住院患者意外拔(脱)管临床特征分析及对策

The characteristics for unplanned extubation of inpatients and prevention strategies

目的分析意外拔(脱)管的临床特征及发生原因,探讨预防对策。方法调查2007年1-12月住我院意外拔(脱)管患者的一般情况、发生原因及采取的护理措施情况等。结果胃肠减压管、鼻饲管和深静脉置管的意外拔(脱)管分别占发生总数的30.91%、29.09%和16.36%;清醒患者占60.00%;发生在夜班占76.36%;在神经内、外科和ICU的占60.00%;患者自拔占78.18%;管道固定松脱占10.91%;拔管前未准确使用约束或约束替代方法的占25.45%。结论加强易拔(脱)管道、重点患者和重点时段管理,实行管道分类标志与管理、提高患者和家属自护能力与改进约束流程等可有效预防意外拔(脱)管的发生。

Objective To analyze characteristics and risk factors of unplanned extubation（UE） in hospitalized patients and develop prevention strategies. Methods A total of 55 cases with unplanned extubations in our hospital in 2007 were analyzed. Some clinical information of patients and circumstances of UE were collected by reviewing medical records and incident reports of unplanned extubafion. Results Among the 55 cases,30.91% of them had gastrointestinal decompression tube, 29.09% had nasal feeding tube and 16.36% had central venous catheters; 60% UE occurred in conscious patients; 76.36% occurred at night; 60.00% occurred in the department of neurology,neurosurgery and ICU; 78.18% were self-extubations of patient; 10.91% occurred In the patients with the tubes loosed and 25.45% in patients who not been correctly constrainted or treated. Conclusions Strengthen the management of easily removed tube, important patients especially at nighttime ,execution of sorting mark and management of the tubes,enhance the self-nursing abilities of the patients and their family members,improvement of the flow of patients constraint, these measurements will effectively prevent the occurrence of UE.