血液病患者PICC导管异位风险评估体系的构建  

Construction of a risk assessment system for PICC catheter malposition in hematology patients

作　　者：李昕砾 王俐 郭洁 绳建丽 魏沅伯 徐丽 解文君 张慧敏 Li Xinli;Wang Li;Guo Jie;Sheng Jianli;Wei Yuanbo;Xu Li;Xie Wenjun;Zhang Huimin(State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Haihe Laboratory of Cell Ecosystem,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China;Tianjin Institutes of Health Science,Tianjin 301600,China)

机构地区：[1]中国医学科学院血液病医院(中国医学科学院血液学研究所)、血液与健康全国重点实验室、国家血液系统疾病临床医学研究中心、细胞生态海河实验室,天津300020 [2]天津医学健康研究院,天津301600

出　　处：《中国实用护理杂志》2025年第6期466-472,共7页Chinese Journal of Practical Nursing

基　　金：中国医学科学院临床与转化医学研究专项(2021-I2M-C&T-B-085)。

摘　　要：目的构建血液病患者经外周静脉置入中心静脉导管(PICC)导管异位风险因素评估体系,为血液病患者中心静脉血管通路异位预防提供参考依据。方法自2022年7月成立课题研究小组,通过文献回顾,检索PubMed、Web of Science等国内外数据库及网站中发表的与PICC导管异位风险相关的文献,经全文筛选和提取,纳入血液病患者PICC导管异位风险评估体系条目池;通过进一步课题组专家讨论,结合循证依据,拟定体系函询条目;采用Delphi专家函询法,构建适用于血液病患者的PICC导管异位风险的评估体系标准。结果邀请25名函询专家:女24名,男1名,年龄(48.36±6.82)岁。经过2轮专家函询和修订,得出血液病患者PICC导管异位风险因素包含4项Ⅰ级指标:患者因素、治疗因素、导管相关因素、操作因素,11项Ⅱ级指标,25项Ⅲ级指标。2轮专家函询问卷有效回收率分别为84%、100%;Kendall协调系数分别为0.22和0.55(均P<0.05);专家权威系数为0.93。结论血液病患者PICC导管异位风险评估体系专家认可度高,一致性好,具有临床实践与指导价值。ObjectiveTo construct an evaluation system for the risk factors of PICC catheter malposition in patients with hematological diseases,providing a reference for the prevention of central venous access malposition in these patients.MethodsFrom July 2022,a literature review was conducted to retrieve literature published in database and website such as PubMed,Web of Science domestically and internationally related to the risk assessment system of PICC catheter malposition in hematology patients.After full-text screening and extraction,the articles were included in the system′s item pool.Through further discussions among the research group′s experts,in conjunction with evidence-based findings,the system′s consultation items were formulated.Using the Delphi expert consultation method,a standard for PICC catheter malposition risk assessment system applicable to hematology patients was ultimately formulated.ResultsIn this study,25 experts were invited for consultation:24 females and 1 male,with an average age of(48.36±6.82)years.After two rounds of expert consultations and revisions,the risk factors for PICC catheter malposition in hematology patients were identified to include 4 first-level indicators:patient factors,treatment factors,catheter-related factors,and operational factors,along with 11 second-level indicators and 25 third-level indicators.The positive coefficients of the experts in the two rounds of consultations were 84%and 100%,respectively;the Kendall coordination coefficients were 0.22 and 0.55(both P<0.05);and the expert authority coefficient was 0.93.ConclusionsThe risk assessment scale for PICC catheter malposition in patients with hematological diseases has high expert recognition and good consistency,and has clinical practice and guiding value.

关 键 词：德尔菲技术 导管插入术 中心静脉 导管异位 风险评估 评价指标 

分 类 号：R47[医药卫生—护理学]