Enfermeria clinica (English Edition)最新文献_第9页

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

Analysis of risk factors associated with phlebitis in peripheral venous catheters. Zero Phlebitis Project 外周静脉置管引起静脉炎的危险因素分析。零静脉炎项目。

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.2025.502298

Marta Ferraz-Torres , Maria Elena Sancho-Sena , Amaya Eguillor de la Torre , Laura Cambra Vidart , Maria Belén Suarez-Mier , Maria Ines Corcuera-Martinez

Introduction

It is necessary to know the rate of phlebitis associated with its use and the risk factors associated with peripheral vascular catheter management that directly influence the presence of phlebitis.

Methodology

observational descriptive study, carried out after the implementation of the Zero Phlebitis Project in a large-capacity (>1,000 beds) urban tertiary hospital of reference in Navarra. The implementation of the Zero Phlebitis Project was carried out progressively, incorporating 4 units (2 medical and 2 surgical) per year, ending in February 2023. Subsequently, data collection for the present study began in May 2023.

Results

687 catheters were included, 48.3% (332) catheters were implanted in men versus 51.7% (355) in women with a mean age of 68 (SD 18.64). A phlebitis rate of 11.93% was detected, with catheter caliber and insertion site factors being directly related to the presence of phlebitis.

Conclusions

The presence of phlebitis is marked by both modifiable factors, being recommended the use of small caliber devices and the forearm area the indicated ones to decrease the rate of phlebitis.

导读：有必要了解与静脉炎的使用相关的发生率，以及与周围血管导管管理相关的直接影响静脉炎存在的危险因素。方法：观察性描述性研究，在纳瓦拉市一家大容量（1000张床位）城市三级参考医院实施零静脉炎项目后进行。零静脉炎项目逐步实施，每年纳入4个单位（2个医疗单位和2个外科单位），到2023年2月结束。随后，本研究的数据收集于2023年5月开始。结果：共纳入687根导管，男性置入48.3%（332根），女性置入51.7%（355根），平均年龄68岁（SD 18.64）。静脉炎检出率为11.93%，导管口径、插入部位等因素与静脉炎的发生有直接关系。结论：静脉炎的存在具有两种可改变的因素，建议使用小口径装置，前臂区域是静脉炎的适应症。

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引用次数: 0

Quality of life instruments for patients with peripherally inserted vascular access devices: A scoping review 外周插入式血管通路装置患者的生活质量工具：范围综述。

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.2025.102145

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：确定评估外周静脉导管（PIVC）、中线导管（MC）和外周插入中心导管（PICC）患者生活质量的研究。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篇论文用于全文筛选，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：迄今为止，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

Clinical trial: Comparison of pressurized infusion saline systems with and without heparin for the maintenance of vascular access in critically ill patients 临床试验：比较加压输注生理盐水系统（含肝素和不含肝素）在维持重症患者血管通路方面的作用。

Enfermeria clinica (English Edition)

Pub Date : 2025-06-01 DOI: 10.1016/j.enfcle.2025.502187

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 < 0.05 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：比较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为差异显著性指标。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：在维持导管通畅方面，使用肝素加压和使用0.9%生理盐水没有显著差异。

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引用次数: 0

Implementation sciences: Transformative potential for the advancement of nurses in vascular access care 实施科学：血管通路护理护士进步的变革潜力。

Enfermeria clinica (English Edition)

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

Quality of life and emotional state of patients who are candidates for CAR-T therapy: Role of the advanced practice nurse CAR-T治疗候选者的生活质量和情绪状态：高级实习护士的作用。

Enfermeria clinica (English Edition)

Pub Date : 2025-04-01 DOI: 10.1016/j.enfcle.2025.502188

Mercedes Montoro-Lorite , Gloria García , Cristina Moreno-García , Ariadna Domènech , Pilar Ayora , Carla Ramos

Introduction

CAR-T therapy is indicated in patients with refractory disease who usually present comorbidities, toxicities associated with previous treatments, and disease instability. Additionally, they must travel close to the infusion center, incurring financial and psychosocial costs. Our study aims to describe the quality of life and psycho-emotional state of candidates for CAR-T therapy.

Methods

An observational study was conducted from January to December 2022. The inclusion criteria were being 18 years or older, eligible for CAR-T therapy, and able to understand Spanish. Sociodemographic, clinical variables and Hospital Anxiety and Depression and quality of life scales were collected.

Results

One hundred and four participants were recruited, among them, seventy percent did not live in their usual residence. Seventy-five percent of the participants had depression, 76% anxiety, and 78% emotional function impairment. No statistically significant differences between the presence of anxiety/depression associated with not residing in their usual address (p 0.056) or receiving psychological care in their center of origin (p 0.583) were found. However, a correlation between the presence of anxiety/depression among participants referred to the psychology service by the Advanced Practice Nurse (APN) (p < 0.001) was found.

Conclusions

In conclusion, assessing the quality of life and psycho-emotional state of candidates for CAR-T therapy with validated scales allows us to identify candidates presenting anxiety and depression with the goal of improving the management of their emotional health. The APN's role is crucial in detecting complications and facilitating early referral to the psychology team.

