腹膜透析护士导管出口处护理实践调查分析

Investigation and analysis of catheter exit-site care by peritoneal dialysis nurses

目的了解腹膜透析(PD)患者导管出口处护理(以下简称“出口处护理”)的培训现状及PD护士出口处护理操作的实践情况,为制定PD出口处护理质量管理标准、持续质量改进提供依据。方法采用自行设计的护士版《腹膜透析导管出口处护理实践调查表》,通过问卷星和微信APP于2018年4~5月对广东省某沿海地区开设有PD门诊的10家医院中26名PD护士进行问卷调查。结果该地区开设有PD门诊的10家医院PD导管相关性感染平均发生率约为0.15次/年;10家医院中5家医院设有专职及兼职护士,另5家医院仅有兼职护士(由病房护士兼任)。26名PD护士中专职PD护士9人(34.62%),护患比约为1∶95.67;兼职PD护士17人(65.38%),护患比约为1∶37.76。专职护士培训患者的平均时间为(15.39±5.06)h,兼职护士培训患者的平均时间为(11.13±5.85)h;所有PD护士均会对患者进行再培训,其中13名PD护士再培训频率固定。92.31%的PD护士要求患者淋浴后进行出口处护理;84.62%的PD护士要求患者出口处感染时每天换药1次,其他换药频率更为频繁;只有2名PD护士要求患者每次换药时常规涂抹抗菌软膏预防感染。92.31%的PD护士能够完成出口处评估;73.08%的PD护士使用生理盐水+碘伏进行消毒换药;出口处成熟前和感染时,所有PD护士均会使用敷料覆盖出口处。结论目前该地区开展PD治疗的医院中一半医院处于起步发展阶段,医院间护患比差别较大,PD护士在患者培训方法、换药前出口处观察评估情况和换药时护理要点三个方面基本与《国际腹膜透析协会导管相关性感染指南》的建议保持一致,但换药时是否涂抹抗菌软膏预防感染与该指南存在差异,有待进一步深入研究。

Objective To understand the training status of catheter exit-site care(hereinafter referred to as"exit-site care")in peritoneal dialysis(PD)patients and the condition of exit-site care by PD nurses,so as to provide basis for the establishment of management standards and continuous improvement on quality of PD exit-site care.Methods The nursing version of Peritoneal Dialysis Catheter Exit-site Care Questionnaire was designed by researchers.From April to May 2018,26 PD nurses in 10 hospitals with PD outpatient clinics in a coastal area of Guangdong Province were investigated through Questionnaire Star and WeChat APP.Results The average incidence of PD catheter-related infections in 10 hospitals with PD clinics in the area was about 0.15 times per year.Five of the ten hospitals had full-time and part-time nurses,and the other five hospitals had only part-time nurses(concurrently with ward nursing job).Among the 26 PD nurses,9 cases(34.62%)were full-time PD nurses,the ratio of full-time nurses to patients was approximately 1∶95.67,and 17 cases(65.38%)were part-time PD nurses,the ratio of part-time nurses to patients was approximately 1∶37.76.The average training time of each patient was(15.39±5.06)hours by full-time nurses,and that by part-time nurses was(11.13±5.85)hours.All the PD nurses would retrain patients,and among them the retraining frequency of 13 PD nurses was fixed.A total of 92.31%of the PD nurses required post-shower exit-site care,84.62%of the PD nurses required patients to change dressing once a day when the exit-site infections occurred,or even more frequently in other dressing changes.Only 2 PD nurses asked patients to routinely apply antibacterial ointment to prevent infections.Altogether 92.31%of the PD nurses could complete wound evaluation as suggested,73.08%of the PD nurses used normal saline and iodine for disinfection and dressing change,and all the PD nurses could use dressings to cover the exit-site before maturity and during infections.Conclusion At present,half of the hospitals in this region that carry out PD treatment are in the initial development stage,and the ratio of nurses to patients among the hospitals varies greatly.The three aspects on training of patients,wound evaluation before dressing change and care points during dressing change are basically consistent with the International Society for Peritoneal Dialysis Guidelines.However,there is a difference in the application of antibacterial ointment from the guideline,which needs to be further studied.