肿瘤患者PICC导管相关性感染的危险因素及护理对策

Risk factors and nursing strategies of PICC catheter associated infection in cancer patients

目的探讨肿瘤患者PICC导管相关性感染的危险因素,并采取相关护理对策。方法选择2014年12月~2016年12月我院肿瘤科行PICC置管的肿瘤患者200例,年龄18岁以上。根据患者是否发生PICC导管相关性感染,分为感染组20例和非感染组180例。比较两组患者在性别、年龄、单次置管穿刺次数、PICC留置时间、导管有无移动、化疗次数、合并糖尿病方面的差异。结果 200例肿瘤化疗留置PICC患者中发生导管相关性感染20例,感染率为10.0%,其中,血流感染2例,局部感染18例,分别占10.0%和90.0%。感染组与未感染组在单次置管穿刺次数、PICC留置时间、导管移动、化疗次数、糖尿病方面比较,差异有高度统计学意义(P<0.01),而在年龄、性别方面比较未见明显差异(P>0.05)。导管出现移动(OR=2.342)、化疗次数多(OR=6.397)、合并糖尿病(OR=3.253)等是肿瘤患者PICC导管相关性感染的危险因素。结论肿瘤患者PICC置管后发生导管相关性感染的危险因素较多,主要为导管出现移动、化疗次数多、合并糖尿病等,临床应针对相关危险因素采取对症护理干预对策,可以最大限度地预防和减少导管相关性感染的发生。

Objective To investigate the risk factors of PICC catheter：related infection in cancer patients, and to take relevant nursing strategies. Methods 200 tumor patients aged over 18 years who underwent PICC catheterization in the Department of Oncology of our hospital from December 2014 to December 2016 were chosen. According to whether the occurrence of PICC catheter-related infection, the patients were divided into infection group of 20 cases and non-in- fection group of 180 cases. The differences in terms of gender, age, number of single catheter puncture, PICC retention time, catheter movement, chemotherapy times,and combination with diabetes mellitus between the two groups were compared. Results 20 cases of catheter infection were found in 200 patients with PICC,with the infection rate of 10.0%. Among them, there were 2 cases of bloodstream infection and 18 cases of local infection, accounting for 10.0% and 90.0% respectively.There were significant differences in the number of single catheter puncture, PICC retention time, catheter movement, the times of chemotherapy and diabetes mellitus between the infected group and the uninfected group, and there was significant difference between the two groups （P〈0.05）, but there was no significant difference in the age and sex （P〉0.05）. The occurrence of catheter movement （OR=2.342）, the multiple times of chemotherapy （OR= 6.397） and the combination of diabetes mellitus （0R=3.253） were the risk factors of PICC catheter-related infection in cancer patients. Conclusion There are many risk factors of catheter-related infection after PICC catheterization, mainly for the occurrence of the movement of the catheter,the multiple times of chemotherapy, combination with diabetes. Symptomatic nursing intervention measures should be taken against risk factors in clinical, which can prevent and re- duce the occurrence of catheter-related infections to the utmost.