中心静脉通路装置相关性皮肤损伤预防方案 在门诊经外周静脉置入中心静脉导管患者中的多中心应用研究  

Multicentered Application of a Prevention Programme on Central Venous Access Device-associated Skin Impairment Among PICC Outpatients

作　　者：祝薇 杨益群[2] 刘明红[3] 卫雯诗 杨靖华[4] 姚建琴 李莉[6] 肖雪月[7] 赵敏艳[8] 瞿红 屈惠琴[10] ZHU Wei;YANG Yiqun;LIU Minghong;WEI Wenshi;YANG Jinghua;YAO Jianqin;LI Li;XIAO Xueyue;ZHAO Minyan;QU Hong;QU Huiqin(School of Nursing,Suzhou Medical College,Soochow University,Suzhou 215006,Jiangsu Province,China;Department of Nursing,Dushu Lake Hospital,Soochow University,Suzhou 215000,Jiangsu Province,China;Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China;Department of Nursing,Jiangyin People’s Hospital,Wuxi 214400,Jiangsu Province,China;Department of Nursing,Suzhou Municipal Hospital East Region,Suzhou 215001,Jiangsu Province,China;Department of Outpatient Medicine,Changshu Second People’s Hospital,Suzhou 215501,Jiangsu Province,China;Intravenous Therapy Clinic,Affiliated Hospital of Jiangnan University,Wuxi 214000,Jiangsu Province,China;Department of Oncology,The Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu Province,China;Department of Nursing,The Ninth People’s Hospital of Suzhou,Suzhou 215299,Jiangsu Province,China;Department of Surgical Oncology,Kunshan Hospital of Traditional Chinese Medicine,Suzhou 215399,Jiangsu Province,China)

机构地区：[1]苏州大学苏州医学院护理学院,江苏苏州215006 [2]苏州大学附属独墅湖医院护理部,江苏苏州215000 [3]苏州大学附属第一医院血液科,江苏苏州215006 [4]江阴市人民医院护理部,江苏无锡214400 [5]苏州市立医院东区护理部,江苏苏州215001 [6]常熟市第二人民医院门诊部,江苏苏州215501 [7]江南大学附属医院静脉治疗护理门诊,江苏无锡214000 [8]苏州大学附属第二医院肿瘤科,江苏苏州215004 [9]苏州市第九人民医院护理部,江苏苏州215299 [10]昆山市中医医院肿瘤外科,江苏苏州215399

出　　处：《军事护理》2023年第12期30-33,80,共5页MILITARY NURSING

基　　金：苏州市科技发展计划项目(SYSD-2019098);苏州大学附属第一医院护理科研项目(HLYJ-2020-03)。

摘　　要：目的探讨中心静脉通路装置(central venous access device,CAVD)相关性皮肤损伤(CAVD-associated skin impairment,CASI)预防方案在门诊经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)患者中的应用效果。方法便利抽样法选取苏州市、无锡市8所三级综合医院门诊行PICC维护的1043例患者为研究对象并采用整群随机对照试验。其中4所医院为对照组,给予PICC常规护理;4所医院为试验组,在常规护理基础上予以CASI预防方案。干预6个月后,比较两组患者CASI发生率、医用粘胶相关性皮肤损伤(medical adhesive-related skin injury,MARSI)及医疗器械相关压力性损伤(medical device related pressure ulcers,MDRPU)发生率和严重程度、血管导管相关感染率和非计划拔管率的差异。结果试验组CASI、MARSI及MDRPU发生率均低于对照组(均P<0.05),两组MARSI、MDRPU严重程度及非计划拔管率无统计学差异(均P>0.05)。两组均未发生血管导管相关感染。结论实施CASI预防方案有利于降低PICC门诊患者CASI的发生率,为临床护士预防CASI提供实践指导。Objective To explore the effect of application of a prevention programme on central venous access device-associated skin impairment among PICC Outpatients.Methods From September 2020 to March 2021,a total of 1043 patients who underwent PICC maintenance in the PICC clinics of eight tertiary hospitals in Suzhou and Wuxi were selected as the objects of a cluster randomized controlled trial.Four hospitals were used as the control group,and patients recruited in the control group were given PICC routine care;four hospitals as the intervention group,given CASI prevention programme based on routine care.After six months of intervention,the incidence of central venous access device-associated skin impairment(CASI),the incidence and severity of medical adhesive-related skin injury(MARSI),medical device-related pressure ulcers(MDRPU),PICC unplanned removal rate and catheter-related infections were compared between the two groups.Results The incidence of CASI,MARSI,and MDRPU in the intervention group and the control group were statistically significant(all P<0.05).There were no significant differences between the severity of MARSI,MDRPU,and unplanned removal rates of the two groups.No catheter-related infections happened in either group.Conclusions Implementing evidence-based CASI prevention programme significantly reduces the incidence of CASI in PICC outpatients and provides a reference for clinical nurses to prevent CASI.

关 键 词：中心静脉通路装置 经外周静脉置入中心静脉导管 皮肤损伤 预防 医用粘胶相关性皮肤损伤 医疗器械相关压力性损伤 

分 类 号：R452[医药卫生—治疗学]