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眼科患者外周静脉留置针舒适度状况调查分析

目的　讨论眼科患者术后采用外周静脉留置针对舒适度的影响及留置位置选择对生活自理的影响。 方法　选取2012年10月－11月住院行手术治疗、术后使用外周静脉留置针的100例眼科患者为调查对象，就外周静脉留置针在治疗过程中的留置时间、留置位置、留置疼痛感及对生活自理的影响等涉及患者舒适度的问题进行问卷调查，并对调查结果进行统计分析。 结果　患者留置针留置时间为2～4 d，不同留置位置其无菌透明敷贴卷边情况差异有统计学意义（Hc=15.179，P=0.002），不同留置位置其疼痛程度无差异，留置针敷贴卷边程度与留置时间呈正相关（rs=0.363，P＜0.001），不同留置位置对生活的影响情况差异有统计学意义（Hc=17.003，P=0.001）。留置针留置过程中患者自觉症状较轻。 结论　眼科患者采用外周静脉留置针，穿刺部位应尽可能选择在前臂，可减少留置针敷贴卷边情况的发生，并能减少留置针对患者生活的影响，以提高其舒适度。

化学疗法经外周静脉置入中心静脉导管路径医护一体化管理模式探讨

【摘要】　目的　总结肿瘤患者化学疗法经外周静脉置入中心静脉导管（peripherally inserted central catheter， PICC）路径医护一体化管理模式的经验与效果，提高医护团队的工作效率。　方法　针对化学疗法PICC路径管理前医护合作存在的问题，通过优化配置医护团队，建立PICC临床路径管理制度，规范PICC技术操作、技术维护质量标准等措施，实现PICC医护一体化管理模式。　结果　医护一体化管理模式能有效地提高医护工作效率，降低PICC并发症，患者满意度提高。　结论　实施肿瘤患者化学疗法PICC路径医护一体化的管理模式，使护理工作流程更加合理化，PICC技术管理更加规范，可为患者节约住院费用，并加快病床周转。

对规范化培训护士外周静脉置入中心静脉导管维护技能的调查分析

【摘要】　目的　了解规范化培训护士对经外周静脉置入中心静脉导管（PICC）相关知识的认知及掌握情况。　方法　采取问卷调查方式，对2009年-2010年已在医院肿瘤科轮转工作过的57名规范化培训护士进行PICC维护知识的不记名调查。　结果　规范化培训护士对揭除穿刺处敷料的方向、穿刺处皮肤消毒面积、PICC导管是否可直接接触无菌胶带、脉冲式冲管及正压式封管的方法等内容，回答正确率均在90.9%以上；而对于PICC术后首次更换敷料的时间、注射器型号的选择、导管相关性血流感染等内容，回答正确率为69.09%。　结论　为降低PICC相关并发症的发生率，保证PICC维护质量安全，对规范化培训护士进行具有针对性、持续性、全面性的PICC维护培训刻不容缓

Implementation and Effects of Continuous Quality Improvement in the Care of Peripherally Inserted Central Catheter

ObjectiveTo evaluate the clinical effects of continuous quality improvement (CQI) in the care of peripherally inserted central catheter (PICC). MethodsWe retrospectively analyzed the clinical data of 40 patients who received PICC treatment in our hospital between January and December 2011, and then we found out the main problems of PICC catheter care, analyzed the related factors for complications of PICC, and formulated corresponding nursing countermeasures. PICC receivers between January and December 2012 were regarded as controls. Then, we compared the complication incidence and satisfaction of patients between the two groups before and after the implementation of CQI. ResultsAfter the implementation of CQI, complication incidence was significantly lower (P<0.05). The satisfaction degree of patients toward caring rose to 87.8%, which was statistically significant (P<0.05). ConclusionThe implementation of CQI is beneficial to reduce complications of PICC treatment, and patients'satisfaction rate is also significantly increased.

Progress in prevention and control strategies for peripheral inserted central catheter-related bloodstreams infection

Peripheral inserted central catheter (PICC) is the most commonly used central venous catheter in hospitalized patients, and catheter-related bloodstreams infection (CRBSI) is one of the most serious complications during PICC retention, which can affect patient prognosis and treatment. Reducing the incidence of intravascular CRBSI is one of the goals of medical quality and safety management, which continues to attract the attention of domestic and foreign experts and scholars. Authoritative institutions at home and abroad have successively issued a series of prevention and control guidelines and expert consensus, and related research on risk assessment of CRBSI is also rapidly developing. This article reviews the risk assessment, prevention and control measures, and information monitoring and feedback of PICC-related bloodstreams infection, in order to provide reference for building a PICC-related bloodstreams infection prevention and control system.

