同期放化疗患者中心静脉通路专业化团队主动管理模式初探

Application of actively vascular catheters management via a professional team with clinical nurse specialist as the core among patients receiving chemo-radiotherapy

目的探讨以静脉治疗专科护士为核心的专业化团队主动管理模式，在同期放化疗肿瘤患者中的应用效果。方法采用方便抽样法，抽取在四川省肿瘤医院放疗病区进行同期放化疗的肿瘤患者762例，将2014年1-12月的300例患者设为对照组，采用常规中心静脉通路管理模式；将2015年1-12月的462例患者设为实验组，采用专业化团队主动管理模式。采用卡方检验和独立样本t检验，比较两组置管后并发症发生情况和导管留置时间。结果对照组出现血栓11例、堵管13例、静脉炎16例，实验组血栓5例、堵管3例、静脉炎8例，实验组并发症发生率小于对照组，差异有统计学意义（χ^2值分别为4．676，12．009，8．876；P〈0．05）；实验组无非计划性拔管，对照组有8例；对照组颈内静脉CVC和PICC平均留置时间分别为（21．2±11．5）d、（55．8±26．3）d，实验组分别为（25．6±13．1）d、（63．8±22．1）d，差异有统计学意义（t值分别为-2．57，-2．97；P〈0．01）。结论在同期放化疗肿瘤患者中应用以静脉治疗专科护士为核心的专业化团队主动模式，可能降低部分并发症的发生率，避免非计划性拔管，延长留置时间。

Objective To explore the effect of actively vascular catheters management via a professional team with clinical nurse specialist as the core among patients receiving chemo-radiotherapy. Methods Totally 762 tumor patients with chemo-radiotherapy in Sihucan cancer hospital were selected as the research object by convenient sampling method. 300 patients from January to December 2014 was taken as the control group （patients received routine management） and 462 patients from January to December 2015 was taken as the experimental group （patients received professional management with clinical nurse specialist as the core）. The incidences of complications and indwelling time in two groups were compared and analyzed by independent- samples T test and chf-square test.Results There were 11 cases of thrombus, 13 cases of tube plugging and 16 cases of phlebitis in the control group, while there were 5 cases of thrombus, 3 cases of tube plugging and 8 cases of phlebitis in the experimental group. The incidences of thrombus, tube plugging and phlebitis in the experimental group were obviously lower than those in the control group （χ^2= 4.676,12.009,8.876;P〈0. 05）. There were 8 cases of unplanned extubations in the control group, but none in the experimental group. The indwelling time of central venous catheter （CVC） and peripherally inserted central catheter （PICC） were （21.2±11.5） d and （55.8±26.3） d in the control group, while they were （25.6±13.1）d and （63.8±22.1）d in the experimental group （ t = -2.57, -2.97; P〈0. 01 ）. Conclusions Tbe actively vascular catheters management via a professional team with clinical nurse specialist as the core among patients receiving chemo-radiotherapy, is likely to reduce some complications after intravenous indwelling catheter, and avoid unplanned extubation and extend the indwelling time.