重症患者静脉输液通路选择策略的调查研究

A Cross-sectional Survey on Strategies for Choosing Venous Access Devices for Critically Ill Patients

目的调查ICU静脉输液通路的认知和选择现状。方法 2015年5月采用问卷调查分析ICU医务人员对重症患者静脉输液通路的认知和选择情况。采用SPSS 19.0进行描述性统计分析。结果共随机发放问卷50份,回收有效问卷46份,有效回收率为92.0%。参加调查的医生和护士分别占39.1%和60.9%,初级、中级和高级职称分别占80.4%、13.0%和6.6%,平均工作年限（5.7±4.9）年。100.0%的医务人员了解套管针（PIV）、急性期中心静脉导管（ACVC）和经外周中心静脉置管（PICC）,69.6%了解植入式输液港（PORT）,43.5%了解隧道型中心静脉导管（TCVC）,13.0%了解中等长度导管（Midline）。100.0%的医务人员在选择输液通路时会考虑输液种类和输液时程,64.0%会考虑患者状态,18.0%会考虑治疗费用。短期输液患者（〈1周）约占25%,选择PIV、ACVC的医务人员分别为91.3%和39.1%;中期输液（1-4周）约占60%,选择PIV、ACVC和PICC的医务人员分别为56.5%、69.6%和26.1%;长期输液（〉4周）约占15%,选择PIV、ACVC、PICC和PORT的医务人员分别为30.4%、39.1%、82.6%和32.6%。52.2%的医务人员熟悉抗感染导管的类型和放置指征。输液困难的主要原因为血管条件差（91.3%）、高龄（52.2%）、皮肤病变（39.1%）和管路堵塞（26.1%）。选择外周静脉的主要原因为感染风险小（87.0%）、短期治疗（82.6%）、普通补液（78.3%）和抗生素治疗（47.8%）;选择中心静脉主要原因为输注刺激性药物（82.6%）、外周血管穿刺困难（69.6%）、血流动力学监测（65.2%）和长期输液（56.5%）。结论重症患者输液通路建立难度大,PIV、ACVC和PICC在ICU较常使用,Midline、TCVC和PORT的使用较少,医务人员对抗感染中心静脉导管认识不够。重症患者病情复杂,需综合评估后选择合适可靠的静脉输液通路。

Objective To investigate and analyze the strategies for choosing venous access devices for critically ill patients.Methods The medical staffs in ICU were required to fulfill a questionnaire on the knowledge and application of venous access devices in critically ill patients in May 2015. A descriptive statistical analysis was carried out on the answers generated from the questionnaire using SPSS 19. 0 software. Results A total of 50 questionnaires were distributed randomly and 46 valid questionnaires were recovered. The effective response rate was 92. 0% . The proportion of junior, intermediate and senior medical staffs was 80. 4% , 13. 0% and 6. 6%, respectively. The proportion of doctors and nurses was 39. 1% and 60. 9%, respectively. The average seniority was （ 5. 7 ±4. 9） years. The proportion of ICU medical staffs who were acquainted with PIV, ACVC, PICC, TCVC, PORT and Midline was 100. 0% , 100. 0% , 100. 0% , 69. 6%, 43. 5% and 13. 0% , respectively. The proportion of ICUmedicial staffs who would take the styles of drug, the time of treatment, the patients’condition and the costs into consideration when choosing venous access devices was 100. 0% ,100. 0% , 64. 0% and 18. 0% , respectively.91. 3% and 39. 1% of ICUmedical staffs would choose PIV and ACVC respectively if the time of treatment was less than 1 week. 56. 5% , 69. 6% and 26. 1% of ICU medical staffs would choose PIV, ACVC and PICC respectively if the time of treatment was between 1 and 4 weeks. 30. 4% , 39. 1%, 82. 6% and 32. 6% of ICU medical staffs would choose PIV, ACVC, PICC and PORT respectively if the time of treatment was more than 4 weeks. 52. 2% of ICU medical staffs were acquaint with the styles and the indication of antibiotic coating central venous catheter. The main reasons for infusion failure were poor vascular condition （ 91. 3% ） , old age （ 52. 2% ） , skin lesions （ 39. 1% ） and pipeline plugging （ 26. 1% ） . The main reasons for choosing the peripheral vein were lower risk of infection （ 87. 0% ） , short-term treatment （ 82. 6%） , common transfusion （ 78. 3%） and antibiotic treatment （ 47. 8% ） . The main reasons for choosing central venous infusion were irritant drugs （ 82. 6% ） , peripheral vascular puncture difficulty （ 69. 6% ） , long-term infusion （ 65. 2%） and hemodynamic monitor （ 56. 5% ） . Conclusions It is difficult to establish a vascular access for critically ill patients. The ICU medical staffs are experienced to PIV, ACVC and PICC but not to Midline, TCVC and PORT. A comprehensive evaluation is essential to choose a suitable and reliable venous access device for critically ill patients.