追踪方法学在放化疗经外周静脉置入中心静脉导管置管患者维护的临床实践与效果

The clinical application and results of tracer methodology in the maintenance of peripherally insertedcentral catheters for chemoradiotherapy

目的探讨追踪方法学改善放化疗经外周静脉置入中心静脉导管（PICC）置管患者维护的护理质量，评估护士维护PICC规范效果，同时观察PICC置管患者感染性并发症发生病例数。方法自2015年7月将追踪方法学运用于放化疗中心PICC置管患者，观察实施前（2014年4月至2015年6月）及实施后（2015年7月至2016年10月）护士维护PICC规范程度及患者感染性并发症例数。结果运用追踪方法学管理PICC置管患者的维护后，放化疗中心护士对PICC置管患者维护规范性明显提高，从（94．00±3．35）分提高到（97．87±1．42）分；PICC静脉炎的发生率从13．39％下降到2．08％；穿刺点感染从25．89％下降到2．91％；导管相关性血流感染从6．23％降至0，差异有统计学意义（P均〈0．001）。结论应用追踪方法学能有效提升护士PICC维护的护理质量，降低PICC置管患者感染性并发症的发生，促进患者安全。

Objective To investigate the quality of nursing care after the application of tracer method- ology in patients undergoing chemoradiotherapy with peripherally inserted central catheters （PICC）, evaluate the nurses＇ adherence to the procedural protocol of PICC, and calculate the number of infectious complications related with the placement. Methods We compared the nurses＇ adherence to the procedural protocol and the number of infectious complications before （ April 2014 to June 2015） and after （ July 2015 to October 2016） the tracer methodology was applied at the Chemoradiotherapy Center of Ningbo First Hospital in July 2015. Results After the tracer methodology was introduced to the care of patients with PICC, the nurses had better adherence to the procedural protocol, as shown in the rise of quality control score from （94. 00＋3.35） to （97.87＋ 1.42）. The incidence of infectious complications dropped significantly （all P〈0. 001 ）. Conclusion The clinical application of tracer methodology can improve the quality of nursing for patients with PICC, re- duce the incidence of PICC-related infectious complications, and promote patient safety.