床边即时超声辅助疑难内瘘穿刺在18家医院的操作现状调查

Investigation on the operational status of point-of-care ultrasound assisted difficult arteriovenous fistula puncture in 18 hospitals

目的调查床边即时超声(point-of-care ultrasound,POCUS)辅助疑难内瘘穿刺在18家医院的护理操作现状,为相关质量管理和专科培训提供科学依据。方法对18家医院的POCUS辅助疑难内瘘穿刺操作视频进行横断面调查,制定操作的评分细则作为评分依据,根据操作中的关键点提取重点环节,对评分结果进行统计分析。结果18例操作视频平均得分(79.25±10.91)分。共提取出6个重点环节,评分为较差的占比分别为:评估与安全核查55.56%、护患沟通50.00%、内瘘常规评估44.44%、感染控制38.89%、超声评估11.11%、超声引导穿刺0。视频时长与操作得分呈正相关(r=0.717,P=0.001)。结论本研究制定的“POCUS辅助疑难内瘘穿刺评分标准”有助于进一步规范此项操作,值得推广。

Objective To investigate the nursing operation status of point-of-care ultrasound(POCUS)assisted difficult arteriovenous fistula(AVF)puncture in 18 hospitals in order to provide a scientific basis for quality management and specialized training of the clinical nursing operations.Methods This was a crosssectional study.The videos of POCUS assisted difficult AVF puncture operation from the 18 hospitals were examined.A scoring rule for the operation was developed as the scoring basis.Six key steps of the manipulation were extracted for the scoring,including routine evaluation and safety verification,nurse-patient communication,infection control,AVF routine evaluation,ultrasound evaluation,and ultrasound guided puncture.The scores were then statistically analyzed.Results The average score of the manipulation on video from the 18 cases was 79.25±10.91.For the six key steps of the manipulation,ratios of the steps with low scores were evaluation and safety verification 55.56%,nurse-patient communication 50.00%,AVF routine evaluation 44.44%,infection control 38.89%,ultrasound evaluation 11.11%,and ultrasound guided puncture 0%.The video duration and the operation score were positively correlated(r=0.717,P=0.001).Conclusion The scoring standard for POCUS assistant difficult fistula puncture developed in this study is helpful to standardize this procedure and is worth promoting.