静脉化疗标准化外渗管理方案的构建与实践  

Construction and practice of extravasation management project

作　　者：林源 徐春兰[1] 张成欢 张冉星 丁佳丽[1] 曹霞[1] 邢志花[1] LIN Yuan;XU Chunlan;ZHANG Chenghuan;ZHANG Ranxing;DING Jiali;CAO Xia;XING Zhihua(Department of Oncology,the First People's Hospital of Changzhou,Changzhou 213000,China;Deparatment of Nursing,the First People's Hospital of Changzhou,Changzhou 213000,China)

机构地区：[1]常州市第一人民医院肿瘤科,江苏常州213000 [2]常州市第一人民医院护理部,江苏常州213000

出　　处：《医药高职教育与现代护理》2022年第6期496-500,共5页Medical Higher Vocational Education and Modern Nursing

基　　金：常州一院护理专项预研项目(yy2018014)。

摘　　要：目的 提高护士静脉化疗外渗管理知识水平,降低患者安全隐患。方法 检索国内外循证数据库获取高质量证据并系统评定文献,结合临床情景分析构建静脉化疗标准化外渗管理方案,明确化疗前评估、化疗期管理以及外渗应急预案的路径化、具体化内容,并对护士进行2周的集中培训。统计2021年2月至11月在常州市第一人民医院肿瘤科7 873例静脉化疗患者(试验组)的中心静脉化疗比例、外渗发生率、外渗等级和引发的医疗纠纷例数,并与2020年2月至11月10 074例静脉化疗患者(对照组)比较,评价静脉化疗标准化外渗管理方案的应用效果。结果 方案培训后,护士外渗知识问卷和应急预案考核得分均有提高(P≤0.001);方案实施后,经中心静脉化疗患者比例提高(94.64%vs. 88.60%,P<0.001),静脉化疗外渗发生率下降(0.24%vs. 0.35%),纠纷发生减少,外渗发生隐患降低。结论 基于循证构建的静脉化疗标准化外渗管理方案临床实施可行性佳,医护患依从性好,临床效果满意。Objective To improve the level of nurses’ knowledge of extravasation management and reduce the potential safety hazard of extravasation in patients undergoing intravenous chemotherapy. Methods High quality evidence was obtained from domestic and foreign evidence-based databases and systematically evaluated. The evidence-based extravasation management project was developed and nurses were trained. 7 873 patients who received intravenous chemotherapy in the oncology department of Changzhou First People’s Hospital from February to November 2021 were seemed as experimental group, and 10 074 patients who received intravenous chemotherapy from February to November 2020 were seemed as control group, the application effect of standardized extravasation management of intravenous chemotherapy was evaluated, and the proportion of central venous chemotherapy, the rate of extravasation, extravasation grade and the number of medical disputes caused were compared. Results The scores of nurses’ extravasation knowledge and emergency plan examination were improved after training(P≤0.001). After the implementation of the program, the proportion of central venous chemotherapy was increased(94.64% vs. 88.60%,P<0.001), the incidence of extravasation(0.24% vs. 0.35%) and the occurrence of disputes were decreased, the hidden dangers of extravasation were reduced. Conclusions The evidence-based extravasation management project has good medical compliance, good clinical implementation feasibility, satisfied clinical effect.

关 键 词：化疗 外渗 循证 方案构建 临床实践 

分 类 号：R473.73[医药卫生—护理学]