颈内中心静脉导管拔除规范化护理方案的制订与应用

doi:10.3761/j.issn.1672-9234.2022.10.013

摘要/Abstract

摘要：

目的构建颈内中心静脉导管拔除护理方案,规范医护人员操作行为,降低患者相关问题发生率。方法通过文献检索、质量评价、提取并汇总证据及专家咨询,制订中心静脉导管拔除规范化护理方案,主要包括拔除时机、拔除前评估、拔除操作要点、拔除后注意事项及并发症处理。采用非同期对照研究,便利选取2021年5月—6月70例住院患者为对照组,采用常规颈内中心静脉导管拔除操作流程;2021年7月—8月的75例住院患者为试验组,实施颈内中心静脉导管拔除规范化护理方案;比较两组患者穿刺点疼痛、穿刺点渗血、拔管困难、导管断裂发生率。结果干预后,两组患者穿刺点疼痛、穿刺点渗血发生率比较,差异有统计学意义（χ²=4.494、4.116,P<0.05）;两组患者拔管困难、导管断裂发生率比较,差异无统计学意义（P>0.05）。结论开展中心静脉导管拔除规范化护理方案,可降低中心静脉导管拔除相关问题发生率,提高中心静脉导管拔除护理质量。

关键词: 护理, 健康教育, 中心静脉导管拔除

Abstract:

Objective To explore the nursing plan for the removal of internal jugular central venous catheter,standardize the operation behavior of medical staff,and reduce the incidence of discomfort symptoms. Methods Through literature search,quality evaluation,extraction and summary of evidence and expert consultation,a standardized nursing plan for central venous catheter extraction was formulated,mainly including extraction time,evaluation before extraction,key points of extraction operation,precautions after extraction and treatment of complications. A non-synchronous controlled study was conducted. Seventy cases were allocated to the control group from May to June 2021 receiving routine central venous catheter extraction operation process. Another 75 cases in the experimental group from July to August 2021 carried out standardized nursing scheme for central venous catheter extraction. The incidence of pain,bleeding,difficulty in extubation and catheter rupture were compared between the two groups. Results After the intervention,there was significant difference between the two groups in the incidence of pain at the puncture point,bleeding at the puncture point（χ²=4.494,4.116;P<0.05）. There were no significant differences in the incidence of difficult extubation and catheter rupture between the two groups（P>0.05）. Conclusion Carrying out the standardized nursing scheme of central venous catheter extraction can reduce the incidence of related questions,so as to improve the nursing quality of central venous catheter extraction.

Key words: Nursing Care, Health Education, Removal of central venous catheter

杨慧,刘赛赛,陈瑞云,王淑粉,赵文利. 颈内中心静脉导管拔除规范化护理方案的制订与应用[J]. 中华护理教育, 2022, 19(10): 932-937.

YANG Hui,LIU Saisai,CHEN Ruiyun,WANG Shufen,ZHAO Wenli. The development and application of a standardized nursing program for removal of internal jugular central venous catheter[J]. Chinese Journal of Nursing Education, 2022, 19(10): 932-937.

图/表 3

参考文献 13

[1]	Haggstrom L, Parmar G, Brungs D. Central venous catheter thrombosis in cancer:a multi-centre retrospective study investigating risk factors and contemporary trends in management[J]. Clin Med Insights Oncol, 2020, 14:1179554920953097.
[2]	Schiffer CA, Mangu PB, Wade JC, et al. Central venous catheter care for the patient with cancer:American Society of Clinical Oncology clinical practice guideline[J]. J Clin Oncol, 2013, 31(10):1357-1370. doi: 10.1200/JCO.2012.45.5733 pmid: 23460705
[3]	Kim DK, Gottesman MH, Forero A, et al. The CVC removal distress syndrome:an unappreciated complication of central venous catheter removal[J]. Am Surg, 1998, 64(4):344-347.
[4]	Wildfeuer S, Standl T. Multiple stroke syndrome caused by air embolism following removal of a central venous catheter[J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2020, 55(10):644-647. doi: 10.1055/a-1142-1664
[5]	Keegan MT, Mueller JT. Removal of central venous catheters[J]. Anesthesiology, 2012, 117(4):917-918;authorreply918-919.
[6]	李亚飞, 汪洋, 张晓菊. 中心静脉导管拔管窘迫综合征的病因及预防研究进展[J]. 中华护理杂志, 2012, 47(6):571-573.
	Li YF, Wang Y, Zhang XJ. Advances in etiology and prevention of central venous catheter extubation distress syndrome[J]. Chin J Nurs, 2012, 47(6):571-573.
[7]	Institute for Safe Medication Practice(ISMP). ISMP safe practice guidelines for adult IV push medications[EB/OL]. (2015-07-23). https://www.ismp.org/guidelines/iv-push.
[8]	Practice guidelines for central venous access 2020:an updated report by the American society of anesthesiologists task force on central venous access[J]. Anesthesiology, 2020, 132(1):8-43. doi: 10.1097/ALN.0000000000002864
[9]	儿童静脉输液治疗临床实践循证指南工作组. 儿童静脉输液治疗临床实践循证指南[J]. 中国循证儿科杂志, 2021, 16(1):1-42.
[10]	Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy stan-dards of practice,8th edition[J]. J Infus Nurs, 2021, 44(1S Suppl 1):S1-S224. doi: 10.1097/NAN.0000000000000396 pmid: 33394637
[11]	孙红, 陈利芬, 郭彩霞, 等. 临床静脉导管维护操作专家共识[J]. 中华护理杂志, 2019, 54(9):1334-1342.
	Sun H, Chen LF, Guo CX, et al. Expert consensus on venous catheter maintenance[J]. Chin J Nurs, 2019, 54(9):1334-1342.
[12]	成芳, 傅麒宁, 何佩仪, 等. 输液导管相关静脉血栓形成防治中国专家共识(2020版)[J]. 中国实用外科杂志, 2020, 40(4):377-383.
[13]	傅麒宁, 吴洲鹏, 孙文彦, 等. 《输液导管相关静脉血栓形成中国专家共识》临床实践推荐[J]. 中国普外基础与临床杂志, 2020, 27(4):412-418.
	Fu QN, Wu ZP, Sun WY, et al. Clinical practice recommendation of Chinese expert consensus on infusion catheter related venous thrombosis[J]. Chin J Bases Clin Gen Surg, 2020, 27(4):412-418.

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