老年患者深静脉透析导管感染的治疗及护理

Therapy and Nursing Experience about Infection of Hemodialysis Catheter in Elderly Patients

目的分析老年维持性血液透析患者深静脉导管感染的相关因素,讨论治疗及预防措施。方法对我科2008年4月～2009年7月193例次深静脉置管的老年患者进行回顾性分析,观察置管类型、部位与导管相关性感染的关系,局部用药及管内使用抗生素的预防和治疗效果。结果193例次深静脉置管患者中,长期留置管感染发生率为1～1.5例次/1000导管日,颈内静脉导管感染发生率为3例次/1000导管日,股静脉导管感染发生率为5.7例次/1000导管日。感染人数中,6例经抗生素局部用药及封管治疗好转;2例出现血培养(+),予管内及全身使用抗生素治疗后,血培养(-),症状好转,导管继续使用;1例血培养为铜绿假单胞感染,经14天管内及全身抗生素治疗无效,予以拔管。结论严格无菌操作,加强个人卫生宣教及心理辅导可防止和降低导管感染的发生,早期发现导管感染及时有效使用抗生素治疗,能明显延长导管的使用时间。

Objective To analyze the relevant factors of deep venous catheter infection in elderly patients with maintenance hemodialysis and to discuss treatment and prevention measures. Methods A retrospective analysis was carried out in data of 193 times of elderly patients who were implanted deep venous catheter from April 2008 to July 2009 to observe the relation of type and site of catheter insertion and catheter-related infection, prevention and treatment effectiveness of local medication and using antibiotic in lumen of catheters. Results In data of 193 times of patients who underwent catheter insertion, incidence of infection of permanent catheter was 1 to 1.5 episodes per 1 000 catheter days, 3 episodes per 1 000 catheter days for jugular vein catheter, 5.7 episodes per 1 000 catheter days for femoral vein. 6 cases took a turn for the better by local medication with antibiotic and tube sealing with antibiotic. Blood culture was positive in 2 cases. After use of systemic antibiotic and antibiotic in lumen, blood culture was negative, symptoms took a turn for the better. Pseudomonas aeruginosa was cultured in 1 case. The catheter was drawn after an ineffective using of antibiotic systemic and through the lumen. Conclusion Strict aseptic technique, reinforcement of personal health education and psychological counseling can reduce incidence of catheter infection. Early detection of catheter infection and effective antibiotic treatment can obviously prolong indwelling period of catheter.