全国31家医院儿科患者中心血管通路应用现况调查

目的调查我国儿童中心血管通路装置使用现状,为儿科患者中心血管通路装置的规范化使用、专业护理提供借鉴,为儿科静脉治疗管理提供支持与依据。方法采取便利抽样方法,于2018年7月23—31日,选取福棠儿童医学发展研究中心成员医院及医联体的31家儿童专科医院、设置儿科的妇幼保健院及综合医院,对所有使用中心血管通路的患儿,采用研究小组自制儿童中心血管通路使用状况调查表进行调查,并观察并发症发生情况。共采集1333份调查表,有效1288份,有效率96.62%。结果31家医院中三级医院22家、二级医院9家,1288例使用中心血管通路输液的患儿中,PICC 860例,占66.77%,中心静脉置管(CVC)342例,占26.55%,输液港(PORT)77例,占5.98%,脐静脉置管9例,占0.70%;科室分布主要集中于血液肿瘤科、ICU、儿外科、心血管科、新生儿科;PICC、CVC、PORT置管部位分别以上肢(90.00%,774例)、颈内静脉(73.39%,251例)、胸部(96.10%,74例)为主;中心血管通路装置维护中,存在多种敷料并存现象。结论中心血管通路在儿科患者群体已经得到广泛使用,中心血管通路装置的选择较为规范,但在管路的维护、敷料的使用、输液接头的选择及相关并发症的控制方面尚有待进一步加强。建议儿科护理专业人员及护理管理者,进一步强化中心血管通路置管及维护的相关知识,依照国际及国家静脉输液治疗指南及标准加大管理及督促力度,进一步降低儿科患者中心血管通路并发症的发生率。

Current status of central vascular access devices in pediatric patients in 31 hospitals nationwide

Objective To explore the currents status of central vascular access devices(CVADs)in children's medical center in China and to provide a reference for the standardized use of CVADs and specialized nursing as well as a basis for pediatric intravenous therapy management.Methods Totally 31 hospitals of Futang Research Center of Pediatric Development,children's hospitals of the medical treatment alliance as well as women and children care centers and general hospitals with pediatric departments were selected by convenient sampling from July 23rd to 31st,2018.All the pediatric patients using CVADs were investigated with the Central Vascular Access Device Questionnaire which was designed by the research group,and the incidence of complications was also observed.Totally 1333 questionnaires were collected,among which 1288 were valid,accounting for an effective recovery rate of 96.62%.Results There were 22 ClassⅢand 9 ClassⅡhospitals among the 31 hospitals.Among the 1288 pediatric patients who used CVADs,860 used peripherally inserted central catheters(PICC),accounting for 66.77%;342 used central venous catheters(CVC),accounting for 26.55%;77 used implantable venous access port(PORT),accounting for 5.98%;and 9 used umbilical venous catheters,accounting for 0.70%.CVADs were mainly used in the Departments of Hematological Neoplasms,ICU,Intensive Care Unit Pediatric Surgery,Vasculocardiology and Neonatals.PICC,CVC and PORT were mainly applied to upper extremities(90.00%,74 cases),jugular vein(73.39%,251 cases)and the breast(96.10%,74 cases)respectively.In the maintenance of CVADs,there was the problem of co-existing dressings.Conclusions CVADs have been widely used in pediatric patients,and the choice of CVADs is relatively standardized.However,the maintenance of the catheters,the use of dressings,the selection of infusion connectors and the control of related complications still need to be strengthened.It is recommended that nursing professionals and nursing managers should further strengthen their knowledge about the placement and maintenance of CVADs,and intensify their management and supervision in accordance with international and national guidelines and standards for intravenous infusion therapy to further reduce the incidence of vascular access complications in pediatric patients.