腹膜透析护士导管出口处护理实践调查分析  

Investigation and analysis of catheter exit-site care by peritoneal dialysis nurses

作　　者：尹唱 廖玉梅[2] 张丽[2] 黄辉娥 YIN Chang;LIAO Yu-mei;ZHANG Li;HUANG Hui-e(Yangtze University Health Science Center,Hubei Province,Jingzhou 434023,China;Department of Nephrology,Peking University Shenzhen Hospital,Guangdong Province,Shenzhen 518000,China)

机构地区：[1]长江大学医学部,湖北荆州434023 [2]北京大学深圳医院肾内科,广东深圳518000

出　　处：《中国当代医药》2020年第12期151-155,共5页China Modern Medicine

基　　金：广东省深圳市卫生计生系统学科建设能力提升项目(SZXJ2017016);广东省深圳市三名工程项目资助(SZSM 201812097)。

摘　　要：目的了解腹膜透析(PD)患者导管出口处护理(以下简称“出口处护理”)的培训现状及PD护士出口处护理操作的实践情况,为制定PD出口处护理质量管理标准、持续质量改进提供依据。方法采用自行设计的护士版《腹膜透析导管出口处护理实践调查表》,通过问卷星和微信APP于2018年4~5月对广东省某沿海地区开设有PD门诊的10家医院中26名PD护士进行问卷调查。结果该地区开设有PD门诊的10家医院PD导管相关性感染平均发生率约为0.15次/年;10家医院中5家医院设有专职及兼职护士,另5家医院仅有兼职护士(由病房护士兼任)。26名PD护士中专职PD护士9人(34.62%),护患比约为1∶95.67;兼职PD护士17人(65.38%),护患比约为1∶37.76。专职护士培训患者的平均时间为(15.39±5.06)h,兼职护士培训患者的平均时间为(11.13±5.85)h;所有PD护士均会对患者进行再培训,其中13名PD护士再培训频率固定。92.31%的PD护士要求患者淋浴后进行出口处护理;84.62%的PD护士要求患者出口处感染时每天换药1次,其他换药频率更为频繁;只有2名PD护士要求患者每次换药时常规涂抹抗菌软膏预防感染。92.31%的PD护士能够完成出口处评估;73.08%的PD护士使用生理盐水+碘伏进行消毒换药;出口处成熟前和感染时,所有PD护士均会使用敷料覆盖出口处。结论目前该地区开展PD治疗的医院中一半医院处于起步发展阶段,医院间护患比差别较大,PD护士在患者培训方法、换药前出口处观察评估情况和换药时护理要点三个方面基本与《国际腹膜透析协会导管相关性感染指南》的建议保持一致,但换药时是否涂抹抗菌软膏预防感染与该指南存在差异,有待进一步深入研究。Objective To understand the training status of catheter exit-site care(hereinafter referred to as"exit-site care")in peritoneal dialysis(PD)patients and the condition of exit-site care by PD nurses,so as to provide basis for the establishment of management standards and continuous improvement on quality of PD exit-site care.Methods The nursing version of Peritoneal Dialysis Catheter Exit-site Care Questionnaire was designed by researchers.From April to May 2018,26 PD nurses in 10 hospitals with PD outpatient clinics in a coastal area of Guangdong Province were investigated through Questionnaire Star and WeChat APP.Results The average incidence of PD catheter-related infections in 10 hospitals with PD clinics in the area was about 0.15 times per year.Five of the ten hospitals had full-time and part-time nurses,and the other five hospitals had only part-time nurses(concurrently with ward nursing job).Among the 26 PD nurses,9 cases(34.62%)were full-time PD nurses,the ratio of full-time nurses to patients was approximately 1∶95.67,and 17 cases(65.38%)were part-time PD nurses,the ratio of part-time nurses to patients was approximately 1∶37.76.The average training time of each patient was(15.39±5.06)hours by full-time nurses,and that by part-time nurses was(11.13±5.85)hours.All the PD nurses would retrain patients,and among them the retraining frequency of 13 PD nurses was fixed.A total of 92.31%of the PD nurses required post-shower exit-site care,84.62%of the PD nurses required patients to change dressing once a day when the exit-site infections occurred,or even more frequently in other dressing changes.Only 2 PD nurses asked patients to routinely apply antibacterial ointment to prevent infections.Altogether 92.31%of the PD nurses could complete wound evaluation as suggested,73.08%of the PD nurses used normal saline and iodine for disinfection and dressing change,and all the PD nurses could use dressings to cover the exit-site before maturity and during infections.Conclusion At present,half of the hospitals in t

关 键 词：腹膜透析护士 导管出口处护理 培训 再培训 腹膜透析导管相关性感染 

分 类 号：R473[医药卫生—护理学]