改良冲管方法预防肿瘤患者经外周置入中心静脉导管药物性堵管的护理

Effect of Improved Method of Washing Pipe on Preventing Pharmaceutical Catheter Blockage of Peripherally Inserted Central Catheter in Cancer Patients

目的探讨应用改良冲管方法预防经外周静脉置入中心静脉导管(PICC)输注大静脉营养液对导管堵塞的影响,分析导管堵塞因素及防护措施。方法将应用PICC输注乳剂大静脉营养液的肿瘤患者135例随机分为对照组(68例)及处理组(67例)。对照组用0.9%生理盐水100 ml冲管,频率为每隔6～8小时1次;处理组用0.9%生理盐水20 ml按照快-慢-快的方法脉冲式注射,每隔4小时1次。记录两组病例导管部分堵塞或全部堵塞发生的情况。结果对照组导管部分堵塞及全部堵塞发生率为13.2%,处理组为4.5%,两组比较差异具有显著性(P<0.001)。对照组1例因严重导管堵塞而拔管、1例发生静脉血栓;处理组无1例因导管堵塞而拔管,无1例发生静脉血栓。结论少量快-慢-快脉冲管方式及适当增加冲管频率是预防PICC输注大静脉营养液(药物性)堵管的有效措施;每天记录输液速度是早期发现导管堵塞的理想方法,彩色多普勒超声检查穿侧肢血管是早期发现静脉血栓的有效措施。

Objective To study the effect of improved method of washing pipe on preventing pharmaceutical catheter blockage of peripherally inserted central catheter （PICC） in intravenous nutrient liquid infusion through vena cava. Methods We randomly divided 135 cancer patients who received intravenous nutrient emulsion by PICC into the control （ n = 68 ） group and the experiment group （ n = 67 ）. In the control group, we routinely washed the pipe by 100 ml normal saline every 6 to 8 hours while in the experiment group we washed the pipe by 20 ml normal saline with the Jimpulse type of fast-slow-fast method every 4 hours. We recorded the infusion rate in ver- tical pressure every 4 hours and the situation of catheter partial blockage and complete blockage in the two groups. Result The rate of catheter partial blockage and complete blockage was 13.2% in control group and 4.5 % in the experiment group （ P 〈 0. 001 ）. Conclusions The impulse fast-slow-fast washing method with little saline and properly increasing the washing frequency are effective to prevent pharmaceutical catheter blockage of PICC in intravenous nutrient liquid infusion through vena cava. Recording the infusion rate daily is useful to identify early catheter embolism and examining the inserted blood vessels by colorful Doppler ultrasound is effective method to discover early venous thrombus.