儿童输液静疗质量横断面调研数据及结果分析

Cross-sectional Survey Data and Results Analysis of Children's Infusion Hydrotherapy Quality

目的基于儿童专科医院静疗质量横断面调研数据及结果分析,了解医院静疗质量现状和尚存在的问题,以制定Ⅳ Team工作目标及计划,为静疗质量持续改进提供依据。方法组织全院具备监督检查能力的静疗小组成员24人,由省静疗专科护士组织专场培训,调研标准以江苏省《静脉治疗护理技术操作规范》为依据,调研重点包括输液工具的选择、穿刺部位的选择、导管固定与维护、敷料固定与维护、连接方式、并发症。于2019年1月21日采集门诊和输液样本,通过普查,拍摄导管状况的照片并进行静脉输液现状的分析。结果本次全院调研样本中门诊输液工具使用钢针比例49.0%,病区输液工具中外周留置针占85.1%,其次PICC占9.2%,钢针比例为0。使用外周留置针者穿刺部位中以手背为主的占53.1%,关节部位穿刺者占28.4%;小儿下肢穿刺(>1岁)例数占总下肢穿刺比例的16.0%。导管维护问题发生率30.4%,其中发生率最高的为延长管/接头内有回血或陈旧性积血(11.3%);敷贴固定与维护问题发生率50.7%,其中发生率最高的为敷贴下有积血和渗液(28.3%);输液相关并发症发生率为6.2%,穿刺点发红发生率最高(78.2%)。结论儿童输液静脉治疗护理技术操作虽日益规范,但通过对本次调研的输液工具的选择、穿刺部位的选择、导管固定与维护、敷料固定与维护、连接方式等数据分析,静疗持续质量改进虽卓见成效,但仍需努力,以最大化减少儿科输液中存在的较大风险。

Objective Based on cross-sectional survey data and results analysis of children's specialist hospitals'quality of static therapy,to understand the current status and existing problems of the quality of static therapy in hospitals,in order to formulate the work goals and plans of the IV Team,and provide a basis for continuous improvement of the quality of static therapy.Methods Twenty-four members of the static therapy team with supervision and inspection capabilities were organized in the hospital.Specialized training was organized by the provincial specialists of static therapy.The research criteria were based on the Jiangsu Province's"Technical Practice of Intravenous Therapy Nursing Technology."The research focuses on the selection of infusion tools and puncture site,catheter fixation and maintenance,dressing fixation and maintenance,connection method,complications.On January 21,2019,outpatient and infusion samples were collected,and through the census,a picture of the condition of the catheter was taken and the status of intravenous infusion was analyzed.Results 49.0%of the outpatient infusion tools used steel needles in this hospital-wide survey sample.Peripheral indwelling needles accounted for 85.1%of the infusion tools in the ward,followed by PICC of 9.2%and steel needles of 0.Among the puncture sites of peripheral indwelling needles,53.1%were dominated by the back of the hand,and 28.4%were punctured at the joints.Pediatric lower extremity punctures(>1 year old)accounted for 16.0%of total lower extremity punctures.Catheter maintenance problems occurred at a rate of 30.4%,with the highest incidence of blood return or old blood in the extension tube/joint(11.3%);the incidence of application fixation and maintenance problems was 50.7%,with the highest incidence of application was hemorrhage and exudate(28.3%);the incidence of infusion-related complications was 6.2%,and the highest incidence of redness at the puncture site(78.2%).Conclusion Although the technical operation of children's infusion intravenous therapy is becoming more and more standardized,through the analysis of data such as the choice of infusion tools,puncture site selection,catheter fixation and maintenance,dressing fixation and maintenance,and connection methods in this survey,although continuous quality improvement of intravenous therapy has achieved remarkable results,efforts need to be made to minimize the greater risks associated with pediatric infusions.