Abstract
Objective To develop a standardized protocol for ultrasound-guided difficult peripheral vascular catheterization that meets the clinical needs in China, in order to improve the standardization, safety, and management quality of catheterization procedures. Methods Based on literature review and qualitative research, a preliminary draft of the plan was formed. Two rounds of Delphi expert inquiry were conducted, and 16 experts were consulted to establish the final draft of the plan. Results The response rate for both rounds of inquiry questionnaires was 100. 00%; The expert authority coefficients were 0. 81 and 0. 84, respectively; The Kendall harmony coefficient for the first and second level items in the first round was 0. 130 and 0. 139, respectively (P＜0. 05), and for the second round it was 0. 172 and 0. 180, respectively (P＜0. 05); After the second round of inquiry, the coefficient of variation for each indicator ranged from 0 to 0. 21. The final plan includes 15 primary items and 24 secondary items. The primary categories included "Indications and Contraindications, " "Environmental Preparation, " "Operator Preparation, " "Equipment Preparation, " "Patient Preparation, " "Ultrasound Machine Settings, " "Pre-Scan Assessment and Puncture Site Localization, " "Target Vein Selection, " "Ultrasound Probe Preparation and Puncture Site Disinfection, " "Puncture Procedure, " "Catheter Position Confirmation, " "Catheter Fixation, " "Health Education, " "Cleaning and Organization, " and "Documentation. " The secondary categories focused on key aspects of ultrasound-guided puncture, such as identifying venous anatomical landmarks, assessing venous patency, performing real-time ultrasound-guided puncture, and confirming needle and catheter positions. Conclusion The standardized protocol for difficult peripheral vascular catheterization under ultrasound guidance constructed in this study has a rigorous process and comprehensive content, which can provide theoretical basis and practical guidance for clinical operation and management. (目的 构建一套符合国内临床实际需求的超声引导下困难外周静脉置管标准化方案, 以提升置管操作规范性、安全性及管理质量。方法 基于文献回顾与质性研究形成方案初稿, 采用两轮德尔菲专家函询法, 函询16名专家后确立方案终稿。结果 两轮函询问卷回收率均为100. 00%; 专家权威系数分别为0. 81和0. 84; 肯德尔和谐系数首轮一、二级条目分别为0. 130和0. 139(P＜0. 05), 次轮分别为0. 172和0. 180(P＜0. 05); 第2轮函询后各指标变异系数为0～0. 21。最终方案包含15个一级条目和24个二级条目。其中一级条目包括“适应证与禁忌证”“环境准备”“操作者准备”“物品准备”“患者准备”“超声仪器设置”“预扫描评估与穿刺部位定位”“目标静脉选择”“超声探头准备与穿刺部位消毒”“穿刺操作”“导管位置确认”“导管固定”“健康教育”“清洁整理”及“文书记录”; 二级条目围绕超声引导穿刺的关键环节展开, 如明确静脉解剖定位、评估静脉通畅性、实时超声引导穿刺、确认针尖及导管位置等。结论 本研究构建的超声引导下困难外周静脉置管标准化方案过程严谨、内容全面, 可为临床操作与管理提供理论依据与实践指导。)