居家PICC肿瘤患者穿刺点细菌定植影响因素分析

Influence Factors of Bacterial Colonization in PICC Cancer Patients at Home

目的探讨引起居家PICC肿瘤患者穿刺点细菌定植的相关因素,并进行对策分析。方法选择2015年10—12月于本院PICC维护中心进行PICC维护的肿瘤患者472例穿刺点采样,并进行细菌学培养及观察分析,同时对患者维护情况进行记录。结果 Logistic回归分析显示,性别、维护间期、敷料卷边范围、周围皮肤是否清洁、自理能力、穿刺点增生及导管体外长度为PICC穿刺点定植的影响因素,其中体外长度在4 cm以内能减少细菌定植。微生物检验显示,革兰氏阳性菌为主要定植菌,其中凝固酶阴性葡萄球菌居首位。结论肿瘤患者居家期间PICC穿刺点细菌定植情况需得到重视,应对穿刺点细菌定植高风险者进行针对性预防护理。置管时用心电图进行定位,维护过程中将体外长度控制在4 cm之内,加强对男性患者及家属的健康宣教,维持穿刺点周围皮肤清洁,若穿刺点增生应进行碘酊湿敷,建立有效联络方式,建立完善的社区维护机制、推广洗必泰消毒剂的应用,从而减少PICC穿刺点细菌定植,降低感染率,降低导管相关性感染的发生。

Objective To investigate the correlation factors of bacterial colonization of PICC cancer patients at home and to analyze its influence factors. Methods Puncture point samples of 472 patients admitted to maintenance center from November to December in 2015 were bacteriologically cultured and observed. Results Logistic regression analysis showed that gender, membrane exchange interval, crimping degree, the cleanliness of the surrounding skin, self-care ability, proliferation and exposed length were factors affecting the colonization of PICC puncture points and when exposed length was less than 4cm can reduce the bacterial colonization.Microbe testing showed gram positive bacteria were the main pathogenic bacteria and coagulase negative staphylococci in the first place. Conclusion To reduce the local bacterial colonization and control the rate of infection and catheter-related infection, we should position PICC catheter with electrocardiogram; in maintenance process, exposed length should be controlled within 4cm; more health education should be conducted among male patients and their families; clean skin around the puncture point, wet compress with tincture of iodine if hyperplasia occurrs in puncture point, effective contact ways of patients, a complete application of good maintenance mechanism in the community and the use of chlorhexidine alcohol will benefit the reducing of catheter-related infection.