基于FMEA模式的风险管理在大面积烧伤患儿PICC置管中的应用价值  

Application value of risk management based on FMEA model in PICC placement in children with large-area burns

作　　者：王媛媛 马蕾[1] WANG Yuan-yuan;MA Lei(Department of Burns and Plastic Surgery,Children s Hospital of Nanjing Medical University,Nanjing 210000,Jiangsu,China)

机构地区：[1]南京医科大学附属儿童医院烧伤整形科,江苏南京210000

出　　处：《川北医学院学报》2024年第11期1572-1575,1584,共5页Journal of North Sichuan Medical College

基　　金：南京医科大学科技发展基金(NMUB20210088)。

摘　　要：目的:分析基于失效模式-效应分析(FMEA)模式的风险管理在大面积烧伤患儿外周穿刺中心静脉导管置管(PICC)中的应用价值。方法:大面积烧伤患儿,按1∶1进行倾向性匹配评分,共112例(56对)纳入研究,按照护理方式不同分为干预组(基于FMEA模式的风险管理)和对照组(常规护理方法管理)。比较两组患儿置管效果、并发症、血管损伤及感染指标、护理满意度。结果:干预组一次穿刺成功率、一次置管成功率均高于对照组(P<0.05);置管操作时间、PICC留置时间均较对照组缩短(P<0.05);非计划性拔管率低于对照组(P<0.05);干预组PICC相关并发症发生率低于对照组(P<0.05);干预后,干预组血管扩张反应(FMD)高于对照组(P<0.05),而内皮微粒(EMPs)、C反应蛋白(CRP)、降钙素原(PCT)均低于对照组(P<0.05);干预组患儿家属护理满意度高于对照组(P<0.05)。结论:基于FMEA模式的风险管理应用于大面积烧伤患儿PICC置管中有较好价值,值得在临床推广。Objective:To analyze the application value of risk management based on Failure Mode and Effects Analysis(FMEA)model in peripherally inserted central catheter(PICC)placement in children with large-area burns.Methods:Children with large-area burns were reviewed and propensity-matched scoring was performed at a 1∶1 ratio.A total of 112 cases(56 pairs)were included in the study,and assigned to the intervention group(FMEA-based risk management)and the control group(conventional nursing management)according to the different nursing methods.Catheterization effects,complications,vascular injury,infection indicators and nursing satisfaction were compared between groups.Results:Comparison between groups found that the success rates of one-time puncture and one-time catheterization in the intervention group were higher(P<0.05).The operation time of catheterization and PICC indwelling time in the intervention group was shorter(P<0.05).The unplanned extubation rate in the intervention group was lower(P<0.05).The incidence of PICC-associated complications in the intervention group was lower than that in the control group(P<0.05).After intervention,flow-mediated vasodilation(FMD)in the intervention group was higher(P<0.05).Endothelial microparticles(EMPs),C-reactive protein(CRP)and procalcitonin(PCT)were lower than those in the control group(P<0.05).The nursing satisfaction rate of family members in the intervention group was higher than that in the control group(P<0.05).Conclusion:Risk management based on FMEA model is beneficial for children with large area burns undergoing PICC catheterization,it is worthy of clinical promotion.

关 键 词：FMEA模式 风险管理 大面积烧伤 外周穿刺中心静脉导管置管 

分 类 号：R473.72[医药卫生—护理学]