北京市三级医院ICU患者外周动脉导管留置与维护情况的调查研究

Investigation on the current situation of peripheral arterial catheter indwelling and maintenance in ICU of Beijing tertiary hospitals

目的调查北京市三级医院成人ICU患者外周动脉导管留置与维护情况。方法采用德尔菲法编制问卷。于2020年5月—6月采用按比例分层整群抽样法,选取北京市20所三级综合医院的ICU护士进行问卷调查。结果共发放问卷992份,回收981份,有效问卷回收率为98.9%。外周动脉导管留置方面,ICU医生(41.1%)和ICU护士(45.2%)为留置外周动脉导管的主要人员;24.1%的护士行桡动脉置管前偶尔做或从不做Allen试验。外周动脉导管维护方面,58.6%的护士表示用肝素盐水作为常规冲洗液;42.2%的护士表示偶尔或从不根据患者情况调整冲洗液种类;54.4%的护士表示偶尔或从不做方波试验。经外周动脉导管采血方面,45.2%的护士表示开放式动脉导管采血前废弃血液量为导管前端容积的3倍,56.4%的护士在采集血液标本后会使用注射器抽吸接头处废血,42.9%的护士会将接头处废血冲洗到容器里。结论目前北京市三级医院ICU护士对于外周动脉导管留置、维护及采血等方面的实践有待进一步改善。建议医护人员共同制订统一标准和规范,加强外周动脉导管留置与维护的相关培训,提高护理质量。

Objective To investigate the situation of insertion and maintenance of peripheral arterial catheter in adult ICU patients of Beijing tertiary hospitals. Methods The questionnaire was developed using Delphi consensus process. ICU nurses were recruited form 20 tertiary general hospitals in Beijing by stratified sampling method from May to June 2020. Results 992 questionnaires were sent out and 981 were received with an effective recovery rate of 98.9%. ICU physicians(41.1%)and nurses(45.2%) were mainly responsible for catheterization. 24.1% of ICU nurses only occasionally or never performed Allen tests before catheterization. 58.6% of nurses used heparin saline as rinse solution. However,42.2% of nurses occasionally or never adjusted the type of rinse solution according to patient conditions,and 54.4% occasionally or never performed square wave test. Only 45.2% of nurses reported that the volume of discarded blood was 3 times the volume in the front of the catheter;56.4% used a syringe to suck blood at the junction;42.9% rinsed blood into a container. Conclusion The cognition and practice of nursing staff in Beijing in terms of catheter insertion,maintenance and blood sampling are still insufficient,which needs to be further improved. Uniform standards and specifications are recommended to be developed both by doctors and nurses. The training on catheter insertion and maintenance should be strengthened in order to enhance nursing quality in the future.