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经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)因其创伤小、易操作、保留时间长、避免药物外渗,被广泛应用于静脉营养、化疗、抗生素治疗等领域,为病人静脉输液提供了安全可靠的通道[1],与此同时,PICC维护相关的并发症如感染[2-3]、血栓[4-5]、渗出[6-7]、导管堵塞[8]等均有发生,虽然多数并发症不会危及生命,但可能导致提前拔除导管,影响治疗。研究[9-10]报道,病人自身因素及治疗因素等诸多因素会影响PICC并发症的发生及预后,但是医疗保健设置有时起决定作用。尤其是相对于中心静脉导管(CVC)及植入式静脉输液港(VPA)等其他中心静脉来讲,PICC在维护过程中的安全性较差[11],加之目前病人住院时间普遍减少,因此化疗间歇期的PICC导管维护与监测更为重要[12],为促进PICC输液治疗规范化发展,提升护理服务质量,我院于2015年末设置PICC专职护士岗位,负责全院及院外PICC导管维护及并发症处理业务,获得满意效果,现作报道。
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PICC门诊2014-2015年(对照组)共有12099人次就诊,处理993人次并发症,占8.21%。PICC专职岗位设置后,2016-2017年(观察组)共有15211人次就诊,处理949人次并发症,占7.84%。2组处理PICC并发症人次相比较,设置专职岗位后并发症处理人次显著低于岗位设置前(P<0.01)(见表 1)。
分组 n 渗血 感染 渗液 静脉炎 血栓 堵管 导管破损 皮疹 合计 χ2 P 对照组 12 099 222(1.83) 236(1.95) 27(0.22) 8(0.07) 2(0.02) 26(0.21) 36(0.30) 436(3.60) 993(8.21) 观察组 15 211 380(2.50) 304(2.00) 50(0.33) 8(0.05) 2(0.01) 35(0.23) 15(0.10) 155(1.02) 949(7.84) 39.53 < 0.01 合计 27310 602(2.20) 540(1.98) 77(0.28) 16(0.06) 4(0.01) 61(0.22) 51(0.19) 591(2.16) 1942(7.11) 表 1 PICC专职岗位设置前后就诊病人PICC并发症发生情况[n;百分率(%)]
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病人满意率,观察组(99.69±0.85)%和对照组(99.67±0.94)%差异无统计学意义(t=0.15,P>0.05);质量控制考核评分,观察组(99.98±0.10)分和高于对照组(99.42±1.14)分,差异有统计学意义(t′=2.24,P<0.05)。
三级医院门诊PICC专职岗位设置效果评价
Evaluation on the effect of PICC full-time post setting in outpatient department of tertiary hospital
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摘要:
目的探讨三级医院门诊设置经外周静脉置入中心静脉导管(PICC)专职岗位的效果。 方法上海市某三级医院于2015年12月起在PICC门诊设置专职岗位,比较岗位设置前后PICC门诊病人就诊人次以及PICC并发症发生率、病人满意度和质量控制考核评分结果,探讨护士PICC专职岗位设立效果。 结果设置PICC专职岗位后,门诊量增加25.72%,就诊病人PICC并发症总体发生率由8.21%下降到7.84%,差异有统计学意义(χ2=39.53,P < 0.01));质量控制考核评分均分由(99.42±1.14)分提高到(99.98±0.10)分,差异有统计学意义(t'=2.24,P < 0.05);病人满意度虽有所提高,但满意度评分较设置PICC专职岗位前差异无统计学意义(P>0.05)。 结论三级医院设置PICC专职护士可以加强PICC导管管理,满足病人出院后PICC导管维护和健康教育需求,提高病人满意度。 -
关键词:
- 经外周静脉置入中心静脉导管 /
- 专职护士 /
- 岗位设置
Abstract:ObjectiveTo investigate the effects of setting peripherally inserted central catheter(PICC) full-time post in outpatient department of tertiary hospital. MethodsThe full-time post was set up in PICC outpatient department in a tertiary hospital of Shanghai from December 2015.The number of outpatients, incidence rate of PICC complications, patient satisfaction and quality control score between before and after the setting of PICC post were compared to investigate the effects of nurse PICC full-time post setting. ResultsAfter the setting of full-time nurse PICC post, the number of outpatients increased 25.72%, the overall incidence of PICC complications decreased from 8.21% to 7.84%, and the difference of which was statistically significant(P < 0.01).The average score of quality control examination increased from(99.42±1.14) to(99.98±0.10), and the difference of which was statistically significant(P < 0.05).The average score of satisfaction of patients increased, and the difference of which between before and after post setting was not statistically significant(P>0.05). ConclusionsThe setting of PICC full-time nurse can strengthen the management of PICC, meet the needs of PICC maintenance and health education of patients, and improve patient's satisfaction. -
Key words:
- peripherally inserted central catheter /
- full-time nurse /
- post setting
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表 1 PICC专职岗位设置前后就诊病人PICC并发症发生情况[n;百分率(%)]
分组 n 渗血 感染 渗液 静脉炎 血栓 堵管 导管破损 皮疹 合计 χ2 P 对照组 12 099 222(1.83) 236(1.95) 27(0.22) 8(0.07) 2(0.02) 26(0.21) 36(0.30) 436(3.60) 993(8.21) 观察组 15 211 380(2.50) 304(2.00) 50(0.33) 8(0.05) 2(0.01) 35(0.23) 15(0.10) 155(1.02) 949(7.84) 39.53 < 0.01 合计 27310 602(2.20) 540(1.98) 77(0.28) 16(0.06) 4(0.01) 61(0.22) 51(0.19) 591(2.16) 1942(7.11) -
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