背景:在规定的静脉治疗完成之前,全球每年约有10亿个外周静脉导管(PIVC)失效,导致可避免的并发症,不满,可避免成本飙升至40亿欧元。我们旨在就减少PIVC失败的临床实践指南建议的相关性和可行性提供国际共识。
方法:e-Delphi研究通过2020年3月至9月的在线问卷调查进行了三轮,招募了由临床医生组成的多专业小组,经理,学术研究人员,以及来自七个发达国家和三个发展中国家的执行专家,反思PIVC护理经验和实施证据。Further,我们在插入中包括了一组以前有经验的慢性病患者,维护,以及爱尔兰和西班牙作为公众和患者参与(PPI)小组的PIVC和静脉治疗的管理。所有专家和患者在4分Likert量表上对每个项目进行评分,以评估相关性和可行性。我们考虑了一致描述符,其中中位数为4,四分位数间隔小于或等于1.5。
结果:超过90%的参与者(16位专家)完成了所有回合的问卷,100%的PPI(5位患者)由于达成了很高的共识而完成了第1回合。我们的德尔菲方法包括49个描述符,这导致在六个领域中达成一致的30个来自(i)一般无菌和皮肤防腐(n=4),(ii)导管充足性和插入(n=3),(iii)导管和导管部位护理(n=6),(iv)导管移除和更换策略(n=4),(v)导管管理的一般原则(n=10),和(六)组织环境(n=3)。
结论:我们为PIVC提供了相关建议的国际共识,认为在临床环境中实施是可行的。此外,这种方法学方法包括临床专家的大量代表,学术专家,耐心和公共专业知识,减轻实施过程中的不确定性,并提供高价值建议,以防止基于上下文和个人特征的PIVC故障,全球经济资源。
BACKGROUND: Around 1 billion peripheral intravenous catheters (PIVC) fail annually worldwide before prescribed intravenous therapy is completed, resulting in avoidable complications, dissatisfaction, and avoidable costs surging to ∼€4bn. We aimed to provide an international
consensus on relevance and feasibility of clinical practice
guideline recommendations to reduce PIVC failure.
METHODS: e-Delphi study with three rounds through an online questionnaire from March-September 2020 recruiting a multispecialty panel formed by clinicians, managers, academic researchers, and experts in implementation from seven developed and three developing countries, reflecting on experience in PIVC care and implementation of evidence. Further, we included a panel of chronic patients with previous experience in the insert, maintenance, and management of PIVC and intravenous therapy from Ireland and Spain as public and patient involvement (PPI) panel. All experts and patients scored each item on a 4-point Likert scale to assess the relevance and feasibility. We considered
consensus descriptor in which the median was 4 with less than or equal to 1,5 interquartile intervals.
RESULTS: Over 90% participants (16 experts) completed the questionnaire on all rounds and 100% PPI (5 patients) completed round 1 due to high
consensus they achieved. Our Delphi approach included 49 descriptors, which resulted in an agreed 30 across six domains emerged from the related to (i) general asepsis and cutaneous antisepsis (n = 4), (ii) catheter adequacy and insertion (n = 3), (iii) catheter and catheter site care (n = 6), (iv) catheter removal and replacement strategies (n = 4), (v) general principles for catheter management (n = 10), and (vi) organisational environment (n = 3).
CONCLUSIONS: We provide an international
consensus of relevant recommendations for PIVC, deemed feasible to implement in clinical settings. In addition, this methodological approach included substantial representation from clinical experts, academic experts, patient and public expertise, mitigating uncertainty during the implementation process with high-value recommendations to prevent PIVC failure based contextual and individual features, and economic resources worldwide.