湖南省二级及以上医院中等长度静脉导管应用及管理现状调查

Application and management of midline intravenous catheters in secondary or above hospitals in Hunan Province

目的调查湖南省二级及以上医院中等长度静脉导管(简称中长导管)应用情况及其管理中存在的问题,为规范中长导管的使用提供依据。方法采用横断面调查法,使用自行设计的《中长静脉导管应用与管理现状调查问卷》对湖南省13个地级市和1个自治州共89家二级及以上医院的相关联络员进行调查,时间自2023年8月至10月。结果全省89家医院中有78家医院引入了中长导管,大多数(占83.33%,65/78)医院因外周静脉穿刺困难引入了中长导管,其次为长期连续静脉输液治疗(占75.64%,59/78)、应用化疗药物(占26.92%,21/78)。在评估置入长度方面,55(占70.51%,55/78)家医院以“从预穿刺点沿静脉走向至同侧锁骨中线”的距离为导管预测置入长度;27(占34.62%,27/78)家医院进行导管尖端定位;69(占88.46%,69/78)家医院规定中长导管的留置时间,其中62家医院认为留置时间可长于4周。28(占35.89%,28/78)家医院制定的中长导管临床应用标准与规范不完善,其中21家医院缺失导管拔除的标准操作流程、16家医院缺少健康宣教标准方案、14家医院缺少并发症的处理流程。66(占84.62%,66/78)家医院采取质量控制措施,但有12(占15.38%,12/78)家医院未采取任何质量控制措施。结论在湖南省二级及以上医院中长导管的应用得到了普及,但置管的适应证不够合理,置管和维护的标准流程有待完善,质量管理体系有待进一步拓展和规范。

Objective To investigate the application and the management issues of midline intravenous catheters in secondary or above hospitals in Hunan Province,and to provide a basis for standardizing the usage of midline catheters.Methods A cross-sectional survey was conducted using a self-designed"Survey on the Application and Management of Midline Catheters".The survey was distributed to relevant coordinators in 89 secondary or above hospitals across 14 cities in Hunan Province,time range was from August 2023 to October 2023.Results A total of 78 hospitals(out of 89 hospitals)introduced midline catheters,most of which introduced midline catheters due to difficult peripheral venous access(83.33%,65/78),followed by long-term continuous infusion therapy(75.64%,59/78)and the application of chemotherapeutic drugs(26.92%,21/78).In terms of evaluating the insertion length of catheters,55 hospitals(70.51%,55/78)used the distance of“the pre-puncture site along the vein to the ipsilateral clavicular line”as the predicted length for catheter insertion;27 hospitals(34.62%,27/78)performed catheter tip positioning;69 hospitals(88.46%,69/78)had a specified dwell time for midline catheters,with 62 hospitals believing the dwell time could exceed 4 weeks.A total of 28 hospitals(35.89%,28/78)had incomplete clinical application standards and protocols for midline catheters,with 21 hospitals lacked standard operating procedures for catheter removal,16 hospitals lacked health education protocols,and 14 hospitals lacked procedures for managing complications.A total of 66 hospitals(84.62%,66/78)implemented quality control measures,while 12 hospitals(15.38%,12/78)did not adopt any quality control measures.Conclusions The application of midline catheters have been popularized in secondary or above hospitals in Hunan Province,but the indications for catheter insertion are not sufficiently rational.The standard procedures for catheter insertion and maintenance need to be improved,and the quality management system requires further development and standardization.