无缝隙护理在极低出生体质量儿脐静脉置管与PICC联合中的应用

Clinical study on seamless venous passage of umbilical venous catheterization combined with PICC applied in nursing of infants with very low birth weight

目的:总结无缝隙护理用于极低出生体质量儿脐静脉插管与经外周静脉穿刺中心静脉置管(PICC)联合的临床体会。方法:将本院2015年3月至2016年3月76例极低出生体质量儿根据无缝隙护理实施前后分为对照组(2015年3月至9月)与观察组(2015年10月至2016年3月),两组均38例。胎儿出生后即刻进行脐静脉插管,7~10 d后改为PICC。对照组采取常规护理;观察组实施无缝隙护理,即无缝隙护理管理培训→建立无缝隙护理团队→联合置管护理评估、对策→出院后管理→无缝隙护理质量控制标准。比较两组患儿出生即刻,出生1、2、4周时体质量变化,分组记录并比较两组置管相关不良事件及并发症发生率。结果:两组患儿随观察时点推移,体质量呈上升趋势,观察组2、4周时体质量均较出生体质量高(P<0.05),对照组4周时体质量与出生体质量才有差异(P<0.05),组间不同时点比较差异均无统计学意义(P>0.05)。观察组联合置管相关不良事件发生率为13.16%,对照组发生率为50%,观察组发生率显著低于对照组(P=0.01);观察组6例患儿出现并发症,对照组11例患儿发生并发症,差异无统计学意义(P>0.05)。结论:无缝隙护理用于极低出生体质量儿脐静脉插管与PICC联合中可加快患儿体质量增加速度,同时可显著降低置管相关不良事件,间接减少患儿置管后并发症发生率,具有良好的临床应用价值。

Objective： To study the application of seamless nursing in umbilical venous catheterization combined with peripherally inserted central catheter （PICC） for infants with very low birth weight. Methods： Seventy-six infants with very low birth weight admitted to our hospital between March 2015and March 2016 were divided into control group （ March to December 2015 ） and observation group （ October 2015 to March 2016） according to the implementation of seamless nursing, 38 cases in each. Immediately after the birth, umbilical venous catheterization was performed, and 7-10d later, it was replaced by PICC. The control group received routine nursing of umbilical venous catheterization and PICC, while the observation group received seamless nursing procedure, including training management, establishment of seamless nursing team, combined catheterization nursing assessment and countermeasures to management after discharge and finally seamless nursing quality control. The changes of body weight were compared between the two groups on birth, 1 week, 2 weeks and 4 weeks after birth. The incidence rates of catheter related adverse events and complications were recorded and compared between the two groups. Results ： Body weight of both groups increased over time, and weight of observation group at 2 weeks and 4 weeks after birth was significantly higher than that on birth （P 〈 0.05 ）. There were significant differences of weight in control group at 4 weeks after birth and on birth （ P 〈 0.05 ）, and the differences between the two groups at different time points were not significant （ P 〉 0.05 ） ; The incidence of combined catheterization related adverse events in observation group was 13.16%. In control group, there were catheterization related adverse events caused by misoperation in 19 cases and the incidence was 50% （ P 〈 0. 05 ） ; In observation group, 5 cases had complications, while in control group, 11 cases instead （ P 〉 0.05 ）. Conclusion ： The application of seamless nursing in umbilical vein catheterization and PICC for very low birth weight infants can accelerate the increase of body weight, significantly reduce catheter related adverse events at the same time, and indirectly reduce the incidence of complications after catheterization.