肿瘤患者PICC导管相关性血流感染的危险因素及护理对策

Risk factors of PICC catheter-related bloodstream infection in patients with cancer and the nursing strategies

目的分析肿瘤患者PICC置管后发生导管相关性血流感染(CRBSI)的危险因素,并提出有效护理对策。方法回顾性分析2014年1月至2019年1月在本院肿瘤内科接受化疗并行PICC置管的362例肿瘤患者的病案资料,按有无发生PICC相关性感染分为感染组26例和未感染组336例,采用logistic回归分析确定患者PICC相关性感染的独立危险因素。结果 362例患者中发生CRBSI26例,感染率为7.18%。Neu计数、化疗次数(≥3次)、置管时间(≥3月)、合并糖尿病及血清白蛋白水平(<30g/L)均为肿瘤患者CRBSI的独立危险因素,合并糖尿病患者显示出最高的感染风险(OR=4.152,95%CI1.730-9.966,P<0.05)。结论 肿瘤患者PICC置管后发生CRBSI的危险因素较多,主要为Neu计数、化疗次数、置管时间、是否合并糖尿病及血清白蛋白水平。护理工作中针对相关危险因素采取相应对策有助于降低CRBSI的发生率。

Objective To analyze the risk factors of catheter-related bloodstream infection (CRBSI) after PICC catheterization in cancer patients, and to propose effective nursing strategies. Methods The data of 362 patients with tumors who underwent chemotherapy and PICC catheterization in our hospital from January, 2014 to January, 2019 were retrospectively analyzed. The patients divided into an infection group (n=26) and an uninfected group (n=336) according to whether they had PICC-related infection. Logistic regression analysis was used to determine the independent risk factors for PICC-associated infection. Results Of the 362 patients, 26 had CRBSI, and the infection rate was 7.18%. Neu count, number of chemotherapy (≥3), catheterization time (≥3 months), diabetes mellitus, and serum albumin level (< 30 g/L) were independent risk factors for CRBSI in the patients, and the patients with diabetes showed the highest risk of infection (OR=4.152, 95% CI 1.730-9.966, P < 0.05). Conclusion There are many risk factors for CRBSI in PICC patients after tumor placement. The main factors are Neu count, number of chemotherapy, catheterization time, diabetes, and serum albumin level. It is helpful to take corresponding countermeasures for relevant risk factors in nursing work to reduce the incidence of CRBSI.