乳腺癌患者围术期的静脉保护  

Vein Protection for Peri-operation Breast Cancer Patients

作　　者：黄爱微[1] 潘莘莘[1] 吴皓宇[1] 

机构地区：[1]温州医学院附属第一医院,浙江温州325000

出　　处：《护理学报》2009年第22期18-19,共2页Journal of Nursing（China）

摘　　要：分析乳腺癌患者围术期静脉使用不当的原因包括:患者知识缺乏,不了解静脉保护的意义;护士健康宣教不够,且未重视静脉保护;轮转护士专科知识缺乏,管理方面未对此类患者进行特殊标识,不利于护士记忆与识别。针对此提出对策:(1)组织科室全体人员共同学习如何针对乳腺癌患者合理选择和使用静脉,并制定工作流程。(2)乳腺癌患者入院第1天,采用粉红色病人识别带,并戴在患侧手腕处与其他住院患者相区别,并做好相应的宣教;要求术前采血、静脉治疗选用患侧静脉;手术当日选用健侧静脉为术中补液及用药,但应避免选用肘关节处的静脉;术后加强患者及家属健康宣教,共同参与静脉保护。(3)加强科室制度化管理力度,建立差错事故登记本与赏罚制度,并与护士行为考核相关联。实施静脉保护措施后PICC置管率由以前的73%提高到88%;贵要静脉置管率在PICC置管中的比例由以前的51%提高到66%。实施静脉保护方法后的前3个月有2例在术前选择健侧静脉输液及采血,后3个月全部患者围术期静脉使用均达标,无1例术后在患侧行静脉输液及采血等。This paper sums up the causes for improper handling of the veins of peri-operation breast cancer patients as follows： patients lack related knowledge and do not know the significance of vein protection; health education is inadequate and moreover, vein protection has not received importance; nurses in rotation lack professional knowledge; the administration does not label the patients of this kind in a special way, which deducts from nurses＇ memory and identification of them. Proceeding from the above, this paper puts forward the following coping ways： （1） Mobilizing the staff to study how to reasonably choose and handle the veins of this kind of patients and formulating the related work flow. （2） On the first day of hospital admission, the patient is requested to wear a pink ribbon at the wrist for identification, health education is offered. Require the use of the veins of the affected side in pre-surgery blood sampling and venous treatment, and the use of the health side veins with those not at the elbow joint for during-surgery fluid infusion and drug administering. And health education should be beefed up for the patients and their dependents. （3） Institutionalized management of the department or section should be reinforced. Books for improper handling and accidents should be set and the punishment-and-reward system, established, a system connected with the nurses＇ examination and checking. After the adopting of the protective measures, PICC intubation rate rose to 88%, as against the 73% before, with the rate of intubation at the major veins to 66% from 51%. During the first 3 months after the intervention, there are 2 cases whose fluid infusions and blood samplings were conducted at the veins of the healthy side, but the peri-surgery vein uses among all the patients reach the standard during the last 3 months, without a single case whose post-surgery fluid infusion or blood sampling was conducted at the veins of the affected side.

关 键 词：持续质量改进 乳腺癌 静脉保护 PICC 

分 类 号：C931.3[经济管理—管理学] R47[医药卫生—护理学]