末梢静脈カテーテル管理におけるイベント交換の費用最小化分析  [in Japanese] Cost Minimization Analysis of Clinically-Indicated Replacement in Peripheral Venous Catheter Management  [in Japanese]

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Abstract

  米国疾病予防管理センター(CDC)ガイドラインは,末梢静脈カテーテルを72~96時間ごとに刺し替える方法(定期交換)を推奨しているが,近年の研究では,臨床的に刺し替えざるを得ないイベント(静脈炎等)が生じた場合だけ刺し替える方法(イベント交換)の安全性が示された.本研究では,「イベント交換」が導入された一施設でヒストリカルコントロールを用いた後ろ向き調査を行い,イベント交換の安全性を確認したうえで費用効果を検証した.<br>   末梢静脈カテーテル関連サーベイランス記録と診療録より,患者属性とイベント発生率を調査した.費用は,輸液療法1回あたりの材料費,人件費,廃棄費を算出した.導入後1か月を除く前後2か月間のイベント(血流感染,静脈炎,血管外漏出,閉塞)の発生率とカテーテル刺し替えにかかる費用を比較した.末梢静脈カテーテルを「定期交換」から「イベント交換」に変更してもイベント発生率に有意な上昇はなかった.費用最小化分析の結果,「定期交換」を止め,「イベント交換」を導入したことによる増分費用は,輸液療法1回あたり−268円であった.<br>

  The Centers for Disease Control and Prevention guidelines recommend replacing peripheral venous catheters every 72–96 h (routine replacement), but studies in recent years have shown that venous catheter replacement is clinically safe to perform only if events occur that make replacement unavoidable, such as phlebitis. This indication is known as the clinically-indicated replacement method. The present historical control study attempted to verify the safety and cost effectiveness of clinically-indicated replacement in a single hospital which had introduced the replacement method. Patient characteristics and event rate were investigated using the peripheral vein catheter-related surveillance records and medical records. Costs and rates of onset of bloodstream infection, phlebitis, extravasation, and occlusion (events) were compared in the 2 months before and after introduction, excluding the first month after introduction of the clinically-indicated replacement method. The calculated cost included the material cost, personnel expenses, and disposal costs per transfusion treatment. No significant increase was found in the onset of events after the switch from the routine replacement method to the clinically-indicated replacement method. Cost minimization analysis found the increment cost was −268 yen per infusion therapy procedure after the switch from the routine replacement method to the clinically-indicated replacement method.<br>

Journal

  • Japanese Journal of Infection Prevention and Control

    Japanese Journal of Infection Prevention and Control 31(1), 17-23, 2016

    Japanese Society for Infection Prevention and Control

Codes

  • NII Article ID (NAID)
    130005144444
  • NII NACSIS-CAT ID (NCID)
    AA12313188
  • Text Lang
    JPN
  • ISSN
    1882-532X
  • NDL Article ID
    027078277
  • NDL Call No.
    Z19-3650
  • Data Source
    NDL  J-STAGE 
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