背景:血管通路装置的最佳选择基于多种因素,并且是减少血管通路装置相关并发症的第一策略。这一过程取决于行为和人为因素。COM-B(Capability,机会,动机,行为)模型被用作理论框架来组织本次系统综述的发现。
■为了综合决定血管通路装置最佳选择的决定因素的证据,以COM-B行为模型为理论框架。
方法:在选择血管通路装置时探索决策的研究的系统评价。
方法:Medline,WebofScience,对Scopus和EbscoHost数据库进行了询问,以提取截至2021年12月31日用英语或西班牙语出版的手稿。
结果:在纳入综述的16项研究中,8/16(50%)专注于身体能力,8/16(50%)心理能力,15/16(94%)物理机会,12/16(75%)社交机会,1/16(6%)的反思性动机和0/16(0%)的自动动机。这种分布在人际和动机影响以及文化和社会环境方面存在很大差距。专家团队(为血管通路装置的插入或维护而创建的团队)是血管通路装置最佳选择的核心(75%的物理能力,62%的心理能力,80%的身体机会和100%的社交机会)。
结论:专家团队主要领导为血管通路装置的最佳选择采取的所有行动。这些行动主要集中在评估机会和能力,经常忽视动机影响和社会环境。
■更注重实施的专业方法可以减少患者之间的不平等和与血管通路装置相关的并发症。
结论:血管通路装置的最佳选择是减轻与这些装置相关的并发症的主要策略。人际和动机影响与文化和社会环境之间存在显着差异。此外,专业团队在促进血管通路装置的最佳选择方面发挥着关键作用。该研究可以使关注血管通路装置及其并发症的机构受益。
■本评论遵循系统评论和荟萃分析(PRISMA)指南的首选报告项目。
■没有患者或公共捐款。这篇文章对更广泛的全球临床社区有什么贡献?:血管装置的最佳选择仍然是一个日益增长但尚未解决的问题,具有昂贵的临床和患者体验影响。改善血管装置最佳选择的干预措施集中在培训上,教育,血管专科团队的算法和实现;唉,这些方法似乎没有实质性地解决这个问题。专业血管团队应发展并转向领导实施质量改进干预措施,优化资源使用,增强其作用。
BACKGROUND: Optimal selection of vascular access devices is based on multiple factors and is the first strategy to reduce vascular access device-related complications. This process is dependent on behavioural and human factors. The COM-B (Capability, Opportunity, Motivation, Behaviour) model was used as a theoretical framework to organize the findings of this systematic review.
UNASSIGNED: To synthesize the evidence on determinants shaping the optimal selection of vascular access devices, using the COM-B behavioural model as the theoretical framework.
METHODS: Systematic review of studies which explore decision-making at the time of selecting vascular access devices.
METHODS: The Medline, Web of Science, Scopus and EbscoHost databases were interrogated to extract manuscripts published up to 31 December 2021, in English or Spanish.
RESULTS: Among 16 studies included in the review, 8/16 (50%) focused on physical capability, 8/16 (50%) psychological capability, 15/16 (94%) physical opportunity, 12/16 (75%) social opportunity, 1/16 (6%) reflective motivation and 0/16 (0%) automatic motivation. This distribution represents a large gap in terms of interpersonal and motivational influences and cultural and social environments. Specialist teams (teams created for the insertion or maintenance of vascular access devices) are core for the optimal selection of vascular access devices (75% physical capability, 62% psychological capability, 80% physical opportunity and 100% social opportunity).
CONCLUSIONS: Specialist teams predominantly lead all actions undertaken towards the optimal selection of vascular access devices. These actions primarily centre on assessing opportunity and capability, often overlooking motivational influences and social environments.
UNASSIGNED: A more implementation-focused professional approach could decrease inequity among patients and complications associated with vascular access devices.
CONCLUSIONS: Optimal selection of vascular access devices is the primary strategy in mitigating complications associated with these devices. There is a significant disparity between interpersonal and motivational influences and the cultural and social environments. Furthermore, specialized teams play a pivotal role in facilitating the optimal selection of vascular access devices. The study can benefit institutions concerned about vascular access devices and their complications.
UNASSIGNED: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
UNASSIGNED: No Patient or Public Contribution. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Optimal selection of vascular devices remains a growing yet unresolved issue with costly clinical and patient experience impact. Interventions to improve the optimal selection of vascular devices have focused on training, education, algorithms and implementation of specialist vascular teams; alas, these approaches do not seem to have substantially addressed the problem. Specialist vascular teams should evolve and pivot towards leading the implementation of quality improvement interventions, optimizing resource use and enhancing their role.