at reducing these complications and enhancing healthcare quality, achieving this goal requires comprehensive knowledge and resources. This includes the use of various lancing devices and technologies, highlighting the imperative need for coordinated and collaborative actions by multidisciplinary teams. Moreover, the importance of professional specialization is crucial for transforming work dynamics into effective collaborative practices. In this context, Vascular Access Specialist Teams (VAST) have the potential to improve patient health, alleviate the discomfort associated with catheterization, and enhance patient satisfaction. They present a promising solution for optimizing the delivery of intravenous therapy and future challenges in this field.

这篇特别的文章讨论了医疗保健中一个高度相关的问题，在这个问题上，对护理和关注的需求显著增加，同时人口逐渐老龄化，多种慢性疾病普遍存在。这些因素对当代医疗保健系统构成了相当大的挑战。血管通路装置，包括外周静脉导管，在医院广泛用于静脉治疗；然而，它们与风险和并发症有关。近50%的导管是在意外情况下拔除的，这加剧了导管相关血流感染的问题，导致死亡率增加和医院费用增加等严重后果。尽管政府组织提出了旨在减少这些并发症和提高医疗保健质量的干预措施，但实现这一目标需要全面的知识和资源。这包括使用各种医疗设备和技术，强调了多学科团队采取协调和合作行动的迫切需要。此外，专业专业化的重要性对于将工作动态转化为有效的协作实践至关重要。在这种情况下，血管准入专家小组（VAST）有可能改善患者的健康，减轻导管插入术相关的不适，并提高患者满意度。他们提出了一个有希望的解决方案，以优化静脉注射治疗的交付和未来的挑战，在这一领域。

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引用次数: 0