CAR-T疗法适用于难治性疾病患者，这些患者通常存在合并症、与既往治疗相关的毒性和疾病不稳定性。此外，他们必须靠近输液中心，从而产生经济和社会心理成本。我们的研究旨在描述CAR-T治疗候选者的生活质量和心理情绪状态。方法：于2022年1月至12月进行观察性研究。纳入标准为18岁或以上，有资格接受CAR-T治疗，并能理解西班牙语。收集社会人口学、临床变量和医院焦虑、抑郁和生活质量量表。结果：招募了104名参与者，其中70%的人不住在他们的常住住所。75%的参与者患有抑郁症，76%的参与者患有焦虑症，78%的参与者患有情绪功能障碍。与不常住地相关的焦虑/抑郁（p 0.056）或在原籍中心接受心理治疗（p 0.583）的存在无统计学意义差异。然而，由高级执业护士（APN）提供心理服务的参与者之间存在焦虑/抑郁之间的相关性(p)结论：总之，用有效的量表评估CAR-T治疗候选人的生活质量和心理情绪状态，使我们能够识别出现焦虑和抑郁的候选人，以改善他们的情绪健康管理。APN的作用是发现并发症和促进早期转介到心理小组至关重要。

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引用次数: 0

Reproducibility of the TRIPED-GM paediatric triage system TRIPED-GM儿科分诊系统的可重复性。

Enfermeria clinica (English Edition)

Pub Date : 2025-04-01 DOI: 10.1016/j.enfcle.2025.502191

M. Concepción Míguez-Navarro , Gloria Guerrero-Márquez , Carmen Ignacio Cerro

Introduction

The triage system aims to determine the level of urgency of patients in order to provide appropriate care and reduce morbidity and mortality. It is essential that the system used is valid, reliable and easy to use. The TRIPED-GM system is a five-level classification system exclusively for pediatric age, which includes six steps, three of which are mandatory (PAT, guiding sign/symptom, and priority rectifiers).

Objective

To determine the reproducibility of the TRIPED-GM system when used on patients evaluated consecutively by 2 nurses.

Method

Observational, descriptive, cross-sectional study involving 237 patients under 16 years of age who attended a third-level pediatric emergency service. Reliability was measured using Kappa (κ), linear Kappa (κp), and quadratic Kappa (κp²) indices, which compared the priority assigned by two research nurses and sixteen paediatric emergency nurses with over a year of experience in triage. Patients were classified consecutively and blindly.

Results

There was agreement in 221 (93.2%) patients. The overall concordance was: κ = 0.84 (95% CI 0.77−0.91), κp = 0.85 (95% CI 0.78−0.92), κp² = 0.85 (95% CI 0.78−0.92). There were no differences in the assignment of more than one priority level in any patient. Concordance in the mandatory steps was: Pediatric Assessment Triangle: κ = 0.82 (95% CI 0.68−0.96), Main reason for consultation: κ = 0.76 (95% CI 0.62−0.89), Rectifiers: κ = 0.94 (95% CI 0.88−1). Concordance was higher in patients who consulted for illness compared to those for trauma/accidents: κ = 0.84 (95% CI 0.76−0.92) vs. κ = 0.79 (95% CI 0.57–1).

Conclusion

The TRIPED-GM pediatric triage system is reliable for use in emergency services with patients of similar characteristics.

导读：分诊系统旨在确定患者的紧急程度，以便提供适当的护理，降低发病率和死亡率。系统的有效性、可靠性和易用性是至关重要的。TRIPED-GM系统是一个专门针对儿童年龄的五级分类系统，包括六个步骤，其中三个是强制性的（PAT，指导性体征/症状和优先纠正）。目的：探讨TRIPED-GM系统在两名护士连续评价患者时的可重复性。方法：观察性、描述性、横断面研究，纳入237例16岁以下的三级儿科急诊患者。信度采用Kappa (K)、线性Kappa （KP）和二次Kappa （Kp2）指数进行测量，这些指数比较了两名研究护士和16名具有一年以上分诊经验的儿科急诊护士分配的优先级。患者按顺序盲目分类。结果：221例（93.2%）患者的结论一致。总体一致性为：K = 0.84 (95% CI 0.77-0.91), KP = 0.85 (95% CI 0.78-0.92), Kp2 = 0.85 （95% CI 0.78-0.92）。在任何患者中，分配一个以上的优先级没有差异。强制性步骤的一致性为：儿科评估三角：K = 0.82 (95% CI 0.68-0.96)，主要咨询原因：K = 0.76 (95% CI 0.62-0.89)，纠正措施：K = 0.94 （95% CI 0.88-1）。与创伤/事故患者相比，疾病患者的一致性更高：K = 0.84 (95% CI 0.76-0.92) vs. K = 0.79 （95% CI 0.57-1）。结论：TRIPED-GM儿科分诊系统在具有相似特征的患者急诊服务中是可靠的。

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引用次数: 0

Sleep quality in patients admitted to an intermediate care unit 中级护理病房病人的睡眠质量。

Enfermeria clinica (English Edition)

Pub Date : 2025-04-01 DOI: 10.1016/j.enfcle.2025.102157

Paula Itxaso Sirera-Pérez , Adriana Martín-Sanjoaquín , Beatriz Juandeaburre-Pedroarena , Itziar Luquin-Iturmendi , Rosana Goñi-Viguria

Introduction

Patients admitted to critical care units (ICU) are subject to develop sleep disturbances, caused by multiple factors that are present in this type of units.

