肿瘤内科中心静脉置管3859例护理总结及体会
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摘要
目的分析经锁骨下中心静脉置管并发症的发生率及其构成、季节分布特点等,进而为并发症的防控提供依据。方法选取盐城市第二人民医院肿瘤内科八病区2000年7月至2013年7月住院患者,按临床技术操作规范经锁骨下穿刺中心静脉置管3 859例,配合全程护理,并分析并发症的相关因素,探讨其防控措施。结果置管成功率:共穿刺3 888例,置管成功3 859例(99.25%)。感染的构成:共发生感染89例(2.31%),其中,局部感染65例(1.68%)、血液感染5例(0.13%)、可疑血液感染17例(0.44%)、局部合并血液感染2例(0.05%)。其中以局部感染发生率最高(P<0.001)。感染的季节性差异:第3季度显著高于第1、2、4季度(P值分别为0.022、<0.001、0.001)。葡萄糖酸氯己定消毒液优于碘伏(P <0.001)。机械性并发症:穿刺损伤性119例(3.08%)、导管异位44例(1.14%)、导管不畅性53例(1.37%)、固定不牢性84例(2.18%)、血液返流至导管20例(0.52%)、拔管困难及拔管时出血各1例(0.03%)、敷贴过敏23例(0.60%)。无并发症相关性死亡。结论肿瘤内科经锁骨下中心静脉置管成功率高,感染发生率较低,机械性并发症虽然种类较多,但每种的发生率很低且不严重。选择最佳消毒液,提高操作技能,严控并发症相关的危险因素,配合并强化全程护理,并发症可防可控。
Objective To analyze the incidence and composition of complications of subclavian central venous catheter in the Department of Oncology, the characteristics of seasonal distribution and so on,and then provide the basis for prevention and control of complications. Methods To select the hospitalized patients from July 2000 to July 2013 in Yancheng Second People′s Hospital Eighth Department of Oncology,and according to the clinical technical standard, 3 859 cases are treated by subclavian puncture central venous catheterization, and cooperate with the whole course nursing. Analyzing the related factors of complications,and discussing its prevention and control measures. Results Catheterization success rate: there were 3 888 cases of puncture in total, and 3 859 catheter cases(99.25%) were succeeded. Infection rate and composition:a total of 89 cases(2.31%) were infected, including 65 cases(1.68%) of local infection, 5 cases(0.13%)of blood infection, 17 cases(0.44%) of blood infection suspicious, and 2 cases(0.05%) of local infection combined with blood infection. The local infection is the higheset(P < 0.001). The infection rate of autumn is higher than spring, summer, and winter(P=0.022、< 0.001、0.001, separately). Chlorhexidine gluconate disinfectant is superior to iodophor(P < 0.001). Mechanical complications: Puncture injury in 119 cases(3.08%), 44(1.14%) cases of ectopic catheter, catheter is not smooth in 53 cases(1.37%), fixation in 84 cases(2.18%), the blood flow back into the catheter in 20 cases(0.52%), the difficulty in decannulation and extubation hemorrhage in 1 cases(0.03%) respectively, 23 cases(0.60%) had allergy to dressing. No complications related to death. Conclusions The success rate of subclavian vein catheterization in the internal medicine oncology is high, the incidence of infection is low. Although there are many kinds of mechanical complications, the incidence of each complication is very low and not serious. Select the best disinfectant, improve the operation skills, and strictly control the risk factors associated with complications,combined with the strengthening of the whole process of care, complications can be controlled.
Objective To analyze the incidence and composition of complications of subclavian central venous catheter in the Department of Oncology, the characteristics of seasonal distribution and so on,and then provide the basis for prevention and control of complications. Methods To select the hospitalized patients from July 2000 to July 2013 in Yancheng Second People′s Hospital Eighth Department of Oncology,and according to the clinical technical standard, 3 859 cases are treated by subclavian puncture central venous catheterization, and cooperate with the whole course nursing. Analyzing the related factors of complications,and discussing its prevention and control measures. Results Catheterization success rate: there were 3 888 cases of puncture in total, and 3 859 catheter cases(99.25%) were succeeded. Infection rate and composition:a total of 89 cases(2.31%) were infected, including 65 cases(1.68%) of local infection, 5 cases(0.13%)of blood infection, 17 cases(0.44%) of blood infection suspicious, and 2 cases(0.05%) of local infection combined with blood infection. The local infection is the higheset(P < 0.001). The infection rate of autumn is higher than spring, summer, and winter(P=0.022、< 0.001、0.001, separately). Chlorhexidine gluconate disinfectant is superior to iodophor(P < 0.001). Mechanical complications: Puncture injury in 119 cases(3.08%), 44(1.14%) cases of ectopic catheter, catheter is not smooth in 53 cases(1.37%), fixation in 84 cases(2.18%), the blood flow back into the catheter in 20 cases(0.52%), the difficulty in decannulation and extubation hemorrhage in 1 cases(0.03%) respectively, 23 cases(0.60%) had allergy to dressing. No complications related to death. Conclusions The success rate of subclavian vein catheterization in the internal medicine oncology is high, the incidence of infection is low. Although there are many kinds of mechanical complications, the incidence of each complication is very low and not serious. Select the best disinfectant, improve the operation skills, and strictly control the risk factors associated with complications,combined with the strengthening of the whole process of care, complications can be controlled.
