临床护士采血存在问题及解决途径的横断面调查

Cross-sectional investigation in problems and solutions of blood specimen collection by clinical nurses

目的调查临床护士血标本采集现状，发现临床操作中存在的问题，为临床循证护理实践提供线索。方法采用自行设计的问卷对8所医院225名护士进行血标本采集现状调查。结果临床护士采血问题选项“经常发生”中最多的为患者方面问题，如一次采血量大为51人（22.7%），患者紧张害怕33人（14.7%）等；护士方面次之，如采用头皮针采血18人（8.0%）、静脉穿刺困难12人（5.3%）等；其他方面较少。既往常见问题如从输液侧采血178人（79.1%）、血标本被污染178人（79.1%）、弄错采血试管144人（640%）等在选项“从不发生”中被选频率最高。临床护士采集血标本遇到问题时，选择咨询其他护士的有214人（95.5%），咨询检验科的有105人（46.9%），咨询医生的有47人（21.0%）。结论临床血标本采集存在一定的问题，这些问题多为偶发且主要来自患者方面。护士方面问题较少，但仍存在进步空间。护士的咨询渠道和培训材料存在一定的局限性。建议护理管理者加大监管力度，开展专业化的培训,推广多元化的操作流程。

Objective To investigate practical status of blood specimen collection by clinical nurses in order to discover problems in clinical practice and provide clues for clinical evidence-based nursing practice. Methods The practical status of blood specimen collection was investigated among 225 nurses from 8 hospitals by self-designed questionnaire.Results The causes of problem with highest frequency in ＂frequent occurrence＂ were mainly from patients. For example, there were 51 nurses （22.7%） of collecting a large amount of blood specimen for one time, 33 nurses（14.7%） patients＇ being of nervous and seared. Next it was cuases from nurses, for example, 18 nurses （8.0%） of collecting a blood specimen with scalp acupuncture, 12 nurses （ 5.3% ） of difficulty in vessel acupuncture. Causes from other aspects were few. The frequency of problem with ＂nooccurrence＂ was the highest. There were 178 nurses （79.1%） of blood collection from the transfusion side, 178 nurses （ 79.1% ） of contaminated blood specimens, 144 nurses （64.0%） of mistaking blood collection tubes. 214 nurses （95.5%） would inquire other nurses when they had problems in blood collection, 105 nurses （46. 9%） would inquire the laboratory department, and 47 nurses （21.0%） would inquire the doctors. Conclusions Some problems exist in clinical blood specimen collection. These problems occur occasionally and mainly come from patients. Problems from nurses are few but they still need to be improved. Limitation exists in nurses＇ consultation channels and training materials. Administrators are suggested to enhance the supervision, and carry out specialized training and promote diversified operating procedures.