《心脏术后桡动脉置管拔管止血方案》的制订和临床应用

Development and application of the hemostasis scheme after extubation of radial artery catheter in patients undergoing heart surgery

目的通过建立《心脏术后桡动脉置管拔管止血方案》(简称《方案》),规范护士心脏术后桡动脉置管拔管止血方法,以期降低拔管后并发症发生率,提高按压止血效率,以及节约资源、减少医疗耗材。方法由病区护士长、责任组长、主管护师、护师组成《方案》小组,统计2011年1～6月我科桡动脉置管拔管后局部皮下出血率和血肿发生率,对15名临床护士进行调查,通过文献检索与临床实际相结合的方法,就拔管后按压面积、力度、材料及时间问题制订《方案》,并对护士培训。2011年7～12月对120例心脏术后需拔除桡动脉置管患者应用《方案》止血。对比实施《方案》前后局部皮下出血率和血肿发生率,检验该《方案》是否可行。结果应用《方案》后,心脏术后桡动脉置管拔管后局部皮下出血率由16.4%下降至5.8%;血肿发生率由8.5%下降至1.7%。结论《方案》有较好的规范临床操作的作用。

Objective To develop a hemostasis scheme after extubation of radial artery catheter in patients undergoing heart surgery,in order to give a guideline for nursing staff to standardize the extubation procedure to reduce the incidence of com plications after extubation, promote the efficiency of hemostasis and save medical resources. Methods A team composed of the head nurse,teamwork leaders,charge nurses and intermediate nurses was set up to analyze the incidence of subcutaneous hem- orrhage and hematoma after extubation of radial artery catheter from January 2011 to June 2011. Based on the results of investigation on 15 nurses and literature review,the scheme of hemostasis after extubation of radial artery catheter was developed focused on the press area,force,materials and time. The scheme was applied in 120 patients undergoing heart surgery from July 2011 to September 2011. The incidence of subcutaneous hemorrhage and hematoma after extubation was compared before and after the application of the scheme. Results After applying the scheme,the incidence of subcutaneous hemorrhage decreased from 16.4 percent to 5.8 percent,and the incidence of subcutaneous hematoma decreased from 8.5 percent to 1.7 percent. Conclusion The hemostasis scheme after extubation of radial artery catheter can standardize the nursing procedure for nursing staff.