精细化管理在预防PICC导管堵塞中的应用研究

Efficacy of delicate management in prevention of periherally inserted central catheter occlusion

目的:探讨精细化管理模式在预防经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)导管堵塞中的应用效果。方法:回顾性分析2014年7月至2017年6月间,某医院呼吸内科监护室实施PICC穿刺的971例患者临床资料,将2014年7月至2015年12月的530例共计3 780使用日作为对照组,2016年1月至2017年6月收治的441例共计3991使用日作为实施精细化管理模式后的观察组,比较2组患者PICC导管堵塞、堵塞后再通失败致非计划拔管及其他PICC相关并发症的发生情况。结果:实施精细化管理模式后,患者PICC完全堵管率(χ~2=4.522,P=0.038)、不完全堵管率(χ~2=5.897,P=0.020)、因堵塞致非计划拔管率(χ~2=13.749,P=0.000)、导管相关并发症发生率(χ~2=6.869,P=0.011)均有明显改善。结论:采用精细化管理模式能够有效预防PICC导管堵塞、减少导管相关并发症的发生,从而减少PICC非计划拔管事件的发生。

Objective：To explore the feasibility and efficacy of delicate management in the prevention of peripherally inserted central catheter（PICC）occlusion. Methods：A retrospective analysis was conducted in 971 cases admitted to our intensive care unit undergoing PICC catheter from July 2014 to June 2017. Totally 530 patients who were admitted from July 2014 to December 2015 were defined as the control group,and 441 patients who were admitted during January 2016 to June 2017 were set as the observation group with application of delicacy management. The catheter occlusion rate,unplanned extraction events rates caused by occlusion and other catheter associated complications in two groups were compared. Results：With the application of delicacy management,the completely PICC catheter occlusion rate（χ~2=4.522,P=0.038）,incompletely PICC catheter occlusion rate（χ~2=5.897,P=0.020）,unplanned extraction rate caused by occlusion（χ~2=13.749,P=0.000）and catheter associated complications were significantly reduced（χ~2=6.869,P=0.011）. Conclusion：Delicacy management can effectively prevent catheter occlusion and other catheter associated complications,thus prolongs the catheter indwelling time.