Enfermeria clinica (English Edition)最新文献_第7页

Patients’ experiences in ultrasound-guided intravenous catheter insertion: A qualitative study 超声引导下患者静脉置管经验的定性研究。

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.2025.102149

Renz Rivera , Steve He , Craig McManus , Nicholas Mifflin , Ton Tran , Lorenza Harrowell , Karla Kuzmins , John Rihari-Thomas , Peta Drury , Steven A. Frost , Evan Alexandrou

Background

Peripheral intravenous catheter (PIVC) insertion is the most performed invasive procedure in healthcare. However, it often presents challenges in patients with non-visible or non-palpable veins, leading to unsuccessful cannulation attempts and associated complications. Ultrasound-guided PIVC insertion is a promising solution for patients with difficult venous access (DIVA). However, there remains a gap in the literature regarding patient experiences with this technique.

Aim

This study aimed to describe the characteristics and experiences of patients referred to a specialised DIVA team for ultrasound-guided PIVC insertion and compare their experiences with previous traditional cannulation.

Method

A qualitative study was conducted at an Australian 980-bed metropolitan tertiary referral centre. Thirteen patients were recruited through purposive sampling and interviewed post-ultrasound-guided cannulation. Data collection was conducted using one-on-one interviews followed by thematic analysis.

Results

The study identified three major themes: the improved patient experience resulting from the expertise of the DIVA team with ultrasound cannulation; the impact of limited equipment and trained personnel on patient experience and outcomes; and the significance of acknowledging patients’ prior cannulation experiences. Participants reported a stark contrast in their experiences between ultrasound-guided and traditional cannulation, with the former significantly reducing physical discomfort, stress and anxiety and improving success rates.

Conclusions

Ultrasound-guided PIVC insertion by trained clinicians significantly enhances the experience for patients with DIVA. However, challenges remain, including the availability of equipment and trained staff. The study highlights the need for policy changes and training in ultrasound-guided cannulation to improve patient care and outcomes. Future research should focus on broader and more diverse populations to validate these findings.

背景：外周静脉导管（PIVC）的插入是医疗保健中最常见的侵入性手术。然而，对于静脉不可见或摸不到的患者，它往往会带来挑战，导致插管失败和相关并发症。超声引导的PIVC插入是静脉通道困难（DiVA）患者的一种很有前途的解决方案。然而，关于这种技术的患者经验，文献中仍然存在空白。目的：本研究旨在描述转介到DiVA专业团队进行超声引导PIVC插入的患者的特征和经验，并将他们的经验与以前的传统插管进行比较。方法：在澳大利亚980个床位的大城市三级转诊中心进行定性研究。通过目的抽样和超声引导插管后访谈的方法招募13例患者。数据收集采用一对一访谈，然后进行专题分析。结果：研究确定了三个主要主题：DiVA团队在超声插管方面的专业知识改善了患者的体验；有限的设备和训练有素的人员对患者体验和结果的影响；以及承认患者先前插管经验的重要性。参与者报告了超声引导和传统插管之间的鲜明对比，前者显著减少了身体不适、压力和焦虑，提高了成功率。结论：经过培训的临床医生在超声引导下进行PIVC插入可显著提高DiVA患者的体验。然而，挑战仍然存在，包括缺乏设备和训练有素的工作人员。该研究强调了超声引导插管的政策变化和培训的必要性，以改善患者的护理和结果。未来的研究应该集中在更广泛和更多样化的人群上，以验证这些发现。

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引用次数: 0

Transition to practice: Student nurses’ experience of venepuncture and peripheral intravenous cannulation learning 向实践的过渡：实习护士静脉穿刺及外周静脉置管的学习体会。

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.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：本研究从教学和临床两方面探讨护生在静脉穿刺和外周静脉置管方面的经验。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可有所改进。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

Vessel health and preservation: Vascular access key risk considerations 血管健康和保存：血管通路的关键风险考虑因素。

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.2025.502302

Nancy Moureau

Vascular access is the most common invasive procedure in hospitalized patients, with over 90% requiring intravenous therapy. Despite its routine nature, improper selection and management of acceso vascular devices (VADs) can lead to complications such as infections, thrombosis, and device failure. Preserving the integrity of the vascular system is essential for ensuring safe and effective treatment delivery across healthcare settings.

This paper describes the key principles of the Vessel Health and Preservation (VHP) model, highlighting its implementation as a structured, evidence-based clinical pathway for optimizing vascular access outcomes, preserving vascular integrity, and reducing complications. It also outlines a stepwise approach to vascular access planning, device selection, management, and escalation based on patient-specific factors and risk profiles.

The VHP model is structured around four main stages: assessment and device selection, insertion, management, and outcome evaluation. Key findings and recommendations include early device planning within 24 h of admission and placement within 48 h, daily reassessment to align access with evolving treatment needs, use of clinical pathways to guide device selection based on diagnosis, therapy type, and duration, emphasis on minimizing the number of device lumens, choosing the least invasive device, and using vascular access teams for assessment and the identification of high-risk patients requiring specialty placement and escalation to interventional radiology or surgical teams.

