《儿童动脉血气分析临床操作实践标准》采血流程的实施研究  

Implementation research on the blood collection process of Clinical Practice Standards for Arterial Blood Gas Analysis in Children

作　　者：庄文鹰 杨玉霞[1] 顾莺 胡静 沈伟杰[1] 陈伟明[1] 陆春香 ZHUANG Wenying;YANG Yuxia;GU Ying;HU Jing;SHEN Weijie;CHEN Weiming;LU Chunxiang(Pediatric Intensive Care Unit,Children's Hospital of Fudan University,Shanghai,201102,China)

机构地区：[1]复旦大学附属儿科医院儿童重症监护病房,上海市201102 [2]复旦大学附属儿科医院护理部,上海市201102

出　　处：《中国护理管理》2022年第11期1623-1629,共7页Chinese Nursing Management

基　　金：2022年度市级医院诊疗技术推广及优化管理项目(原临床科技创新项目)(SHDC22022221);2021年上海市“医苑新星”青年医学人才培养资助计划(沪卫人事〔2022〕65号)。

摘　　要：目的:基于探索-预备-实施-持续模型进行《儿童动脉血气分析临床操作实践标准》(以下简称《标准》)推荐的动脉留置导管采血流程的实施研究,并评价《标准》的实用性和有效性。方法:《标准》实施前后共纳入652人次外周动脉留置导管采血的实践行为及86名医护人员,进行质量审查,分析实施过程中的障碍因素,拟定相应的对策。比较某三级甲等儿童专科医院重症监护病房《标准》实施前后医护人员采血行为依从性、知信行水平、采血效果、动脉导管留置时间及并发症情况。结果:与《标准》实施前相比,实施后,22项审查指标中12项依从性较差的审查指标执行率有提高(P<0.05);医护人员对于实践标准推荐的动脉留置导管采血行血气分析的知信行水平均有提高(P<0.05);采血时长缩短(P<0.05),动脉血气标本缺陷率、医护人员血液暴露发生率降低(P<0.05);动脉导管留置时间延长(P<0.05),导管堵塞的发生率降低(P<0.05)。结论:《标准》的实施可规范医护人员的行为,延长外周动脉导管留置时间,改善采血效果,降低外周动脉导管相关并发症的发生率,值得临床应用与推广。Objective:To study the implementation of arterial indwelling catheter blood collection process recommended by Clinical Practice Standards for Arterial Blood Gas Analysis in Children based on Exploration,Preparation,Implementation,Sustainment(EPIS)framework,and to evaluate its practicability and effectiveness.Methods:Before and after the implementation of the practice standard,a total of 652 patients with indwelling peripheral arterial catheters for blood collection and 86 medical staff were included to conduct quality review,analyze the obstacles in the implementation process,and formulate corresponding countermeasures.To compare the compliance,knowledge,attitude and behavior,blood collection effect,indwelling time of arterial catheter and complications of medical staff before and after the implementation in Pediatric Intensive Care Unit of a tertiary grade A children's hospital.Results:After the implementation,12 of the 22 review indicators with poor compliance were significantly improved(P<0.05);the knowledge,attitude and behavior of medical staff for blood gas analysis with arterial indwelling catheter recommended by the practice standard were significantly improved(P<0.05);blood collection time was shortened(P<0.05),arterial blood gas specimen defect rate and blood exposure rate of medical staff were decreased(P<0.05);the indwelling time of ductus arteriosus was prolonged(P<0.05),and the incidence of catheter blockage was decreased(P<0.05).Conclusion:The implementation of the practice standard can regulate the behavior of medical staff,prolong the indwelling time of peripheral arterial catheter,improve the blood collection effect,and reduce the incidence of complications related to peripheral arterial catheter,which is worthy of clinical application.

关 键 词：儿童 动脉血气分析 实践标准 实施研究 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]