护士静脉采血现状调查分析及对策

A current status survey and analysis of venous blood collection by nurses and countermeasures

目的调查我科临床护理人员的静脉采血相关知识认知现状及回顾分析不合格血液标本发生情况,为提高血液标本采集质量提供依据。方法采用便利抽样方法,于2018年3月对我科371名在职的临床护理人员采用一般资料调查表和静脉采血临床现状凋查表进行调查。回顾分析本院检验科反馈的内科病区及内科门诊2017年10月至2018年3月不合格标本发生情况。结果共发放问卷378份,回收有效问卷371份,有效回收率98.14%,其中护士对多管采集的顺序(15.36%)、拔管/换管的时机(43.94%)、血标本混匀方式(14.56%)、压脉带松开时间(21.83%)、难采血时的处理方式(8.63%)的知晓率较低。内科病区及内科门诊不合格血标本数781例,总样本量为410 493例,不合格率为0.190%。不合格标本的主要原因是溶血(26.50%)、凝血(20.61%)、标本量不足(11.27%)、容器错误(10.24%)。结论护士对静脉采血知识掌握欠准确全面,不合格标本的发生率较高,应加强护理人员采血知识培训及考核,规范操作流程,建立血标本质量控制体系,提高血液标本的采集质量。

Objective To provide some references for improving the quality of blood specimen collection through a survey of the knowledge of the clinical nursing staff for the Clinic of Internal Medicine about venous blood collection and retrospective analysis of the occurrence of unqualified blood specimens.Methods Convenience sampling was adopted.In March,2018,the surveyors surveyed 371 in-service clinical nursing staff members of the Clinic of Internal Medicine using the general information questionnaire and the questionnaire on the clinical status of venous blood collection.The surveyors retrospectively analyzed the occurrence of unqualified specimens at the inpatient and outpatient wards of the Clinic of Internal Medicine from October,2017 to March,2018 as reported by the Laboratory Medicine of the Hospital.Results A total of 378 questionnaires were distributed,and 371 valid questionnaires were recovered,with an effective recovery rate of 98.14%.Specifically,the nurses'awareness rates of the order of multi-tube collection (15.36%),the timing of tube withdrawal/replacement (43.94%),the method of mixing blood specimen (14.56%),the timing of loosening tourniquet (21.83%),and the method of handling blood collection difficulty (8.63%) were low.There were 781 unqualified blood specimens at the inpatient and outpatient wards of the Clinic of Internal Medicine,while the total sample size was 410 493.The unqualified specimen rate was 0.190%.The main causes of the unqualified specimens were hemolysis(26.50%),coagulation(20.61%),insufficient specimen quantity(11.27%),and container error(10.24%).Conclusion The nurses have inaccurate and non-comprehensive knowledge of venous blood collection,and the incidence of unqualified specimens is high.The training and assessment of the nursing staff's blood collection knowledge should be strengthened;the operating procedure standardized;a blood specimen quality control system established;and the collection quality of blood specimens improved.