摘要
目的 检索、评价和整合血液透析导管血栓预防的最佳证据,为血液透析患者导管血栓预防提供循证依据.方法 系统检索国际指南协作网、苏格兰学院间指南网络、美国国立指南库、加拿大安大略注册护士协会、英国国家卫生与临床优化研究所、UpToDate、BMJ Best Practice、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、欧洲肾脏学会、美国肾脏病基金会、英国肾脏病协会、加拿大肾脏病学会、日本透析治疗学会、医脉通、Cochrane Library、PubMed、Embase、中国知网、维普数据库、万方数据库、中国生物医学文献数据库中关于血液透析导管血栓预防的相关研究,包括指南、临床决策、证据总结、系统评价和专家共识等.检索时限为建库至2023年3月31日.由研究者分别进行质量评价,根据主题对证据进行提取和汇总.结果 共纳入16篇文献,包括临床决策5篇、临床指南4篇、证据总结2篇、专家共识5篇,最终形成15条最佳证据,包括透析导管留置、抗凝策略、冲封管技术、日常管理4个主题.结论 护理人员应结合临床情境选择血液透析导管血栓预防的最佳证据,降低导管血栓的发生,延长导管使用寿命,改善患者结局.
Abstract
Objective To retrieve,evaluate,and integrate the best evidence for prevention of hemodialysis catheter thrombosis,so as to provide evidence-based basis for catheter thrombosis prevention in hemodialysis patients.Methods Guidelines,clinical decisions,evidence summaries,systematic reviews,and expert consensus on the prevention of hemodialysis catheter thrombosis were systematically searched on Guidelines International Network,Scottish Intercollegiate Guidelines Network,Agency for Healthcare Research and Quality,Registered Nurses'Association of Ontario,National Institute for Health and Clinical Excellence,UpToDate,British Medical Journal(BMJ)Best Practice,Joanna Briggs Institute Evidence-Based Health Care Center Database,European Renal Association,National Kidney Foundation,UK Kidney Association,Canadian Society of Nephrology,Japanese Society for Dialysis Therapy,Medlive,Cochrane Library,PubMed,Embase,China National Knowledge Infrastructure,VIP,and Wanfang Data and Chinese Biomedical Database.The search period was from database establishment to March 31,2023.Investigators conducted quality evaluations separately and extracted and summarized evidence based on the theme.Results A total of 16 articles were included,including five clinical decisions,four guidelines,two evidence summaries,and five expert consensuses.Finally,15 best pieces of evidence were formed,including four themes of indwelling dialysis catheters,anticoagulation strategies,flushing and sealing techniques,and daily management.Conclusions Nursing staff should choose the best evidence for preventing thrombosis in hemodialysis catheters based on clinical situations,reduce the occurrence of catheter thrombosis,extend the usage time of catheters,and improve patient outcomes.
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