Objetive

Describe patients' perceptions of night rest, to relate them to sociodemographic variables, and determine factors that interfere with their sleep quality.

Methodology

Descriptive, prospective, observational study in an ICU of a tertiary level university hospital. Sleep perception was assessed with the five-item Richards-Campbell Sleep Questionnaire (RCSQ). Sociodemographic and clinical variables were collected. A self-developed questionnaire with 9 questions addressing the main factors mentioned in the literature that influence sleep was utilized. Descriptive and inferential statistics were performed, being considered statistically significant p < ,05.

Results

The sleep of 75 patients was studied, for 146 nights.

The sleep perception was rated as fair, with moderate ease in falling asleep, average awakenings, and moderate ease in returning to sleep. The mean RCSQ score was 60.22 (SD: 24.81).

It was observed that concern (p < .001), noise (p = .016), pain (p = .008), discomfort (p = .001), ambient light (p = .026), and the presence of nearby patients (p = .027) significantly influenced in the sleep.

Conclusions

Patients’ perception of night sleep was fair. Keeping patients informed, minimizing ambient light and noise, optimizing analgesic guidelines, and promoting a comfortable position could facilitate night rest.

入住重症监护病房（ICU）的患者容易出现睡眠障碍，这是由多种因素引起的，这些因素存在于这类病房中。目的：描述患者对夜间休息的感知，将其与社会人口学变量联系起来，并确定干扰其睡眠质量的因素。方法：在某三级大学医院ICU进行描述性、前瞻性、观察性研究。睡眠感知通过五项理查兹-坎贝尔睡眠问卷（RCSQ）进行评估。收集社会人口学和临床变量。使用了一份自行开发的问卷，其中包含9个问题，解决了文献中提到的影响睡眠的主要因素。结果：对75例患者进行了为期146晚的睡眠研究。睡眠感知被评为公平，入睡适度，醒来平均，恢复睡眠适度。RCSQ平均评分为60.22 （SD: 24.81）。结论：患者对夜间睡眠的感知一般。让患者了解情况，减少环境光和噪音，优化镇痛指南，促进舒适的体位可以促进夜间休息。

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引用次数: 0

Comparison of content validity indices for clinical nursing research: A practical case 临床护理研究内容效度指标的比较：一个实际案例。

Enfermeria clinica (English Edition)

Pub Date : 2025-04-01 DOI: 10.1016/j.enfcle.2025.502214

Paulina Hurtado-Arenas , Miguel R. Guevara , Víctor M. González-Chordá

Objective

To compare techniques to analyze the content validity of measurement instruments applicable to nursing care research through a practical case.

Method

Secondary study derived from validating the Hospital Survey on Patient Safety (HSOPS) in a Chilean hospital. The study setting was hospital care, with a population focused on nursing staff and a sample of 12 expert nurses who are teachers or have clinical experience in quality and patient safety. Design and content validity test based on three phases: identification of primary methods, calculation of methods, comparison of similarities and differences of methods.

Results

Lawsche, Tristan-López, Lynn, Polit et al. methods are similar. The modified kappa value is similar to the content validity index (I-CVI) value, with a slight variation when penalizing the value by probability according to chance. There are significant differences between all methods and Hernández Nieto’s content validity coefficient (CVC).

Conclusions

The Polit et al. method is more rigorous, and its mathematical formulation is better justified, providing solidity to clinical nursing research. Furthermore, the Hernandez-Nieto method is suggested when validating more than one characteristic.

目的：通过一个实际案例，比较分析适用于护理研究的测量工具的内容效度。方法：二级研究来源于对智利一家医院患者安全调查（hsop）的验证。研究环境是医院护理，人口集中在护理人员和12名专家护士，他们是教师或在质量和患者安全方面有临床经验。设计和内容效度检验基于三个阶段：确定主要方法、计算方法、比较方法的异同点。结果：Lawsche， Tristan-López, Lynn， Polit等方法相似。修正后的kappa值与内容效度指数（I-CVI）值相似，但在根据偶然性对该值进行概率惩罚时略有变化。各方法与Hernández涅托内容效度系数（CVC）差异显著。结论：Polit等方法更为严谨，其数学公式更合理，为临床护理研究提供了坚实依据。此外，在验证多个特征时，建议使用Hernandez-Nieto方法。

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引用次数: 0

Political participation of occupational health nurses: A necessity? 职业卫生护士的政治参与：必要吗？

Enfermeria clinica (English Edition)

Pub Date : 2025-04-01 DOI: 10.1016/j.enfcle.2025.502213

Javier González-Caballero

引用次数: 0