肺癌患者PICC导管相关血流感染的影响因素及其风险管理体系建立效果分析

Influencing factors of PICC catheter-related bloodstream infection in patients with lung neoplasms and the establishment effect of risk management system

目的探讨肺癌患者PICC相关血流感染(CRBSI)的影响因素及其风险管理体系建立的效果。方法采用便利抽样法,以2016年6月—2017年12月在河北省唐山市人民医院行PICC导管留置的180例肺癌患者为研究对象,将2016年6—12月纳入的115例患者设为对照组(常规护理干预),统计对照组患者的CRBSI发生率,并采用单因素、多因素Logistic回归分析肺癌患者PICC留置后CRBSI发生的影响因素。将2017年1—12月纳入的65例肺癌患者作为观察组,依据CRBSI发生的风险环节和Logistic多元回归分析结果为观察组建立系统的风险管理体系,观察风险管理体系建立的防控效果。结果对照组115例肺癌患者中,22例发生CRBSI,发生率19.13%(22/115);穿刺方式、留置时间、导管移位、导管管腔、导管材料、周期性导管维护、免疫功能、并发症是肺癌患者CRBSI发生的影响因素(P<0.05)。风险管理体系建立后,观察组患者的CRBSI发生率、导管移位发生率、并发症发生率低于对照组,差异有统计学意义(P<0.01)。结论穿刺方式、导管留置时间、导管移位、导管管腔、导管材料、周期性导管维护、免疫功能等是肺癌PICC导管CRBSI发生的影响因素,而风险管理体系建立的护理干预能够降低PICC置管肺癌患者的CRBSI、并发症等的发生率。

Objective To explore the occurrence factors of catheter-related bloodstream infection(CRBSI)in patients with lung neoplasms undergoing peripherally inserted central catheter(PICC)and the establishment effect of risk management system.Methods A total of 180 patients with lung neoplasms who underwent PICC catheterization in Tangshan People's Hospital of Hebei Province from June 2016 to December 2017 were selected as research objects by the convenient sampling method.The 115 patients enrolled from June to December 2016 were set as the control group(routine nursing intervention),and the incidence of CRBSI in the control group was counted.The univariate and multivariate Logistic regression were used to analyze the influencing factors of CRBSI in patients with lung neoplasms after PICC indwelling.A total of 65 patients with lung neoplasms from January to December 2017 were included as the observation group.Based on the risk links that occurred in CRBSI and the results of Logistic multiple regression analysis,a systematic risk management system was established for the observation group to observe the prevention and control effects of the risk management system.Results In the 115 patients with lung neoplasms in the control group,CRBSI occurred in 22 cases,with an incidence of 19.13%(22/115).Puncture method,indwelling time,catheter displacement,catheter lumen,catheter material,periodic catheter maintenance,immune function and complications were the influencing factors of CRBSI in patients with lung neoplasms(P<0.05).After establishment of the risk management system,the incidence of CRBSI,catheter displacement,and complications in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.01).Conclusions Puncture method,catheter indwelling time,catheter displacement,catheter lumen,catheter material,periodic catheter maintenance and immune function are the influencing factors of the occurrence of CRBSI in PICC patients with lung neoplasms.And the nursing intervention established by the risk management system can reduce the incidence of CRBSI and complications in PICC patients with lung neoplasms.