儿科PICC置管的潜在风险因素及护理对策  

Potential risk factors in peripheral inserted central catheter procedure in pediatric patients and countermeasures thereagainst

作　　者：张向兰[1] 由丽华[1] 赵冠华[1] 仙亚蒙 班钟介[1] 秦鹏飞[1] 

机构地区：[1]中国人民武装警察部队总医院儿科,北京100039

出　　处：《中国急救复苏与灾害医学杂志》2011年第5期430-432,共3页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的 总结儿科PICC置管风险因素并研究护理对策.方法 2008年10月31日至2009年10月31日住院的45名肿瘤患儿（对照组）接受PICC置管和常规护理,2009年11月1日至2010年10月31日住院的性别、年龄、病种无差异的45名患儿（研究组）接受PICC和有针对性的护理干预,包括术前评估,进行穿刺难度分级,加强护患交流,让家长签知情同意书,对监护人进行维护培训等.术后每周进行一次电话随访,密切观察,记录临床效果和并发症,分析风险因素.结果 研究组患儿的总并发症率、堵管率、和导管破损漏液率分别为8%（4/45）,4%（4/45）,和4%（2/45）,均显著低于对照组[11%（5/45）、6%（3/45）和6%（3/45）,均P〈0.05].均无投诉及护患纠纷.据观察,导致置管失败和并发症的风险因素包括患儿不合作,血管过细,护士培训不足,对监护人健康教育不到位等.结论 通过针对儿科PICC置管的不安全因素采取相应的护理对策,能有效防范和降低置管风险.Objective To investigate the potential risk factors in peripheral inserted central catheter （PICC） procedure in pediatric patients and countermeasures thereagainst. Methods Forty-five pediatric patients with tumors hospitalized from Oct 31 2008 to Oct 31 2009 （control group） underwent PICC procedure for chemotherapy and conventional nursing care and then 45 sex-, age-, and disease spectrum-matched patients hospitalized from Nov 1 2009 to Oct 31 2010 （experiment group） underwent PICC procedure and, in addition, special nursing care, including assessment before PICC procedure, grading of difficulty in puncture, strengthening nurse-patient communication, signing informed consent form by the parents, training of the custodians on the maintenance of catheter, and implementation of operation access system and total quality control. Close observation was carried out on the incidence of complications and relevant risk factors for 6 months. Results The total incidence rate of complications （4/ 45）, and the incidence rates of catheter closure and catheter leakage in the experiment groups were 8% （4/ 45）, 4% （2/45）, and 4% （2/45） respectively, all significantly lower than those in the control group （24%, 11%, and 11% respectively, all P〈0.05）. No complaint and nurse-patient dispute were recorded. The risk factors of failure of PICC procedure and complications after PICC included noncooperation of the children, too small blood vessel, too long exposure during PICC, insufficient training for the nurses, and insufficient training and health education for the patients. Conclusion Strengthening nursing care is effective to reduce and prevent the risk of PICC procedure.

关 键 词：儿科 中心静脉导管 护理 

分 类 号：R472.9[医药卫生—护理学]