PICC置管前评估流程图的设计与应用

Design and Application of Assessment Flowchart for PICC Catheterization

目的实施PICC置管前全面评估,确保置管安全,减少并发症。方法基于近年来PICC置管前评估大量循证研究,设计置管前评估流程图,该流程图分为3个阶段,按照"患者是否适合使用PICC、哪侧上肢适合留置PICC、上肢的哪条静脉适合穿刺PICC以及穿刺时的注意事项"的顺序分6个步骤,在临床应用于82例患者的PICC置管前评估。结果经评估,82例患者中不适合置入PICC的患者有10例;在适合置入PICC的72例患者中,双侧上肢风险评估未见异常者有55例,均选择非主利手上肢置入PICC;高风险者17例,选择健侧上肢置入PICC 14例,选择患侧上肢置入PICC 2例,改选输液港置入1例。穿刺中、置管后未出现因评估不全导致的相关并发症。结论 PICC置管前评估流程图可以指引PICC护士实施全面、正确评估,具有内容全面、条理清晰、逻辑性强、及时给出指导、缩短评估时间等优点,有利于客观评价PICC适应证、禁忌证及风险因素,便于确认PICC穿刺侧肢体及静脉。

Objective To conduct comprehensive assessment before PICC catheterization for the safety of catheterization and reducing complications. Methods An assessment flowchart for PICC catheterization including three phases and six steps was developed based on recent evidence-based researches on assessment before PICC catheterization, then it was applied in the assessment of 82 patients clinically. Results After assessment, PICC was placed based on patients ＇ individual condition and no complications were found induced by incomplete assessment in and after the catheterization. Conclusion Assessment flowchart for PICC catheterization benefits nurses＇ overall evaluation of patients＇ condition and the indication, contraindication and risk factors of PICC.