Ask an answerable question (PICO)：
Intravenous injection is one of the necessary routes for drug administration, nutrition, blood transfusion. It will destroy the integrity of the skin and allow microorganisms to invade the bloodstream. There is a 0.1% chance of blood infection and a 36% chance of phlebitis (Marsh, 2018). Regular Replacing the peripheral intravenous catheters will increase the patient's discomfort, and the family members will not bear to see the patient being repeatedly injected, resulting in anger and a sense of helplessness, and will also increase clinical nursing manpower, time and cost, etc.
The Method and Analysis of Literature Review：
Based on empirical nursing steps, use P, I,C, O keywords, including natural language and MeSH term, use Boolean logic "OR" and "AND", use search strategy 6S, set Filter to improve search efficiency, and Create Alert to keep track of the latest updates at any time. Documents were searched in the databases of UpToDate, DynaMed, PubMed, Cochrane Library, Trip Database, Airiti Library. The inclusion criteria were 1.Limit the document age to 5 years ; 2.The subject is the patient who needs to perform intravenous injection ; 3. The intervention measures are to replace peripheral venous catheter when clinically indicated, and finally 1 systematic review and 1 randomized controlled trials were selected, which best meets the clinical problem.
Critical Appraisal：
The literature review tool adopts the "Systematic Review Checklist" and "Randomised Controlled Trial Checklist" of the CASP to assess the validity of the evidence, methodologically sound, the importance of the results and the clinical applicability. The level of evidence adopts the clinical research evidence grading table recommended by the Centre for Evidence Medicine, Oxford University. Systematic review are Level 1. Randomized controlled trials are Level 2.Research results show that replace peripheral venous catheter when clinically indicated does not increase the incidence of phlebitis.
Clinical Application of Evidence：
Noticing the pain and discomfort of patients with peripheral intravenous catheters, an empirical group was established on January 1, 2020. The study was a prodromal study, and the case was collected by convenience sampling. The intervention measures were divided into 72 hours, 96 hours, and the peripheral intravenous catheters was replaced according to the symptoms of infection at the peripheral intravenous injection site.
Evaluation of Effectiveness：
This evidence is divided into 3 groups, a total of 88 cases were received, 72 hours: 34 people, 96 hours: 26 people, according to clinical indications: 28 people, there was no significant difference in age, gender, catheter size, etc. (p>0.05), 3 Groups have high homogeneity and comparability. The results showed that, according to clinical symptoms, there was no significant difference in the incidence of phlebitis between 72 h, 96 h and replacement of peripheral venous catheters (p=1.00). Therefore, it is recommended to replace the peripheral venous catheter according to clinical symptoms.
Conclusions and Recommendations：
Patients said that it can reduce the fear and pain during injection, and increase nursing satisfaction. Colleagues said that the saved nursing hours can be applied to clinical care, and it can reduce the pressure on patients and their families during the injection process. Since this article only accepts patients in three wards, it is recommended to continue to implement clinical applications in the future, expand the number of samples, and collect nationwide empirical data to make it more effective. To remove the catheters as soon as possible, if there are symptoms of phlebitis, the injection site should be replaced immediately to avoid phlebitis.
