外周静脉留置针致静脉损伤与恢复的临床研究  

Venous injury caused by peripheral intravenous indwelling catheter and recovery

作　　者：赵改婷[1] 李彬[2] 齐新荣[3] 胡倩 王翠兰 Zhao Gaiting;Li Bin;Qi Xinrong;Hu Qian;Wang Cuilan(Department of Pediatrics,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Nursingy Harrison International Peace Hospital,Hebei Province,Hengshui 053000,China;Department of Nursing,Affiliated Hospital of Hebei University,Baoding 071002,China;Department of Nursing,North China Petroleum General Hospital,Cangzhou 062552,China;Department of Gastroenterology,980 Hospital,People’s Liberation Army Joint Service,Shijiazhuang 050082,China)

机构地区：[1]河北医科大学第二医院儿科,石家庄050000 [2]河北衡水哈励逊国际和平医院护理部,衡水053000 [3]河北大学附属医院护理部,保定071002 [4]华北石油总医院护理部,沧州062552 [5]解放军联勤保障部队第九八〇医院消化内科,石家庄050082

出　　处：《中华现代护理杂志》2019年第29期3733-3738,共6页Chinese Journal of Modern Nursing

基　　金：河北省卫计委2018年度医学科学研究重点课题项目(20180297)。

摘　　要：目的观察使用外周静脉留置针致静脉损伤的相关因素,从而指导临床静脉留置针的合理使用,以避免静脉损伤,促进血管恢复.方法本次研究在5家三级甲等医院开展,各家医院随机抽取消化内科、肾内科、肝胆外科、腺体外科和呼吸内科中的1个科室作为研究科室,选择2018年3-6月收治的住院患者,在符合入组条件且经患者同意下整体纳入研究.本次研究共成功留置和观察符合条件的外周静脉留置针输液的患者共有81例.遵医嘱按医院科室规定使用外周静脉留置针输液,对入组患者安排固定的专人记录患者输入液体、评估穿刺前留置针穿刺部位及穿刺前静脉血管评估结果.观察并记录留置针拔除原因、拔针时通畅情况、留置时间、标记留置静脉、评估并记录留置针穿刺部位表现及静脉炎级别并记录.在拔针后第14天对静脉血管的弹性、血管充盈度恢复情况进行评估记录.结果(1)静脉留置针拔针时,局部静脉炎的严重程度与血管损伤程度呈正相关;拔针时局部症状为Ⅰ级静脉炎者,中重度血管损伤发生率9.09%;拔针时局部症状为Ⅱ级及Ⅲ级静脉炎者,中重度血管损伤发生率95.83%;两组中重度血管损伤发生率比较差异有统计学意义(P<0.01).(2)非症状拔除静脉留置针后穿刺静脉无中重度血管损伤发生,血管恢复率100.00%;以症状拔除静脉留置针的穿刺静脉中重度血管损伤发生率为42.37%,血管恢复率57.63%;两组相比静脉损伤与恢复发生率差异有统计学意义(P<0.01).(3)在本次临床研究时间内,静脉留置针留置时间与静脉炎发生率及血管损伤与恢复率差异无统计学意义(P>0.05).结论外周静脉留置针输液后静脉炎是造成血管损伤、影响静脉恢复的主要原因.临床穿刺与使用静脉留置针时应做好预防感染措施;留置针的拔除不应仅依据留置时间;对使用中的留置针应按规定评估穿刺部位的症状�Objective To observe the correlation factors of venous injury caused by peripheral intravenous indwelling catheter,so as to guide the rational use of clinical intravenous indwelling catheter,so as to avoid venous injury and promote vascular recovery.Methods This study was carried out in five ClassⅢGrade A hospitals.In each hospital,we randomly selected one of the departments:Digestive Internal Medicine,Nephrology,Hepatobiliary Surgery,Extraglandular Surgery and Respiratory Medicine as the research departments.The inpatients admitted from March to June 2018 were selected and included in the study as a whole with the consent of the patients.In this study,81 qualified patients were successfully injected with the peripheral intravenous indwelling catheter infusion and observed.According to the prescription of the doctors and hospital department policies,peripheral intravenous indwelling catheter was used for infusion.Specialists were arranged to record the patients'infused solution,evaluate the puncture site of the indwelling catheter before puncture and the results of venous blood vessel evaluation before puncture.Observe and record the reasons for the removal of indwelling catheter,the patency during the removal,the indwelling time,the marking of indwelling vein,evaluate and record the condition of the puncture site of indwelling catheter and the grade of phlebitis.The elasticity and filling degree of venous vessels were evaluated and recorded on the 14th day after catheter removal.Results (1)The severity of local phlebitis was positively correlated with the severity of vascular injury when removing intravenous indwelling catheter;the incidence of moderate and severe vascular injury was 9.09%when local symptoms were gradeⅠphlebitis;the incidence of moderate and severe vascular injury was 95.83%when local symptoms were gradeⅡandⅢphlebitis when removing intravenous indwelling catheter;and there was statistical difference in the incidence of moderate and severe vascular injury between the two groups(P<0.01).(2

关 键 词：静脉炎 外周静脉留置针 血管恢复 血管损伤 留置时间 拔管指征 

分 类 号：R47[医药卫生—护理学]