重慶市部分區(qū)縣醫(yī)院靜脈治療質(zhì)量現(xiàn)況調(diào)查及對策

　　[摘要] 目的 探討重慶市區(qū)縣級醫(yī)院靜脈治療質(zhì)量現(xiàn)況，為臨床開展相關(guān)培訓(xùn)和質(zhì)量改進提供依據(jù)。 方法 2016年3月21日，通過橫斷面調(diào)查重慶市江津區(qū)中心醫(yī)院、三峽中心醫(yī)院、梁平縣人民醫(yī)院的所有住院患者靜脈輸液治療目前所處的水平和存在問題。調(diào)查重點為輸液工具的選擇、輸液穿刺部位的選擇、各種導(dǎo)管的維護情況、導(dǎo)管的固定及并發(fā)癥。 結(jié)果 ①共計住院患者3232例，其中輸液患者2680例，輸液率為82.9%。最終納入1954例輸液患者作為研究對象。②穿刺工具的使用情況：頭皮針占46.0%，留置針占49.0%，CVC占3.7%，PICC占1.3%。③穿刺部位的選擇：手背占61.0%，前臂占24.0%，其他部位占15.0%。④敷料的選擇和固定：透明敷料占98.9%，紗布敷料占1.1%。敷料固定和維護不規(guī)范共計384例，其中標(biāo)識不規(guī)范共計183例，占47.6%；敷料固定不當(dāng)共計81例，占21.1%；敷貼內(nèi)有積血或滲液共計72例，占18.8%；敷料卷邊共計48例，占12.5%。⑤導(dǎo)管的維護：導(dǎo)管/接頭內(nèi)有陳舊性積血/回血占15.0%。⑥輸液相關(guān)并發(fā)癥：并發(fā)癥共計126例，穿刺點發(fā)紅最多見，占51.6%。 結(jié)論 所調(diào)查醫(yī)院關(guān)于穿刺部位的選擇及敷貼固定操作比較規(guī)范，但在輸液工具的選擇及導(dǎo)管維護方面，仍存在許多不足。護理管理者應(yīng)針對現(xiàn)狀進行分析，開展相關(guān)培訓(xùn)和指導(dǎo)，進一步規(guī)范操作行為，保證患者輸液安全，防止輸液并發(fā)癥發(fā)生。
　　[關(guān)鍵詞] 靜脈治療；護理管理；對策
　　[中圖分類號] R473 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1673-7210（2018）02（c）-0044-04
　　[Abstract] Objective To discuss the present situation of the quality of venous treatment in the county hospitals of Chongqing， in order to provide the basis for the clinical training and quality improvement. Methods On March 21， 2016， through a cross-sectional survey， the current level and problems of intravenous infusion treatment for all hospitalized patients in Jiangjin Central Hospital of Chongqing， Three Gorges Central Hospital， and Liangping County People′s Hospital were investigated. In this study， the investigation focuses on the selection of infusion tools， selection of infusion puncture site， maintenance of various catheters， fixation and complications of catheter. Results ①Among a total number of 3232 patients in hospital， 2680 patients have been treated with infusion， accounting for 82.9%， among which， 1954 patients were chosen and recorded in research database. ②The use of the puncture tool was as follows： scalp needles accounted for 46.0%， the retention needle accounted for 49.0%， CVC accounted for 3.7%， and PICC accounted for 1.3%. ③The selection of puncture sites was as follows： 61.0% were conducted on the back of hands， 24.0% were in the forearm， and 15.0% were in other parts. ④The choice of dressing and fixation： 98.9% were transparent dressings， 1.1% were gauze dressings. There were 384 cases of nonstandard fixation and maintenance of dressings， including 183 nonstandard cases， accounting for 47.6%； 81 improper cases， accounted for 21.1%； 72 cases of hematocele or leakage in the wound dressing， accounting for 18.8%； 48 cases of edge curl， which accounted for 12.5%. ⑤Catheter maintenance： hematocele in catheter or joint， accounted for 15.0%. ⑥Related complications of infusion： 126 cases on complications where red points were mostly occurred in puncture sites， accounted for 51.6%. Conclusion According to the investigation， the surveyed hospitals operate quite well in choosing puncture sites and fixation， but there exist many defects in the selection and maintenance of catheter infusion tools. Nursing staff should analyze the current situations and carry out the relevant training and guidance to further standardize the operation behaviors so as to ensure the safety of transfusion and to prevent the occurrence of transfusion complications.

相關(guān)熱詞搜索：重慶市 現(xiàn)況 靜脈 區(qū)縣 對策