山东省ICU护士中心静脉通路装置维护的实践现状调查

Investigation on the current practice status of central venous access device maintenance among intensive care unit nurses in Shandong province

目的了解山东省二级及以上医疗机构重症监护病房(ICU)护士中心静脉通路装置(CVAD)维护的实践现状,为进一步落实降低中央导管相关血流感染发生率的有效措施提供依据.方法基于国内外CVAD维护相关证据编制《CVAD维护实践问卷》,于2022年10月对山东省二级及以上医疗机构内的ICU护士CVAD维护实践现状进行调查.结果1492名护士参与调查,回收有效问卷1461份,有效回收率97.92%.被调查护士所在科室使用的CVAD类型以中心静脉导管为主[92.3%(1349/1461)],在每次操作时评估情况最好的项目为导管是否通畅[81.1%(1185/1461)],最差的为患者主观感觉[40.7%(594/1461)].在评估导管通畅性时,59.8%(873/1461)的护士将回血抽至导管内.在输液接头的使用中,三通接头[76.0%(1110/1461)]与肝素帽[65.3%(910/1461)]是使用频率最高的输液接头,在对无针接头进行消毒时绝大多数护士可遵循正确的消毒范围,但消毒时间有待延长,最常用的消毒物品为碘伏棉球/棉签[44.3%(647/1461)].输液接头的更换时机有待规范.绝大多数护士对导管冲管时会选择生理盐水,在封管时选择生理盐水与肝素盐水的护士人数各占50%左右.绝大多数护士可使用规范的注射器,遵循规范的冲封管技术.在进行CVAD维护时,84.7%(1237/1461)的护士选择专用护理包套件.最常用的皮肤消毒剂为碘伏[63.7%(931/1461)].绝大多数护士可遵循规范的皮肤消毒范围,但消毒待干意识有待加强.覆盖穿刺点的敷料以透明敷料[99.7%(1457/1461)]与纱布敷料[94.7%(1383/1461)]最多,纱布敷料的更换频次有待规范.在CVAD维护过程中护士的手卫生与无菌意识较好,但手卫生及佩戴无菌手套的时机有待规范.结论ICU护士的CVAD维护操作基本符合最新证据推荐,但在评估、维护相关物品使用以及手卫生与无菌技术等方面有待进一步规范.建议护理管理者尽可能提升ICU护理人力资源配置,并形成中央导管相关血流感染(CLABSI)防控管理体系,从而逐步降低CLABSI在ICU内的发生率.

Objective To understand the current practice status of central venous access device(CVAD)maintenance among intensive care unit(ICU)nurses in secondary and above medical institutions in Shandong province,and to provide a basis for further implementation of effective measures to reduce the incidence of central catheter-related bloodstream infections.Methods The CVAD maintenance practice questionnaire was compiled based on domestic and international evidence related to CVAD maintenance,and a survey was conducted in October 2022 to investigate the status of ICU nurses'CVAD maintenance practice in secondary and above medical institutions in Shandong Province.Results There were 1492 nurses participated in the survey and 1461 valid questionnaires were recovered,with a valid recovery rate of 97.92%.The type of CVAD used by the nurses was mainly central venous catheters[92.3%(1349/1461)],and the item with the best assessment at each operation was patency of the catheter[81.1%(1185/1461)],and the worst was the patient's feeling[40.7%(594/146)].When assessing catheter patency,[59.8%(873/1461)]of nurses drew back blood into the catheter.In the use of infusion connectors,three-way connectors[76.0%(1110/1461)]and heparin caps[62.3%(910/1461)]were most frequently used.When sterilizing needleless connectors,most nurses could follow the correct range of disinfection,but the time of disinfection needed to be extended,and the most used items for disinfection were povidone-iodine cotton balls/swabs[44.3%(647/1461)].The timing of changing infusion connectors needs to be standardized.Most nurses would choose saline for catheter flushing,and the number of nurses choosing saline versus heparinized saline when locking the catheter was about 50%.Most nurses can use correct size syringes and follow standardized techniques for flushing and locking.When performing CVAD maintenance,84.7%(1237/1461)of nurses chose a specialized care package kit.The most used skin antiseptic was povidone-iodine[63.7%(931/1461)].Most nurses could follow the standardized range of skin disinfection,but awareness of drying needs to be improved.Dressings covering puncture points were most frequently transparent[99.7%(1457/1461)]and gauze[94.7%(1383/1461)],and the frequency of gauze dressing changes needs to be standardized.Hand hygiene and aseptic awareness of nurses during CVAD maintenance was good,but hand hygiene and the timing of wearing sterile gloves need to be standardized.Conclusions ICU nurses'CVAD maintenance practices were generally in line with the latest evidence-based recommendations,but assessment,use of maintenance-related items,and hand hygiene and aseptic technique need to be further standardized.It is recommended that nursing administrators enhance ICU nursing human resource allocation as much as possible and form a central line associated bloodstream infection(CLABSI)prevention and control management system to gradually reduce the morbidity of CLABSI within the ICU.