ICU患者血液净化专用中心静脉导管封管情况的调查

目的 调查ICU患者血液净化专用中心静脉导管的封管情况,并比较不同等级医院之间的差异。 方法 2020年9月,采用便利抽样法对23个省份117所医院共228名ICU护士长进行在线调查,调查内容包括医院及ICU的基本信息、ICU患者血液净化专用中心静脉导管的封管现状。结果 共回收222份有效问卷。肝素溶液是ICU患者血液净化专用中心静脉导管最常用的封管液,其次是枸橼酸钠溶液,尿激酶溶液使用最少。肝素溶液的浓度以1 250 U/ml为主,枸橼酸钠溶液的浓度以4%为主。封管液剂量以1倍导管容量居多;护士多在每次血液净化结束后封管,封管方式以正压联合脉冲封管为主;封管前均进行回抽,回抽次数以2次居多,每次回抽量以2倍导管容量居多。非三级医院的ICU在封管液浓度、封管液剂量、封管频次、封管前回抽次数、每次回抽量等方面均与三级医院不同,差异具有统计学意义（均P<0.05）。结论 各ICU在血液净化专用中心静脉导管封管液的种类、浓度、剂量及封管频次等方面不尽相同,建议制订ICU患者血液净化专用中心静脉导管封管护理实践标准,规范护士封管行为。

The status of central venous catheter closure for blood purification in ICU patients

Objective To investigate the current situation of central venous catheter closure for blood purification patients in ICUs,and to compare the differences between different hospitals. Methods In September 2020,the convenience sampling method was used to conduct an online survey of 228 ICU wards in 117 hospitals of 23 provinces. The survey included general information and the current status of the central venous catheter closure for blood purification patients in the ICUs. Results A total of 222 valid questionnaires were collected. Heparin was the most commonly used sealing liquid,followed by citric acid,and urokinase was the least. The concentration of heparin was mainly 1 250 U/ml,and the concentration of citric acid was mainly 4%. The dosage of the sealing solution was mostly 1 times the volume of the catheter;the frequency of sealing is more after each dialysis;the sealing method is mainly positive pressure combined with pulse sealing. The catheter was withdrawn before sealed;the number of withdrawals was mostly 2 times,and the withdrawal volume per time was mostly twice the catheter capacity. There are significant differences in terms of the concentration,dosage,frequency of sealing,number of withdrawals,withdrawal volume per time between tertiary hospitals and non-tertiary hospitals（all P<0.05）. Conclusion The selection,concentration,dosage,frequency of the sealing of the central venous catheter for blood purification in ICUs are not the same. It is recommended to formulate the nursing standards for sealing the central venous catheter for blood purification patients in the ICU to standardize the reasonable and effective sealing of the tube by clinical nurses.