应用失效模式和效果分析降低经外周静脉中心静脉导管置管风险的研究

Study on application of failure mode and effect analysis in reducing the risk of peripherally inserted central catheter

目的应用失效模式和效果分析降低经外周置人中心静脉导管（PICC）置管护理风险。方法以上海市闵行区中心医院100例PICC患者为实验组，应用失效模式和效果分析，计算风险顺序数（RPN）值风险排列，根据RPN值的大小判断确定计划，改善后指导临床操作和护理。以莘庄卫生服务中心、闵行区肿瘤医院PICC置管98例患者为对照组进行传统护理，分组对照。数据采用SPSS11．0统计软件进行分析处理。采用r检验比较实施失效模式和效果分析（FMEA）管理模式PICC置管护理风险发生率的差别。结果应用FMEA可降低PICC置管后的护理风险：局部，全身感染数，渗血、出血、过敏、机械性静脉炎、置入过深、置入颈静脉、折入腋静脉、堵管、导管滑脱、送管困难、穿刺失败等的发生率，2组比较差异均有统计学意义。结论应用FMEA降低了PICC置管护理风险，减少了医疗纠纷，减轻患者痛苦，降低因PICC并发症而产生的医疗费用，提高患者满意度，提高临床护理质量。

Objective To apply failure mode and effect analysis （FMEA） to reduce nursing risk of peripherally inserted central catheter （PICC）. Methods 100 patients with PICC in central hospital of Minxing District of Shanghai were named as the experimental group, failure mode and effect analysis were performed in this group to obtain the value of risk priority number （PRN） and array them according to the RPN value to work out improved plan systematically and put it into practice to guide the clinical operation and nursing care. 98 PICC patients in Xinzhuang health sexwiee center and Tumor Hospital of Mi^hang dis- trict were set as the control group, which were subjected to traditional nursing. All statistical analysis were done by SPSS 11.0 software paekage, the differences of the incidence of PICC-related nursing risk between the two groups due to the implementation of FMEA was analyzed by X2 test. Results Application of FMEA could reduce the nursing risk of PICC, After the applieation of FMEA, the incidence of PICC-relat- ed complications sueh as focal or systemic infection,puncture site oozing and bleeding, skin allergies, me- ehanical phlebitis, tOO deeply placed catheter,catheterization into cervical veins and reflexed into axillary vein, catheter occlusion, catheter migration,difficult removal of catheter, puncture failure in the experi- mental group decreased obviously, the differences had statistical meaning. Conclusions The applieation of failure mode and effeets analysis can reduce the nursing risk of PICC, decrease medical disputes, allevi- ate the suffering of patients, reduce medieal costs caused by PICC-related complications, and improve the satisfaetion degree of patients and the quality of nursing care.