连续性肾脏替代治疗患者中心静脉导管相关血栓预防的最佳证据总结

doi:10.3761/j.issn.2096-7446.2024.05.015

Abstract

Abstract: Objective To retrieve,evaluate,and integrate the best evidence for the prevention and management of central venous catheter-related thrombosis（CRT） in patients with continuous renal replacement therapy（CRRT）. Methods We searched BMJ Best Practice,UpToDate and Cochrane Library,Australian Joanna Briggs Institute Evidence-Based Health Care Center database,International Guide Network,UK Institute for Health and Care Excellence,Scottish Interuniversity Guide Network,American Kidney Disease Foundation and other professional related websites,PubMed,Embase,CNKI,Wanfang Database,China Biology Medicine disc,Medlive to collect clinical decisions,guidelines,best practices,expert consensus,systematic review,summary of evidence,and original research related to central venous CRT prevention in CRRT patients. The retrieval period was from the establishment of the database to March 2023. Literature selection,quality evaluation and data extraction were conducted by two members of the evidence-based team. Results A total of 12 literatures were included,including 3 clinical decisions,4 guidelines,2 systematic reviews and 3 expert consensuses. 27 best pieces of best evidence were summarized in 8 aspects,including assessment,cannulation and extubation,catheter type,vascular access monitoring methods,tube sealing,anticoagulants,thrombolysis,training and management. Conclusion In the clinical prevention practice of central venous CRT for CRRT patients,ICU medical staff should carefully select the best evidence to enhance treatment efficacy and safety based on the specific clinical context and the patient‘s wishes,so as to maximize the benefits of patients.

Key words: Continuous Renal Replacement Therapy, Catheter-Related Thrombosis, Prevention, Evidence Summary, Evidence-Based Nursing

LI Lili, HUA Jiali, ZHANG Xinyin, DONG Yongze, SONG Yuying, CHEN Juanying, YAO Huiping. Summary of the best evidence for the prevention and management of central venous catheter-related thrombosis in patients undergoing continuous renal replacement therapy[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(5): 466-473.

