肿瘤患者PICC置管并发症及护理

Complications and nursing of PICC catheter in cancer patients

目的:探讨经外周静脉穿刺置入中心静脉导管的并发症的预防及护理措施.方法:选取河北大学附属医院介入血管外科2011-10/2014-11收治的187例PICC置管的肿瘤患者,对其出现的并发症进行观察及护理.结果:所有患者中,发生静脉炎27例,发生率为14.0%.穿刺点渗血渗液23例,发生率为12.0%.静脉血栓形成8例,发生率为4.2%.导管感染5例,发生率为2.6%.导管堵塞2例,发生率为1.1%.导管脱出2例,发生率为1.1%.导管外移7例,发生率为3.7%,局部皮疹2例,发生率为1.1%.导管破裂4例,发生率为2.1%.结论:为预防和减少PICC导管在使用中存在的并发症的发生,护理人员在实际操作中必须做到以下几点.1置管前要做好对血管的评估和患者的心理护理.2做好PICC置管后的宣教,出院时指导患者置管的注意事项,并提高患者的依从性.3要选择合适的导管,并正确使用PICC导管.4操作时既要严格遵守无菌技术操作原则,还要提高自己的穿刺技术水平和技巧,置管成功后要采取积极的预防处理措施.5导管使用过程中要密切观察,及时发现并发症的早期症状,并尽早采取相应的护理措施.这样才能保证PICC导管的正常使用,延长其使用寿命,减轻患者的痛苦.

AIM： To investigate the prevention and nursing measures of complications of peripherally inserted central catheter.METHODS： A total of 187 cases of cancer patients with PICC admitted into Interventional Vascular Surgery,Affiliated Hospital of Hebei University from October 2011 to November 2014 were selected as study objects. The complications of peripherally inserted central catheter of these patients were observed and nursed. RESULTS： Of all patients treated,phlebitis accounted for 27 cases（ 14.0%）,oozing of puncture point accounted for 23 cases（ 12.0%）,venous thrombosis accounted for 8 cases（ 4. 2%）,catheter infection accounted for 5 cases（ 2. 6%）,catheter blockage accounted for 2 cases（ 1.1%）,catheter prolapse accounted for 2 cases（ 1.1%）, PICC displacement accounted for 7 cases（ 3.7%）,local skin rash occurred in 2 cases（ 1.1%）,and catheter rupture occurred in 4 cases（ 2.1%）. CONCLUSION： In order to prevent and reduce the complications of PICC,the following things should be done by nursing staff. The assessment of blood vessels and psychological care of patients should be done firstly. Secondly, patients should be told the consideration of PICC catheter at discharge. Thirdly,It emphasized the importance of closing the appropriate catheter and proper use of PICC catheter. Then,doctors must strictly follow aseptic operation principles and improve their techniques and skills of puncture. After successful treatment,prevention treatment measures should be done. Finally,close observation,timely detection of early symptoms of complications,and corresponding nursing measures must be done during use of PICC catheter as soon as possible. Only after that can we ensure the normal use of PICC catheter,extend its service life and relieve the pain of patients.