重度烧伤患者静脉留置导管并发症的原因分析与预防策略

Assay and counter measure for complicatios after intravenous indwelling catheter in severe burn patient

【目的】探讨重度烧伤患者静脉留置导管并发症的原因,为临床护理提供实证依据。【方法】以回顾性分析的方法,总结我科2002年1月-2007年6月998例留置静脉导管重度烧伤患者中出现并发症资料,以非计划拔管、导管相关感染、导管堵塞、静脉栓塞、局部渗液、血肿为研究指标,探究并发症的发生与穿刺部位、导管类型的相关性。【结果】(1)998例留置静脉导管重度烧伤患者中发生并发症136例,发生率13.6%,其中非计划拔管83例、导管相关感染27例、导管堵塞15例、静脉栓塞3例、局部水肿4例、局部血肿4例。(2)并发症的构成比,以穿刺部位分:股静脉19.6%,锁骨下静脉7.8%,周围静脉6.5%。其中股静脉和锁骨下静脉的并发症差异有统计学意义(χ2=33.7,P<0.01);以导管类型分:双腔管19.1%,单腔管6.4%,PICC导管6.2%。其中双腔管和单腔管的并发症差异有统计学意义(χ2=38.3,P<0.01)。【结论】根据重度烧伤病人的特点,锁骨下静脉穿刺较股静脉穿刺为好;单腔管较双腔管为好;烧伤休克期、大手术及静脉高营养病人尽量用深静脉导管;康复期及长期输液的病人宜使用PICC导管。

[Objective] To explore the cause of complicatios after intravenous indwelling catheter in severe burn patient, and to present evidence for clinical nursing interventions. [Methods] Complications after intravenous indwelling catheter in 998 severe burn patients from 2002 January to 2007 June were analyzed retrospectively. Unplanned extubation, catheter related sepsis, catheter obstruction, phlebothrombosis, local fluid leakage, local hematoma were used as index to study the correlation between the incidence of the complications and puncture point, type of intravenous indwelling catheter. [Results] （1） 136 cases among 998 suffered from comphcations, the incidence was 13.0%. Among these, 83 cases were unplanned extubation; 27 cases were catheter related sepsis; 15 cases were catheter obstruction; 3 cases were phlebothrombosis; 4 cases were local fluid leakage; 4 cases were local hematoma. （2） According to puncture point, the proportion in complications were as following： femoral venous catheterization was 19.6%, infraclavicula venous catheterization was 7.8%, PICC was 6.5%. There was significant difference between femoral venous catheterization and internal jugular venous catheterization （ χ^2 = 33.7, P 〈 0.01）. According to the channel of intravenous indwelling catheter, the two-lumen central venous catheterization was 19.1%, single-lumen central venous catheterization was 6.4%, PICC was 6.2%. There was significant difference between the two-lumen central venous catheterization and the central venous catheterization （χ^2 = 38.3, P 〈 0.01）. [Conclusions] According to characteristics in severe burn patients femoral venous catheterization is better than infraclavicula venous catheterization, and the single-lumen central venous catheterization is better than the two-lumen central venous catheterization. Deep venous catheterization is indicated for shock stage after burn, major operation or IVH patients. PICC is indicated for long-term intravenous fluid infusion patients or during convalescence stage.