References

[1] Neyra JA,Tolwani A.CRRT prescription and delivery of dose[J]. Semin Dial,2021,34(6):432-439.
[2] Gautam SC,Lim J,Jaar BG.Complications associated with con-tinuous RRT[J]. Kidney360,2022,3(11):1980-1990.
[3] Takashima M,Schults J,Mihala G,et al.Complication and fai-lures of central vascular access device in adult critical care settings[J]. Crit Care Med,2018,46(12):1998-2009.
[4] Timsit JF,Rupp M,Bouza E,et al.A state of the art review on optimal practices to prevent,recognize,and manage complications associated with intravascular devices in the critically ill[J]. Intensive Care Med,2018,44(6):742-759.
[5] Xia R,Sun X,Bai X,et al.Efficacy and safety of ultrasound-guided cannulation via the right brachiocephalic vein in adult patients[J]. Medicine (Baltimore),2018,97(50):e13661.
[6] 徐波,耿翠芝. 肿瘤治疗血管通道安全指南[M]. 中国协和医科大学出版社,2015.
Xu B,Geng CZ.Guidelines for vascular access safety in tumor treatment[M]. Chinese Union Medical University Press,2015.
[7] Chen P,Zhu BQ,Wan GM,et al.The incidence of asympto-matic thrombosis related to peripherally inserted central catheter in adults:a systematic review and meta-analysis People's[J]. Nurs Open,2021,8(5):2249-2261.
[8] 王玲. 连续性肾脏替代治疗患者导管相关性血栓形成风险评估模型的初步构建[D]. 吉首:吉首大学,2022.
Wang L.Preliminary construction of risk assessment model for catheter-related thrombosis in patients undergoing continuous renal replacement therapy[D]. Jishou:Jishou University,2022.
[9] Debourdeau P,Lamblin A,Debourdeau T,et al.Venous throm-boembolism associated with central venous catheters in pa-tients with cancer:from pathophysiology to thromboprophylaxis,areas for future studies[J]. J Thromb Haemost,2021,19(11):2659-2673.
[10] Dicenso A,Bayley L,Haynes RB.Accessing pre-appraised evi-dence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs,2009,12(4):99-101.
[11] The AGREE Reporting Checklist:a tool to improve reporting of clinical practice guidelines[J]. BMJ,2016,354:i4852.
[12] Brouwers MC,Lavis JN,Spithoff K,et al.Assessment of health systems guidance using the Appraisal of Guidelines for Re-search and Evaluation-Health Systems(AGREE-HS) instru-ment[J]. Health Policy,2019,123(7):646-651.
[13] Foster MJ,Shurtz S.Making the Critical Appraisal for Sum-maries of Evidence(CASE) for evidence-based medicine(EBM):critical appraisal of summaries of evidence[J]. J Med Libr Assoc,2013,101(3):192-198.
[14] Joanna Briggs Institute. Critical appraisal tools[EB/OL].(2022-11-18)[2023-01-02]. https://jbi.global/critical-appraisal-tools.
[15] 国家卫生健康委员会. 血液净化标准操作规程(2021版)[EB/OL].(2021-11-09)[2023-01-02]. https://guide.medlive.cn/gui-deline/.
National Health Committee. Blood purification standard opera-ting procedures(2021 edition)[EB/OL].(2021-11-09)[2022-01-02]. https://guide.medlive.cn/guideline/.
[16] Cheng YL,Tang HL,Tong MKL.Clinical practice guidelines for the provision of renal service in Hong Kong:Haemo-dialysis[J]. Nephrology(Carlton),2019,24(Suppl 1):41-59.
[17] Ibeas J,Roca-Tey R,Vallespín J,et al.Spanish clinical guide-lines on vascular access for haemodialysis[J]. Nefrologia,2017, 37(Suppl 1):1-191.
[18] Gallieni M,Hollenbeck M,Inston N,et al.Clinical practice guideline on peri-and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults[J]. Nephrol Dial Transplant,2020,35(12):2203.
[19] 中国重症血液净化协作组,中国重症血液净化协作组护理学组. 中国重症血液净化护理专家共识(2021年)[J]. 中华现代护理杂志. 2021,27(34):4621-4632.
China Critical Care Blood Purification Cooperation Group, Nursing Group of China Critical Care Blood Purification Coo-peration Group. Expert consensus on the nursing of critical blood purification in China(2021)[J]. Chin J Mod Nurs,2021,27(34):4621-4632.
[20] 中国医院协会血液净化中心分会血管通路工作组. 中国血液透析用血管通路专家共识(第2版)[J]. 中国血液净化,2019, 18(6):365-381.
Vascular Access Working Group of Blood Purification Center Branch of Chinese Hospital Association. Expert consensus on vascular access for hemodialysis in China(2nd edition)[J]. Chin J Blood Purif,2019,18(6):365-381.
[21] 血液净化急诊临床应用专家共识组. 血液净化急诊临床应用专家共识[J]. 中华急诊医学杂志,2017,26(1):24-36.
Expert Consensus Group on Emergency Clinical Application of Blood Purification. Expert consensus on the clinical appli-cation of blood purification in emergency department[J]. Chin J Emerg Med,2017,26(1):24-36.
[22] Beathard GA. Malfunction of chronic hemodia-lysis catheters[EB/OL].(2021-06-30)[2023-01-05]. http://www-uptodate-com-443.bjmu.ilibs.cn/contents/zh-Hans/malfunction-of-chronic-hemo-dialysis-catheters.
[23] Chopra V. Central venous access:Device and site selection in adults.[EB/OL].(2022-01-28)[2023-01-04]. http://www-uptoda-te-com-443.bjmu.ilibs.cn/contents/zh-Hans/central-ve-nous-access-device-and-site-selection-in-adults.
[24] Bander SJ,Yuo TH. Central venous catheters for acute and chronic hemodialysis access and their management[EB/OL].(2020-10-16)[2023-01-05]. http://www-uptodate-com-443.bjmu.ilibs.cn/contents/zh-Hans/cen-tral-catheters-for-acute-and-chronic-hemodialysis-access-and-their-management.
[25] Tsujimoto H,Tsujimoto Y,Nakata Y,et al. Pharmacological in-terventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy[J]. Cochrane Da-tabase Syst Rev,2020,12(12):CD012467.
[26] Tsujimoto Y,Miki S,Shimada H,et al. Non-pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy[J]. Cochrane Data-base Syst Rev,2021,9(9):CD013330.
[27] Timp JF,Braekkan SK,Lijfering WM,et al.Prediction of recu-rrent venous thrombosis in all patients with a first venous thrombotic event:the Leiden Thrombosis Recurrence Risk Prediction model(L-TRRiP)[J]. PLoS Med,2019,16(10):e1002883.
[28] 刘斌亮,谢俊英,王延风,等. 乳腺癌患者中心静脉置管导管相关性血栓的发生情况及其影响因素[J]. 中华肿瘤杂志,2021, 43(8):838-842.
Liu BL,Xie JY,Wang YF,et al.Exploration of the high-risk factors of catheter-related thrombosis in breast cancer[J]. Chin J Oncol,2021,43(8):838-842.
[29] Dubbink-Verheij GH,Pelsma ICM,van Ommen CH,et al. Femoral vein catheter is an important risk factor for ca-theter-related thrombosis in(Near-) term neonates[J]. J Pediatr Hematol Oncol,2018,40(2):e64-e68.
[30] Hryszko T,Brzosko S,Mazerska M,et al.Risk factors of non-tunneled noncuffed hemodialysis catheter malfunction. A pro-spective study[J]. Nephron Clin Pract,2004,96(2):c43-c47.
[31] 周星帆,周文珍,王利伟,等. CT静脉造影显示下肢深静脉血栓分布的临床价值[J]. 介入放射学杂志,2019,28(12):1140-1143.
Zhou XF,Zhou WZ,Wang LW,et al.Clinical value of CT venography in the distribution of lower extremity deep venous thrombosis[J]. J Interv Radiol,2019,28(12):1140-1143.
[32] Montrief T,Auerbach J,Cabrera J,et al.Use of point-of-care ultrasound to confirm central venous catheter placement and evaluate for postprocedural complications[J]. J Emerg Med,2021,60(5):637-640.
[33] O'Grady NP,Alexander M,Burns LA,et al. Summary of reco-mmendations:guidelines for the prevention of intravascular catheter-related infections[J]. Clin Infect Dis,2011,52(9):1087-1099.
[34] Ricci D,Panicali L,Cavallari G,et al. Choice and manage-ment of anticoagulation during CRRT[J]. G Ital Nefrol,2019, 36(2):2019-vol2.
[35] Son JT,Min SY,Kim JI,et al.Thrombolytic therapy using uro-kinase for management of central venous catheter thrombosis[J]. Vasc Specialist Int,2014,30(4):144-150.
[36] Kumwenda M,Dougherty L,Spooner H,et al.Managing dysfu-nctional central venous access devices:a practical approach to urokinase thrombolysis[J]. Br J Nurs,2018,27(2):S4-S10.
[37] 刘明晨,姚惠萍. 医护操作对CRRT体外循环凝血因素影响的研究进展[J]. 护士进修杂志,2016,31(16):1460-1462.
Liu MC,Yao HP.Research progress on the effect of doctor-nurse operation on coagulation factors of CRRT extracor-poreal circulation[J]. J Nurses Train,2016,31(16):1460-1462.

