以问题为中心的持续质量改进在预防新生儿PICC置管术后机械性静脉炎中的应用

Application of problem-centered continuous quality improvement in the prevention of neonatal mechanical phlebitis after PICC catheterization

目的探讨以问题为中心持续质量改进在预防新生儿外周静脉置入中心静脉导管(PICC)机械性静脉炎中的应用价值。方法选取2016年6月至2018年6月我院收治的106例接受PICC置管的新生儿为研究对象,按照随机数字法将其等分为观察组和对照组,对照组予以PICC置管常规护理,观察组在对照组基础上实施以问题为中心持续质量改进护理。比较两组患儿一次性穿刺成功率、非计划拔管率、导管留置时间、并发症发生率、家属满意度和护理投诉率。结果观察组患儿一次性穿刺成功率和家属护理满意度均高于对照组(P<0.05),导管堵塞、导管异位、导管相关性感染、机械性静脉炎、血栓形成等并发症发生率、非计划拔管率以及家属对护理投诉率均低于对照组(P<0.05),导管留置时间长于对照组(P<0.05)。结论对接受PICC置管的新生儿采取以问题为中心持续质量改进护理,可有效提高一次性穿刺成功率,减少非计划拔管、并发症发生和护理纠纷,改善患儿家属对护理满意度。

Objective To study the application value of problem-centered continuous quality improvement in the prevention of neonatal peripherally inserted central venous catheters(PICC) mechanical phlebitis. Methods A total of 106 neonates who received PICC catheterization from June 2016 to June 2018 were selected as the study subjects. They were equally divided into observation group and control group according to random number method. The control group was given routine nursing for PICC catheterization, while on the basis of the control group, the observation group was given problem-centered continuous quality improvement nursing. The one-time puncture success rate, unplanned extubating rate, catheter indwelling time, complication rate, family satisfaction and nursing complaint rate were compared between the two groups. Results The one-time puncture success rate and family nursing satisfaction of the observation group were higher than those of the control group( P <0.05). The incidence of complications such as catheter blockage, catheter ectopic, catheter-related infection, mechanical phlebitis, thrombosis, unplanned extubating rate and family members' complaints of nursing were lower than that of the control group( P <0.05). However, the catheter retention time was longer than that of the control group( P <0.05). Conclusion The application of problem-centered continuous quality improvement nursing for neonates receiving PICC can improve the success rate of one-time puncture effectively. Meanwhile, it can reduce unplanned extubation, complications and nursing disputes, and improve the satisfaction of family members.