两种不同加压包扎方法在PICC置管后穿刺部位中的应用

Clinical effects of aseptic gauze dressing vs alginate dressing on PICC puncture site in breast cancer patients:a comparative study

目的探讨两种不同加压包扎方法在经外周置入中心静脉导管(peripherally inserted central catheter,PICC)后穿刺点应用的效果,为临床提供一种新的包扎方法。方法采用随机数字表法将本院416例乳腺癌PICC患者随机分为对照组与试验组,分别208例。对照组患者PICC置管后应用无菌纱布覆盖并加压包扎穿刺点,24h进行常规换药,试验组PICC置管后应用藻酸盐敷料覆盖穿刺点并加压包扎,在无局部渗血情况下置管后7d换药。比较两组患者置管后24h内穿刺点渗血发生率、患者舒适度、换药次数及费用与7d内感染情况。结果对照组205例完成研究,试验组208例完成研究。试验组患者置管后24h穿刺点渗血发生率低于对照组(试验组27.88%,对照组38.05%,χ^(2)=4.829,P=0.028),24h换药次数少于对照组(Z=205.235,P<0.001),换药费用低于对照组(对照组换药费用中位数56.94元,试验组换药费用中位数10.20元,Z=-8.990,P<0.001);试验组患者局部疼痛和瘙痒评分低于对照组(Z=-12.079,Z=-12.194,均P<0.001),组间比较,差异有统计学意义;两组患者均未发生穿刺点感染。结论乳腺癌患者PICC置管后应用藻酸盐敷料加压包扎穿刺点,可将24h穿刺点未发生渗血者首次换药时间延长至置管后7d,该方法减少了穿刺点渗血发生率,增加患者舒适度,同时减少换药次数和换药费用,从而减少护士工作量。

Objective To investigate the clinical effects of two methods of compressive coverage with aseptic gauze dressing and alginate dressing on haemostasis in placement of peripherally inserted central catheter(PICC)so as to provide a new dressing method for clinical application.Methods A total of 416 breast cancer patients undergoing PICC were randomly divided into two groups,with 208 per group.In the control group,the puncture sites for PICC were dressed with aseptic gauze immediately after the placement of PICC,with a daily aseptic gauze dressing change once per 24 hours.In the trial group,the puncture sites were dressed with alginate dressing immediately after the placement of PICC,with a weekly dressing change at the 7th day after PICC placement,while no local bleeding on the puncture site.The incidence,within 24 hours,of bleeding,degree of comfort,frequency and cost of dressing change as well as the infection rate within 7 days after the PICC placement were monitored and compared between the groups.Results A total of 205 patients in the control group and 208 in the observation group had completed the study.In the trial group,the incidence of bleeding at puncture sites within 24 hours after placement of PICC was significantly lower than that of the control group(27.88%vs.38.05%,χ^(2)=4.829 P=0.028).The frequency of dressing change within 24 hours in the observation group was significantly less than that of the control group(Z=205.235,P<0.001).The cost of dressing change in the observed groups was also significantly less than that of the control group(56.94 vs.10.20 yuan in average,Z=-8.990,P<0.001).The incidence rates of local pain and itche reported by the patients in the observation group were significantly lower than those in the control group(Z=-12.079,P<0.001;Z=-12.194,P<0.001).No infection at the puncture site was observed in both groups.Conclusions Application of alginate dressing immediately after PICC placement in breast cancer patients can extend the time for initial dressing change up to 7 days in the patient without bleeding at the puncture site within 24 hours after the placement of PICC.An alginate dressing can reduce the incidence of bleeding at the puncture site,increase the comfort of patients,lower the frequency and cost of dressing change hence the nursing workload.