Summary of the best evidence for the prevention and management of central venous catheter-related thrombosis in patients undergoing continuous renal replacement therapy

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	HAN Jianping, REN Yaxing, LI Ying, HOU Pengxiao, WANG Yali, E Haiyan. A study on the construction of evidence map for non-pharmacological analgesia in critically ill patients [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(7): 827-835.
[2]	PAN Chenxin, ZHANG Yan, LI Xihan, CHEN Jing. Summary of the best evidence for the application of the family participation model in the rehabilitation nursing of ICU patients [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(7): 870-876.
[3]	XIE Caiqin, DUAN Haoran, WANG Yunhua, HAO Fangfang, ZHANG Ying, CHEN Wensi, ZHANG Jianxia, WANG Lixin. Summary of the best evidence on adult hematopoietic stem cell infusion management [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(7): 877-884.
[4]	LI Jing, HU Min, LU Xiaoying, YANG Yaya, CHEN Xue-mei, HU Bing. Meta-analysis of delay rate from hospital admission to balloon dilation and influencing factors in patients with acute ST-elevation myocardial infarction [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(6): 689-696.
[5]	CHANG Qiuyan, WANG Lili, SONG Lili. Study of hypoactive delirium in critically ill patients following cardiac surgery：a scoping review [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(6): 697-703.
[6]	CAI Shasha, SHUAI Qinyan, HE Yangmengyuan, ZHANG Mei, XIANG Xinyue, ZHANG Mingyue, HUANG Lihua. Evidence summary for the management of mechanical ventilation in patients with sepsis [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(6): 740-747.
[7]	CHEN Ruoxi, LIU Lihong, FAN Luo, WANG Huixia, JIA Qianhui, YANG Zhen, FAN Kaisheng, WANG Yuanyunzi. Evidence summary of de-escalation measures for patient-nurse violence in emergency departments [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(6): 748-754.
[8]	ZHOU Min, WANG Linjuan, LI Jiajia, YANG Na, WANG Qiaoxia, FU Kunhui, HUANG Quelan, MENG Lingyu. Evidence-based nursing practice for evaluation and insertion of peripheral arterial catheters in children in pediatric intensive care unit [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(5): 546-553.
[9]	WAN Shanshan, CHEN Lihua, ZHU Jihua. Summary of the best evidence for prevention and nursing of high-flow intestinal fistula after enterostomy in neonates with necrotizing enterocolitis [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(5): 554-560.
[10]	HU Ziwei, OUYANG Lanxin, KE Haiming, LIN Yin, LIU Di. Development of audit indicators for structured triage of emergency chest pain patients and analysis of barriers and facilitators [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(4): 469-475.
[11]	GONG Lichao, MEI Aiying, CAO Wenya, SUN Rui, LI Cuijing, CHANG Hong. Best evidence summary for oral feeding management in tracheostomy patients [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(4): 496-502.
[12]	CHEN Zhaofei, WANG Wei, ZHAI Zhenguo. Implementation and quality control of an integrated prevention and management strategy for venous thromboembolism [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(3): 274-278.
[13]	XU Yaling, YUAN Jing, ZHANG Yujiao, WANG Weina, YING Jinping. Nursing care for an elderly patient undergoing lung transplantation complicated with rhabdomyolysis and receiving continuous renal replacement therapy [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(3): 322-324.
[14]	SUN Huihui, DING Jingping, ZHANG Yuxin, HAO Xiaochen, ZHANG Bingliang. Summary of the best evidence for prevention and management of alcohol relapse behavior in patients with alcoholic liver disease after liver transplantation [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(3): 350-357.
[15]	DENG Meng, GAO Helei, WANG Wenchun, LI Xiaoqing, ZHANG Zonghao, YU Yun. Best evidence summary for infection prevention and management in patients with left ventricular assist device implantation [J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(3): 358-365.