引文
[1]何续逊,孙雪琴,夏月琴,等.肿瘤内科深静脉置管3 930例临床应用分析[J/CD].中华介入放射学电子杂志, 2017, 5(3):162-165.
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[5]蔺英,杨梅,杨舒曼,等.老年结直肠癌患者术后PICC置管化疗的临床观察及护理[J/CD].中华结直肠疾病电子杂志, 2015,4(6):673-676.
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[9]龚翠平,胡潳潳,张蓉.肿瘤患者中心静脉置管医院感染因素分析及管理对策[J].河北医学, 2013, 19(8):1257-1259.
[10]刘艳琴.肿瘤内科患者经锁骨下中心静脉置管感染因素及防护措施[J].现代诊断与治疗, 2014, 25(7):1661-1662.
[11]孙雪琴,何续逊,朱寒贫,等.肿瘤患者经锁骨下中心静脉置管伴发感染的相关因素分析[J].临床肿瘤学杂志, 2009, 14(3):249-251.
[12]中华医学会重症医学分会.血管内导管相关性感染的预防与治疗指南(2007)[J].中华内科杂志, 2008, 47(8):691-699.
[13]马坚,胡必杰.导管相关性血流感染的预防控制指南2011年版本[J].中华医院感染学杂志, 2011, 21(12):2648-2650.
[14]孙雪琴,何续逊,朱寒贫,等.敷料在中心静脉置管中的临床应用现状[J].实用临床医药杂志, 2011, 15(8):91-93.
[15]孙雪琴,何续逊,夏月琴,等.经锁骨下中心静脉置管机械性并发症分析及对策探讨[J].中国医学创新, 2009, 6(35):30-32.
[2]中华医学会.临床技术操作规范?肿瘤学分册[M].北京:人民军医出版社, 2006:23-24.
[3]何续逊,孙雪琴.经锁骨下中心静脉置管的技术改进及经验探讨[J].交通医学, 2009, 23(1):50-51, 53.
[4]何续逊,孙雪琴,夏月琴,等.肿瘤内科中心静脉置管临床应用价值的探讨[J].中国临床研究, 2014, 27(4):436-438.
[5]蔺英,杨梅,杨舒曼,等.老年结直肠癌患者术后PICC置管化疗的临床观察及护理[J/CD].中华结直肠疾病电子杂志, 2015,4(6):673-676.
[6]茅培英译.预防中心静脉插管的并发症(综述)[N].中国医学论坛报, 2003-03-20:17-19.
[7]谭冠先.经皮中心静脉置管术基础与临床[M].人民卫生出版社,2007:154-160.
[8]张晓霞,陈惠蓉,付岚,等.肿瘤患者中心静脉置管相关性感染的研究[J].中国循证医学杂志, 2011, 11(11):1259-1261.
[9]龚翠平,胡潳潳,张蓉.肿瘤患者中心静脉置管医院感染因素分析及管理对策[J].河北医学, 2013, 19(8):1257-1259.
[10]刘艳琴.肿瘤内科患者经锁骨下中心静脉置管感染因素及防护措施[J].现代诊断与治疗, 2014, 25(7):1661-1662.
[11]孙雪琴,何续逊,朱寒贫,等.肿瘤患者经锁骨下中心静脉置管伴发感染的相关因素分析[J].临床肿瘤学杂志, 2009, 14(3):249-251.
[12]中华医学会重症医学分会.血管内导管相关性感染的预防与治疗指南(2007)[J].中华内科杂志, 2008, 47(8):691-699.
[13]马坚,胡必杰.导管相关性血流感染的预防控制指南2011年版本[J].中华医院感染学杂志, 2011, 21(12):2648-2650.
[14]孙雪琴,何续逊,朱寒贫,等.敷料在中心静脉置管中的临床应用现状[J].实用临床医药杂志, 2011, 15(8):91-93.
[15]孙雪琴,何续逊,夏月琴,等.经锁骨下中心静脉置管机械性并发症分析及对策探讨[J].中国医学创新, 2009, 6(35):30-32.