成年重症连续性肾脏替代治疗患者血管通路维护最佳证据总结OA

Objective To search for,evaluate,and summarize the best evidence on vascular access maintenance protocols for adult critically ill patients receiving continuous renal replacement therapy(CRRT),thereby providing references for clinical practice.Methods Following the"6S"evidence-based resource model,relevant guidelines,expert consensus statements,evidence summaries,systematic reviews,meta-analyses,and best practices concerning catheter indwelling and maintenance in critically ill adult CRRT patients were retrieved from domestic and international databases from in-ception to April 3,2025.Two researchers independently appraised the quality of the included studies.The Joanna Briggs Institute Centre for Evidence-Based Health Care Level of Evidence and Grade of Recommendation System(2014 version)was used for evidence grading,and the extracted evidence was classified and synthesized.Results A total of 14 articles were included(4 guidelines,2 systematic reviews,2 evidence summaries,3 expert consensus statements,2 clinical decision documents,and 1 randomized controlled trial).Ultimately,29 best evidence statements were synthesized across 10 categories:pre-catheterization assessment,catheter selection,catheter insertion and removal,cathe-ter locking and flushing techniques,catheter hub maintenance,dressing and dressing change,intra-dialytic management and functional maintenance of vascular access,anticoagulation therapy and thrombosis prevention,infection prevention,and continuous quality improvement.Conclusion This study systematically summarizes the best evidence for vascular access maintenance in adult critically ill CRRT patients.It is recommended that clinical healthcare professionals integrate the medical con-text and patient preferences,and apply evidence in accordance with individualized principles,so as to improve the standardization and safety of vascular access management in adult critically ill CRRT patients.