326例上肢深静脉置管化疗患者的置管护理

Nursing care of upper limb deep venous catheter for chemotherapy in 326 cases

目的：探讨深静脉置管化疗患者置管期间的护理经验与有效方法,提高化疗患者深静脉置管的有效性。方法对中南大学湘雅医院2年内收治的326例肿瘤患者通过深静脉置管实施化疗,在深静脉置管化疗期间,特别强调宣教与观察,落实深静脉置管前、置管后护理要点。结果326例患者共实施338例次深静脉置管术,1次穿刺成功率为99.39%（324/326）；12例次（12/338,3.55%）在置管过程中出现一过性心律失常；10例患者（10/326,3.07%）在留置导管10-15 d 时出现脱管；8例患者（8/326,2.45%）出现穿刺点少许发红伴少许渗出,经妥善处理后2-3 d内红肿消失；无一例发生导管扭曲、折断、栓塞、静脉炎、导管堵塞以及导管相关性血流感染等并发症；导管留置时间16-120 d,均顺利拔管。结论熟练掌握深静脉穿刺技术,做好置管前后皮肤护理,遵守化疗药物静脉注射的注意事项,加强导管管理,是确保深静脉置管化疗患者置管有效的关键。

Objective To improve the effectiveness of deep venous catheter by nursing experience and effective methods in patients with deep venous catheter for chemotherapy. Methods Within 2 years in Xiangya Hospital, we had treated 326 cases of cancer patients who received chemotherapy by deep venous catheter. During the period of deep vein catheter chemotherapy, we paid attention to education and observation, and carried out the key points of nursing before and after deep venous catheterization. Results Out of 326 patients, 338 times of deep venous catheterization had been implemented, with a successful rate 99. 39% （324/326）;the transient arrhythmia incidence rate was 3. 55%（12/338） in the process of catheterization;tube detached in 10-15 days incidence rate was 3. 07%（10/326）, and the rate of puncture point red swelling with effusion was 2. 45%（8/326）,which disappeared after proper treatment in 2-3 days. No patients had tube twisted, broken, embolism, phlebitis, catheter blockage, catheter-related bloodstream infections and other complications. All of tubes were drawn smoothly after being kept 16-120 days. Conclusions To ensure effective chemotherapy for patients with deep venous catheters, we should get familiar with deep vein puncture technology, professional skin care before and after catheterization, follow matters needed attention for the intravenous chemotherapy drugs, and strengthen the management of catheter.