山东省腔内心电定位引导PICC置管实践现状的调查

The investigation of practice status of intracavitary electrocardiography-guided PICC placement in Shandong Province

目的:了解山东省腔内心电定位引导PICC置管的实践现状,为推动腔内心电定位技术的应用、开展系统化的培训以及制定标准化的腔内心电定位引导PICC置管操作流程提供参考。方法:采用便利抽样法,选取2019年7—8月山东省258家医院的1034名PICC专科护士作为研究对象,采用自行设计的"山东省腔内心电定位引导PICC置管的实践现状调查问卷"调查山东省PICC专科护士腔内心电定位引导PICC置管实践的现状。共计回收问卷1034份,有效问卷903份,回收有效率为87.33%。结果:903名PICC置管护士中,有835名(92.47%)的护士了解过腔内心电定位引导PICC置管,368名(40.75%)参加过腔内心电定位引导PICC置管的培训,只有363名(40.20%)应用过腔内心电定位引导PICC置管。在363名应用过腔内心电定位引导PICC置管的护士中,93.66%(340/363)在穿刺术前评估了患者体表心电图,49.31%(179/363)认为最高尖P波为PICC送管至P波出现负向后退管至负向波刚消失,91.18%(331/363)认为应用腔内心电定位引导PICC置管后必须拍摄胸片进行导管尖端定位。结论:目前腔内心电定位引导PICC置管的培训及推广应用有待加强,亟需制定腔内心电定位引导PICC置管统一规范化操作流程,以提高此应用的科学性和规范性。

Objective To understand the practice status of intracavitary electrocardiography(ECG)-guided peripherally inserted central catheter(PICC)placement in Shandong Province,so as to provide a reference for promoting the application of intracavitary ECG positioning technology,carrying out systematic training and formulating standardized intracavitary ECG-guided PICC placement procedures.Methods From July to August 2019,convenience sampling was used to select 1034 PICC specialist nurses from 258 hospitals in Shandong Province as the research object.The self-designed questionnaire Survey Questionnaire on the Practice Status Quo of Intracavitary ECG-guided PICC Placement in Shandong Province was used to investigate the practice status of the intracavitary ECG-guided PICC placement by PICC specialist nurses in Shandong Province.A total of 1034 questionnaires were returned,and 903 valid questionnaires were collected,with a valid rate of 87.33%.Results Among the 903 PICC specialist nurses,835(92.47%)of the nurses had learned about the intracavitary ECG-guided PICC placement,368(40.75%)had participated in the training of intracavitary ECG-guided PICC placement,and only 363(40.20%)had used intracavitary ECG-guided PICC placement.Among 363 nurses who had used intracavitary ECG-guided PICC placement,93.66%(340/363)evaluated the patient s body surface electrocardiogram before puncture,and 49.31%(179/363)believed that PICC was delivered when P wave was the highest,and the catheter was retreated when P wave appeared negative until the negative wave just disappear;91.18%(331/363)thought that chest radiographs must he taken to locate the catheter tip after the application of intracavitary ECG-guided PICC placement.Conclusions At present,the training,promotion and application of intracavitary ECG-guided PICC placement needs to be strengthened.There is an urgent need to develop a unified and standardized operation process for intracavitary ECG-guided PICC placement to improve the scientific and standardization of this application.