Implementing a VHP program across institutions requires leadership support, interprofessional education, and integration into electronic health records. Adopting this proactive model improves first-attempt insertion success, reduces delays in therapy, and lowers complication rates. In complex cases, timely advancement to specialty placement ensures continued vascular health while maintaining access to essential treatments.

血管通路是住院患者中最常见的侵入性手术，90%以上需要静脉注射治疗。尽管其常规性质，不适当的选择和管理的辅助血管装置（vad）可导致并发症，如感染，血栓形成，和设备失效。保持血管系统的完整性对于确保整个医疗机构安全有效地提供治疗至关重要。本文描述了血管健康与保存（VHP）模型的关键原则，强调了其作为优化血管通路结果、保持血管完整性和减少并发症的结构化、循证临床途径的实施。它还概述了基于患者特定因素和风险概况的血管通路规划、设备选择、管理和升级的逐步方法。VHP模型围绕四个主要阶段构建：评估和设备选择、插入、管理和结果评估。主要发现和建议包括入院24小时内的早期设备规划和48小时内的放置，每日重新评估以使获取与不断变化的治疗需求保持一致，根据诊断、治疗类型和持续时间使用临床路径来指导设备选择，强调尽量减少设备流明的数量，选择侵入性最小的设备。并使用血管准入小组进行评估和识别需要专科安置和升级到介入放射学或外科小组的高风险患者。跨机构实施VHP计划需要领导支持、跨专业教育和集成到电子健康记录中。采用这种主动模式提高了首次尝试插入的成功率，减少了治疗延误，降低了并发症发生率。在复杂的情况下，及时推进到专业安置，确保持续的血管健康，同时保持获得必要的治疗。

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引用次数: 0

CUIDAVEN®, an app for the care of people with vascular access. A care innovation project CUIDAVEN，这是一款用于治疗血管疾病的应用。一个护理创新项目。

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.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

Rethinking the world of vascular access management with a focus on collaboration 重新思考以协作为重点的血管通路管理世界

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.2025.502334

Sally M. Havers , Claire M. Rickard

引用次数: 0

GloVANet and WoCoVA: Platforms that integrate evidence and practice in vascular access GloVANet和WoCoVA：整合血管通路证据和实践的平台。

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.2025.502166

Gloria Ortiz Miluy , Timothy Spencer

Vascular access globally has experienced exponential development in recent years in all aspects. The speed with which these advances have become part of clinical practice recommendations requires quick and easy communication between professionals, accessibility to impact scientific publications, updating of procedural protocols and the implementation of new models of care to guarantee the quality of health care. In a world full of social, economic and demographic challenges, initiatives that promote the integration of scientific evidence into clinical practice in a standardised manner are essential. Under this premise, the Global Vascular Access Network (GloVANet), together with the World Congress on Vascular Access (WoCoVA) seeks to establish a platform for the dissemination of knowledge, training and research in vascular access, while formalising the role of professionals specialised in this field.

近年来，全球血管通路在各个方面都经历了指数级的发展。这些进展迅速成为临床实践建议的一部分，需要专业人员之间快速方便的沟通，获得有影响力的科学出版物，更新程序协议和实施新的护理模式，以保证保健质量。在一个充满社会、经济和人口挑战的世界中，促进以标准化方式将科学证据纳入临床实践的举措至关重要。在此前提下，全球血管通路网络（GloVANet）与世界血管通路大会（WoCoVA）寻求建立一个传播血管通路知识、培训和研究的平台，同时使该领域专业人员的作用正规化。

引用次数: 0

Management of the care and maintenance of vascular access devices: A challenge for nursing care 血管通路装置的护理和维护管理：对护理的挑战。

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.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 (CVPCs) 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（CVPCs）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

Pain and anxiety due to venipuncture in the adult population 成人静脉穿刺引起的疼痛和焦虑。

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.2025.102143

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

Aim

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

2157 adults participated, of whom 1464 (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 1206 (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：评价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联。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：2157名成年人参与调查，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很高，并且有几个因素可能会增加这种发生率。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

Reflections and experiences in conducting a European survey in relation to clinician practices with vascular access devices for systemic anti-cancer therapy 在欧洲进行一项关于血管通路装置用于全身抗癌治疗的临床医生实践的调查的反思和经验。

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.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 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欧洲进行全面调查所采取的行动。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：本文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

Infusion sets and vascular access as a strategy to address future challenges in intravenous therapy 输液器和血管通路作为解决未来静脉治疗挑战的策略。

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.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, Infusion and Vascular Access Devices (IVADs) 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 addressing 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，输注和血管通路装置（IVADs）有可能改善患者的健康，减轻与导尿相关的不适，并提高患者的满意度。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解决未来在这一领域的挑战。

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引用次数: 0