三级儿童专科医院住院患儿外周留置针应用现状及其并发症风险因素分析  

Current status and complications risk analysis on the utilization of peripheral intravenous catheters in hospitalized children in ClassⅢchildren's specialized hospitals

作　　者：吴心怡[1] 白志媛[2] 徐洋 冯俊[4] 俞珍[5] 叶雪芬 宇亚娟[7] 刘海蓉 Wu Xinyi;Bai Zhiyuan;Xu Yang;Feng Jun;Yu Zhen;Ye Xuefen;Yu Yajuan;Liu Hairong(Nursing Department,National Center for Children's Health,China,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China;Department of Traditional Chinese Medicine,National Center for Children's Health,China,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China;Nursing Department,Harbin Children's Hospital,Harbin 150010,China;Department of Hematology,Kunming Children's Hospital,Kunming 650034,China;Nursing Department,Children's Hospital of Soochow University,Suzhou 215025,China;Infusion Room,Hangzhou Children's Hospital,Hangzhou 310014,China;NICU,Changchun Children's Hospital,Changchun 130061,China;Nursing Department,Shunyi Women's and Children's Hospital of Beijing Children's Hospital,Beijing 101320,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院护理部,100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院中医科,100045 [3]哈尔滨市儿童医院护理部,150010 [4]昆明市儿童医院血液科,650034 [5]苏州大学附属儿童医院护理部,苏州215025 [6]杭州市儿童医院输液室,310014 [7]长春市儿童医院NICU,130061 [8]北京儿童医院顺义妇儿医院护理部,101320

出　　处：《中华现代护理杂志》2020年第1期21-25,共5页Chinese Journal of Modern Nursing

摘　　要：目的调查三级儿童专科医院住院患儿的外周留置针使用现状,以期发现留置针使用中存在的问题,为临床护士及护理管理者提升儿科静脉治疗质量,规避护理风险提供参考。方法本研究采用现场调查法,于2018年7月23—31日,首先通过方便抽样法在全国23个省、直辖市、自治区抽取25家三级儿童专科医院;其次采用整群抽样的方法,以当日入住该医院的所有置有留置针的患儿为调查对象。采用自行设计儿童患者静脉治疗横断面调查表进行调查,并对图像和资料进行分析。采用SPSS 17.0软件进行统计学分析。结果本研究共调查了8635例外周留置针患儿,使用率占所有静脉穿刺工具的86.9%(8635/9942),其中穿刺部位选择手背者4665例(54.0%),头部1234例(14.3%);安全型留置针仅占45.8%(3954/8635);54.6%(4712/8635)的留置针为非邻苯二甲酸二(2-乙基)己酯(DEHP)产品,留置针留置期间并发症的发生率为7.9%(682/8635)。单因素分析及多因素Logistic回归多因素分析结果显示,留置针留置时间、穿刺部位、敷料固定是否存在问题、导管维护是否存在问题以及患儿年龄是患儿留置针并发症发生的风险因素(P<0.05)。结论外周留置针在儿童患者中应用广泛,穿刺部位以手背为主,其次为头部和腕关节。在留置针的材质及类型选择方面尚需改进,以保证儿科静脉治疗的安全性。留置针留置期间需采取护理措施早期识别风险因素并进行有效干预,从而降低并发症的发生。Objective To investigate the utilization of peripheral intravenous catheter(PIVC)in hospitalized children in ClassⅢspecialized children's hospitals,aiming to discover existing issues of PIVC in order to provide reference for clinical nurses and nurse administer to improve the quality on intravenous therapy and to avoid potential risk.Methods This study uses the field survey method.From July 23rd to 31st,2018,25 ClassⅢchildren's specialized hospitals were first sampled in 23 provinces,municipalities,and autonomous regions of the country by the convenient sampling method.The cluster sampling method was then used to select all the pediatric patients with PIVCs admitted to the hospital on the date of investigation.A self-designed'Cross-sectional Questionnaire for Pediatric Patients with PIVC'was used for survey,and images and data were analyzed.SPSS 17.0 software was used to statistically analyze the data.Results In this study,8635 cases of PICVs were investigated,and the utilization rate of PICVs accounted for 86.9%(8635/9942)of all venipuncture tools.Among these cases,4665(54.0%)cases'puncture sites were at the dorsal side of the hand,and 1234(14.3%)were at the head.Among the PIVCs,45.8%(3954/8635)were safety PIVCs.And 54.6%(4712/8635)of the PIVCs were di(2-ethylhexyl)phthalate(DEHP)free products.The incidence rate of PICV related complications was 7.9%(682/8635).Univariate analysis and multivariate logistic regression analysis showed that the PIVC time,IV site,dressing fixation problems,catheter maintenance problems,and patient age were risk factors for PIVC related complications(P<0.05).Conclusions PIVC is the widely used among pediatric patients.The IV site is mainly at the dorsal side of the hand,followed by head and wrist.The selection of material and type of PIVC still require further improvement to ensure the safety of pediatric intravenous therapy.Nursing measures should be taken during the use of PIVC to identify the risk factors at early stage and intervene effectively,which can reduce the occurrence

关 键 词：儿童 并发症 外周留置针 风险因素 

分 类 号：D66[政治法律—政治学] R19[政治法律—中外政治制度]