全国部分医院静脉导管维护现状调查

Status of venous catheter maintenance in some hospitals in China

目的调查全国部分医院静脉导管维护现状,为标准修订、规范静脉治疗工作提供参考。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/自治区选择医院采用"静脉导管维护情况调查表"进行问卷调查。本研究在全国28个省、直辖市、自治区发放问卷759份,回收有效问卷740份,有效回收率为97.5%。结果740家医院中,分别有737家(99.6%)、621家(83.9%)、634家(85.7%)、373家(50.4%)、245家(33.1%)医院开展了静脉留置针、经外周静脉置入中心静脉导管(PICC)、中心静脉导管(CVC)、输液港(PORT)、中长导管(MC)维护技术,三级医院开展PICC、CVC、PORT、MC维护技术的比例高于二级医院,差异有统计学意义(P<0.05)。583家医院(93.9%,583/621)PICC在治疗间歇期常规1周维护1次,351家医院(94.1%,351/373)PORT治疗间歇期常规4周维护1次,476家医院(64.6%,476/737)静脉留置针72~96 h更换1次;492家医院(79.2%,492/621)PICC留置时间一般不超过12个月;MC多按产品说明书进行留置,有105家医院(42.9%,105/245)。多数医院进行外周、中心静脉维护时使用2%葡萄糖酸氯已定乙醇溶液、0.5%以上有效碘浓度的碘伏、75%乙醇溶液和碘伏,但仍有18.4%~52.6%的医院使用未被推荐的安尔碘或仅75%乙醇溶液。患者发生静脉炎时,525家医院(70.9%,525/740)使用水胶体敷料;患者发生渗出或外渗时,分别有414家(55.9%,414/740)和332家(44.9%,332/740)医院使用水胶体敷料和纱布敷料。结论我国静脉导管维护技术开展广泛,基本符合行业标准《静脉治疗护理技术操作规范》,但发展存在不平衡性,专用护理包有待在临床推广应用;皮肤消毒剂的选择不够规范,中长导管维护和并发症的处理相关标准、规范亟待制订。

Objective To investigate the status of venous catheter maintenance in some hospitals in China,so as to provide a reference for standard revision and standardization of venous therapy.Methods This study was a cross-sectional survey.From October to November 2018,the members of the Intravenous Therapy Nursing Professional Committee of the Chinese Nursing Association selected hospitals in their provinces,municipalities and autonomous regions with the convenience sampling method to conduct a questionnaire survey using the"Venous Catheter Maintenance Questionnaire".A total of 759 questionnaires were distributed in 28 provinces,municipalities and autonomous regions across the country,and 740 valid questionnaires were recovered,with a valid recovery rate of 97.5%.Results Among the 740 hospitals,737(99.6%),621(83.9%),634(85.7%),373(50.4%),and 245(33.1%)hospitals carried out venous indwelling needles,peripherally inserted central catheter(PICC),central venous catheter(CVC),PORT,midline catheter(MC)maintenance technology,respectively.The proportion of PICC,CVC,PORT,and MC maintenance techniques carried out in ClassⅢhospitals was higher than that in ClassⅡhospitals,and the difference was statistically significant(P<0.05).A total of 583 hospitals(93.9%,583/621)routinely maintained PICC once a week during the treatment interval,351 hospitals(94.1%,351/373)routinely maintained PORT once every 4 weeks during the treatment interval,and 476 hospitals(64.6%,476/737)intravenous indwelling needles were replaced once every 72 to 96 hours.In 492 hospitals(79.2%,492/621),the indwelling time of PICC was generally not more than 12 months.In 105 hospitals,MC was indwelled according to the product instructions(42.9%,105/245).Most hospitals used 2%chlorhexidine gluconate ethanol solution,iodophor with an available iodine concentration of more than 0.5%,75%ethanol solution and iodophor for peripheral and central venous maintenance,but 18.4%to 52.6%of hospitals still used unrecommended Ann's iodine or 75%ethanol solution only.When patients developed phlebitis,525 hospitals(70.9%,525/740)used hydrocolloid dressings.When patients developed exudation or extravasation,hydrocolloid dressings and gauze dressings were used in 414(55.9%,414/740)and 332(44.9%,332/740)hospitals,respectively.Conclusions The maintenance technology of venous catheters in China is widely carried out,which basically conforms to the industry standard Nursing Practice Standards for Intravenous Therapy.However,there is an imbalance in development,and special nursing packages need to be popularized and applied in clinical practice,and the selection of skin disinfectants is not standardized enough,and the relevant standards and norms for the maintenance of medium and long catheters and the treatment of complications need to be formulated urgently.