血液透析患者中心静脉导管非计划性拔管原因分析和护理对策

Cause analysis and nursing strategies for unplanned extubations of hemodialysis patients with central vascular catheter

目的：探讨血液透析患者留置中心静脉导管发生非计划性拔管的原因和护理对策。方法采用回顾性调查方法，对2010年1月-2012年12月在某院行中心静脉置管作为透析血管通路的11例发生非计划性拔管患者进行原因分析，并提出有效预防和护理对策。结果11例非计划性拔管的发生与人员因素（包括患者和护士）、中心静脉导管维护管理等因素有关。根据上述原因制定相应护理对策，2013年未再发生非计划性拔管不良事件。结论制定操作流程和指引，加强护士的培训，严格执行操作规程，及时发现潜在因素，以及与患者和家属的充分沟通交流等可以有效降低非计划性拔管的发生率。

Objective To discuss the causes and nursing strategies for unplanned extubations of hemodialysis patients with central vascular catheter .Methods Using the retrospective method , we analyzed and reviewed 11 unplanned extubations hemodialysis patients with central vascular catheter in our hospital between January 2010 and December 2012, in order to proposed the effective preventive nursing strategies . Results Eleven unplanned extubations were related to personal （ patients and nurses ） factors and central vascular catheters ’ maintenance and management .According to above causes , nursing strategies were made and none unplanned extubations happened after January 2013 .Conclusions During the process of using central vascular catheters , many reasons may cause unplanned extubation .Through designing workflow and guidelines , improving nurse training , strictly following operation specification , early detection of potential factors and the communication with patients and their relations , the rate of unplanned extubations can be effectively reduced .