摘要
目的探讨胸部肿瘤患者经外周静脉置入中心静脉导管非计划拔管影响因素及发生特征。方法采用便利抽样法,选取2018年3月至2021年12月上海交通大学医学院附属胸科医院胸部肿瘤患者为研究对象,采用Logistic回归分析确定患者非计划拔管的影响因素。结果本研究共纳入242例患者,42例发生非计划拔管,发生率为17.3%。造成非计划拔管的原因依次是导管相关皮炎、导管滑脱、导管堵塞、导管相关血栓、局部或导管相关感染。Logistic多因素回归分析显示,放疗史(OR 0.295,95%CI 0.108~0.806,P=0.017)、手术史(OR 0.247,95%CI 0.076~0.799,P=0.020)是预防非计划拔管的保护因素,历经春季或秋季(OR 8.771,95%CI 2.828~27.204,P<0.001)、导管相关皮炎(OR 12.404,95%CI 4.176~36.845,P<0.001)、导管滑脱(OR 25.105,95%CI 7.040~89.523,P<0.001)、导管堵塞(OR 6.155,95%CI 1.713~22.111,P=0.005)、导管相关血栓(OR 17.817,95%CI 2.848~111.479,P=0.002)是患者非计划拔管的独立危险因素。非计划拔管在导管留置期间均可能发生,但导管留置前期的发生轨迹呈下降趋势,置管后第一个月更可能发生非计划拔管。导管相关并发症存在季节特征,导管相关血栓和导管堵塞易发生在秋冬季节,导管相关皮炎和导管滑脱一年四季均可发生。结论胸部肿瘤患者经外周静脉置入中心静脉导管的非计划拔管发生率高,护理人员应了解其影响因素和发生特征,结合导管相关并发症的季节特征,加强并发症的评估及早期干预,以降低非计划拔管发生率,提高患者带管体验。
Objective To explore the risk factors and event characteristics of unplanned removal of peripherally inserted central catheters(PICCs)in patients with chest tumors.Methods The convenience sampling method was used to select chest cancer patients treated in a hospital in Shanghai between March 2018 and December 2021.Logistic regression analysis was used to identify the risk factors of unplanned removal in these patients.Results A total of 242 patients were included in this study,of whom 42(17.3%)experienced unplanned removal.The most common causes of unplanned removal in descending order were catheter related dermatitis,catheter slippage,catheter occlusion,catheter related thrombosis,and local or catheter related infections.Logistic multivariate regression analysis showed that a history of radiation therapy(OR=0.295,95%CI:0.108 to 0.806,P=0.017)and a history of surgery(OR=0.247,95%CI:0.076 to 0.799,P=0.020)were protective factors for preventing unplanned removal.Catheterization during spring or autumn(OR=8.771,95%CI:2.828 to 27.204,P<0.001),catheter-related dermatitis(OR=12.404,95%CI:4.176 to 36.845,P<0.001),catheter slippage(OR=25.105,95%CI:7.040 to 89.523,P<0.001),occlusion(OR=6.155,95%CI:1.713 to 22.111,P=0.005),and catheter related thrombosis(OR=17.817,95%CI:2.848 to 111.479,P=0.002)were independent risk factors of unplanned removal.Unplanned removal may occur anytime when the patient had the catheter inserted,but is less likely to happen in the early stage and more likely in the first month after catheterization.Besides,catheter related complications demonstrated seasonality,with catheter related thrombosis and occlusion more frequent in autumn and winter,compared with dermatitis and catheter slippage showing no difference in incidence around the year.Conclusions The incidence of unplanned removal is high in chest tumor patients with PICC.Nursing staff should familiarize themselves with the risk factors,event characteristics,and the seasonality of catheter related complications,and improve the evaluation and e
作者
王艳
缪苗
徐敏珊
万光明
Wang Yan;Miao Miao;Xu Minshan;Wan Guangming(Shanghai Jiao Tong University School of Nursing,Shanghai 200025,China;Shanghai Chest Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200030,China)
出处
《中华临床营养杂志》
CAS
CSCD
2023年第6期354-361,共8页
Chinese Journal of Clinical Nutrition
