52例留置双腔Power PICC行造血干细胞移植患者的非预期拔管原因与对策探讨

目的:探讨经外周留置中心静脉导管(PICC)患者的非预期拔管原因,并探讨相关解决对策。方法:选取52例造血干细胞移植患者为研究对象,以FMEA(失效模式和效应分析,failure mode and effect analysis, FMEA)模式前瞻性分析评估患者PICC导管非预期拔管的失效模式,潜在风险因素与危害影响,针对于PRN较高失效模式制定出改进方案。结果:FMEA管理方案实施后的PICC发生率显著低于方案实施前(P<0.05)。FEMA管理实施后,护士对PICC理论知识得分、技能实践得分显著高于方案实施前(P<0.05),患者自护知识掌握情况显著优于方案实施前(P<0.05)。结论:针对PICC患者非预期拔管原因进行分析制定FMEA管理方案,提高患者自护知识掌握率及护士对PICC知识掌握率均有积极作用。

Objective: To investigate the causes of unexpected extubation in patients with peripherally inserted central venous catheter(PICC) and to discuss the countermeasures. Methods: 52 cases of patients with hematopoietic stem cell transplantation as the research object, using FMEA(failure mode and effect analysis, failure mode and effect analysis, FMEA) model of prospective evaluation of patients with PICC catheter extubation unanticipated failure modes, potential risk factors and harm effect for high PRN failure mode improvement plan. Results: the incidence of PICC after the implementation of the FMEA management program was significantly lower than that before the implementation of the program(P < 0.05). After the implementation of FEMA management, nurse PICC theoretical knowledge score, practice skills scores were significantly higher than the first implementation of the program(P < 0.05), self-care knowledge implementation scheme is significantly better than before(P < 0.05). Conclusion: according to the analysis of the causes of unexpected extubation to develop FMEA management scheme of PICC patients, improve patient self-care knowledge and nurse of rate has positive effect PICC knowledge.