摘要
目的探讨精细化管理在儿童重症患者PICC置管和维护中的应用及效果。方法选择2017年1月至2018年12月置入PICC的819例患者为对照组,实施常规置管和维护,选择2019年1月至2020年12月置入的699例患者为观察组,在常规置管和维护的基础上实施精细化管理,从“精、准、细、严”四个角度,建立全程、全面PICC质量管理体系,构建分级、可执行的PICC质量安全标准,以问题为导向,流程化、细节化PICC置管和维护流程,常态化、过程化落实PICC质量安全控制,并开展以需求为导向的教育培训。比较开展前后,两组PICC尖端一次性到位率和静脉炎、堵管、导管相关血流感染(CRBSI)发生率的差异。结果实施精细化管理后,PICC尖端一次性到位率由86.9%提升至93.1%,差异有统计学意义(P<0.01),PICC堵管发生率由1.0%降至0.1%,差异有统计学意义(P<0.05),静脉炎发生率由0.4%降低至0.1%,CRBSI发生率由0.7%降至0.3%,差异无统计学意义(P>0.05)。结论精细化管理可提高PICC置管成功率,降低部分PICC相关并发症,适合在PICC领域推广,应基于医院和科室特点,建立适用的、可执行的、有效的精细化管理方案。
Objective To study the effects of refined management in PICC catheterization and daily maintenance in children with severe diseases.Methods From January 2017 to December 2018,819 patients who were placed in PICC and receiving routine care were selected as control group(CG).From January 2019 to December 2020,699 patients who were placed in PICC were selected as observation group(OG).Refined management was carried out in OG from four perspectives of precision,accuracy,detail and strictness.Comprehensive quality management system of PICC was established.Grading quality and safety standards of PICC was implemented.Problem-oriented,flow-oriented detailed PICC catheterization and maintenance process was advanced.And quality and safety of PICC was checked,along with oriented education and training.Differences of rate of phlebitis,occlusion,catheter-related bloodstream infection(CRBSI)and tip positioning accuracy of PICC were compared.Results Compared with CG,tip positioning accuracy of PICC increased from 86.9%to 93.1%with statistically significant difference(P<0.01).Incidence of PICC tube occlusion decreased from 1.0%to 0.1%with statistically significant difference(P<0.05).Rate of phlebitis decreased from 0.4%to 0.1%and incidence of CRBSI declined from 0.7%to 0.3%with no statistically significant difference(P>0.05).Conclusion Refined management could improve PICC tube placement efficiency,reduce some complications.It is suitable for quality promotion in PICC field.Based on characteristics of hospitals and departments,an applicable refined management strategy could be established.
作者
冯梅
罗玉兰
胡琳
唐梦琳
Feng Mei;Luo Yulan;Hu Lin(Intensive Care Unit,West China Hospital of Sichuan University,Chengdu,Sichuan 610041;West China School of Nursing,Sichuan University,Chengdu,Sichuan 610041,China)
出处
《四川医学》
CAS
2021年第11期1162-1166,共5页
Sichuan Medical Journal
基金
四川大学华西医院学科卓越发展1·3·5工程项目(编号:2018HXFH042)。
关键词
精细化管理
经外周穿刺中心静脉置管
质量
安全
儿童
重症监护
refined management
peripherally inserted central catheter
quality
safety
pediatric patients
intensive care
