743家二级和三级医院静脉治疗现状的调查研究

Current status of infusion therapy in 743 Class Ⅱ and Class Ⅲ hospitals

目的了解我国二级和三级医院静脉治疗现状,为加强静脉治疗管理提供参考。方法本研究为横断面调查,采用便利抽样法,于2018年10-11月由中华护理学会静脉治疗护理专业委员会委员在其所在省/直辖市/自治区便利选择医院进行问卷调查。采用中华护理学会静脉治疗护理专业委员会设计的"全国各级医院静脉输液治疗护理情况调查"。本研究共在全国28个省/直辖市/自治区医院发放问卷759份,回收759份,有效问卷743份,有效回收率为97.9%。结果本调查中,在调查日全院住院输液人数占住院总人数的68.0%~90.0%,平均79.6%;输液2.8~4.3袋/d,人均3.4袋/d。628家(85.3%,628/736)医院开展了中心静脉导管(CVC)技术,595家(80.8%,595/736)医院开展了PICC技术,三级医院开展PICC、中长导管盲穿、超声引导下应用塞丁格穿刺技术、X线、心电图进行PICC导管尖端定位技术的比例高于二级医院,差异均有统计意义(P<0.05)。静脉治疗专科护士队伍以本科学历、中级职称、10年及以上工作年限为主。70%以上的医院静脉治疗/PICC专科护士承担了PICC置管与维护、并发症处理、专科护理门诊、会诊、培训等相关工作。结论我国人日均输液量处于较高水平,输液管理亟待加强;静脉治疗技术得到了快速发展,静脉治疗质量管理信息系统有待大范围推广。我国初步建成了一支具有较高素质的静脉治疗专科护士队伍,静脉治疗专科护士工作地点得到拓展,工作内容以临床实践、教学为主。但不同等级医疗机构静脉治疗发展水平存在不平衡性,二级医院静脉治疗技术、质量管理与信息化发展较为滞后。

Objective To understand the current status of infusion therapy in ClassⅡand ClassⅢhospitals in China so as to provide a reference for strengthening infusion therapy management.Methods This study was a cross-sectional survey.From October to November 2018,convenience sampling was used to select hospitals in provinces(municipalities,autonomous regions)where the members of the Infusion Therapy Nursing Professional Committee of Chinese Nurse Association were located for the questionnaire survey.The study adopted the"Survey on Infusion Therapy Nursing in Hospitals at all Levels Nationwide"designed by the Infusion Therapy Nursing Professional Committee of Chinese Nurse Association.A total of 759 questionnaires were distributed in hospitals of 28 provinces(municipalities,autonomous regions)across the country,and 759 were returned with 743 valid questionnaires,and the effective response rate was 97.9%.Results On the survey day,the number of inpatients with infusions in the whole hospital accounted for 68.0%-90.0%of the total number of inpatients,with an average of 79.6%;the number of infusion bags was 2.8-4.3 bags per day with an average of 3.4 bags per capita.A total of 628(85.3%,628/736)hospitals implemented central venous catheter(CVC)technology,595(80.8%,595/736)hospitals implemented peripherally inserted central catheter(PICC)technology.The proportion of blind puncture of PICC and med-length catheter,and ultrasound-guided Seldinger technique in ClassⅢhospitals was higher than that in ClassⅡhospitals,and the difference was statistically significant(P<0.05).The proportion of PICC catheter tip positioning technology carried out by X-ray and electrocardiography(ECG)in ClassⅢhospitals was higher than that in ClassⅡhospitals,and the difference was statistically significant(P<0.05).The team of infusion therapy specialist nurses were mainly undergraduates,intermediate titles with working years of 10 years or more.More than 70%of hospital infusion therapy/PICC specialist nurses were responsible for PICC placement and maintenance,complication management,specialist nursing clinics,consultations and training.Conclusions The daily infusion volume per capita in China is at a high level,and the management of large infusions needs to be strengthened;infusion therapy technology has been rapidly developed,and the quality management information system for infusion therapy needs to be widely promoted.Our country has initially established a team of high-quality specialist nurses for infusion therapy.The work place of infusion therapy specialist nurses has been expanded,and the work content is mainly clinical practice and teaching.However,there is an imbalance in the development of infusion therapy in different levels of medical institutions,and the development of infusion therapy technology,quality management and information in ClassⅡhospitals is relatively backward.