外周静脉置入中心静脉导管术在高原地区肿瘤患者中的应用观察

目的　探讨外周静脉置入中心静脉导管（PICC）术在高原地区肿瘤患者中的临床应用，为西藏地区更好开展PICC技术提供依据。 方法　回顾性分析2010年8月－2012年4月113例肿瘤患者临床资料。 结果　穿刺成功111例，失败2例，成功率为98.2%。发生相关并发症14例，发生率12.4%，其中导管异位6例（5.3%），导管相关性感染3例（2.7%），栓塞2例（1.8%），机械性静脉炎2例（1.8%），导管部分脱出1例（0.8%）。 结论　PICC置管是一种置管成功率高，保留时间长，并发症较少、可靠有效的静脉治疗新途径，可在高原地区广泛推广应用。

静脉/动脉血液管理保护管路与经外周静脉置入中心静脉导管的联合应用

目的　总结静脉/动脉血液管理保护管路（VAMP）与经外周静脉置入中心静脉导管（PICC）联合应用于重症患者的血液标本采集的方法及护理。 方法　对2011年8月－11月79例留置PICC的患者应用VAMP采集血标本的方法进行回顾总结。 结果　79例患者所取血液标本合格率达100%，未发生针刺伤，且采血时未断开输液接头。 结论　PICC导管与VAMP配合应用可有效避免反复抽血给患者带来的痛苦，同时减少血样采集时的感染、针刺伤和血液废弃物，值得临床推广。

经外周静脉置入中心静脉导管异位至锁骨下静脉成“8”字形复位一例

Heparin Added in Total Nutrient Admixture for Preventing Peripherally Inserted Central Catheter Occlusion in Neonate: A Case Report

Objective　To make an individualized administration scheme via evidence-based medicine methods, namely adding heparin into the total nutrient admixture (TNA) solution, so as to help a neonate to prevent the occlusion of peripherally inserted central catheter (PICC). Methods　After carefully assessing the condition of neonate, this clinical issue was put forward in accordance with the PICO principles. Randomized controlled trials (RCTs) and systematic reviews on neonates’ PICC occlusion were collected from The Cochrane Library, CCTR, DARE, NGC, MEDLINE (Ovid) and CBM from inception to 2011. The clinical intervention scheme was finally made after the assessment of the retrieved evidence and neonate’s physiological condition. Results　A total of 4 RCTs and 1 systematic review related to the issues were identified. The following scheme was finally made for the neonate through the assessment of the retrieved evidence and combination of intentions of the patient’s family members: heparin (0.5 U/mL) was added into TNA to prevent PICC occlusion. During the application, blood routine test and blood coagulation were monitored, and the catheter opening time and extubation reason were recorded. Through the above treatment, the neonate successfully completed the treatment before extubation. The time of both PICC detaining and opening was 20 days in total, and there were no PICC occlusion, no catheter thrombosis, and no catheter related bloodstream infection. Moreover, no observation showed thrombopenia and aggravated coagulation disorders resulted from heparin. Conclusion　The evidence-based medicine method is an effective way to make reasonable heparin scheme for neonate, so as to prevent PICC occlusion, reduce catheter thrombosis, decrease risks of catheter related blood circulation infection, assure successful completion of treatment, and guarantee the safety of patients.

新生儿外周静脉置入中心静脉导管堵管原因分析

目的探讨新生儿经外周静脉置入中心静脉导管（PICC）堵塞原因，寻求措施以减少堵管发生率。 方法对2010年1月－2013年3月97例留置PICC发生管道堵塞的患儿资料进行分析，总结堵管原因并提出护理对策。 结果97例PICC置管患儿中，17例发生堵管，发生率17.5%，堵管后再通成功12例。低年资护士维护者堵管发生较多；夜间堵管较多。 结论针对新生儿PICC堵管的主要原因给予相应护理干预能降低PICC堵管率。