综合干预降低肿瘤化疗患者PICC置管期间相关性感染的临床研究

Study on multifaceted interventions decreasing peripherally inserted central catheter related infection in tumor patients with chemotherapy

目的通过对肿瘤化疗患者经外周静脉插入中心静脉导管(PICC)相关性感染的原因分析,探讨干预措施,降低感染的发生率。方法留置PICC的肿瘤化疗患者1000例,随机分为改良组和对照组,改良组410例,对照组590例,对照组采取常规导管置管、维护方法 ,改良组在对照组的基础上采取干预措施:六步洗手法洗手、专职护理人员在超声引导下,在PICC维护门诊置管、维护,穿刺部位选在肘关节以上;对比改良前后患者导管相关性感染的发生率。结果改良组导管相关性感染率明显低于对照组,差异有统计学意义(P<0.05)。结论通过改进PICC置管环境、穿刺方法等干预措施,有效降低PICC置管的感染率,对保障输液安全起到积极作用。

Objective To explore the causes of peripherally inserted central venous catheter（PICC） related infection in the tumor patients with chemotherapy to decrease the infection rate. Methods Divided 1000 patients who underwent PICC into improved group（n=410） and control group（n=590） randomly. The control group was performed the catheterization and maintenance in accordance with PICC standard operation procedure under the normal condition, while the improved group was performed the additional interventions on the basis of the same treatment as the control group：hand washing by six-step hand-washing method;the catheterization was performed under the ultrasound guidance by full-time nursing staff;the catheterization and maintenance were performed in the PICC outpatient service;the puncture site was above the elbow. Incidence rates of before and after improved in patients with catheter-related infection were compared. Results The catheter-related infection of the improved group was significantly lower than that of the control group, the differences were statistically significant（P〈0.05）. Conclusion The infection rate of PICC could be decreased effectively by interventions such as improving the environment of the catheter performed and the puncture method, which will play a positive role in guaranteeing the safety of patients.