外周中心静脉置管肿瘤患者居家期间的护理问题分析及干预

目的 探讨外周中心静脉置管（PICC）化疗患者带管居家期间出现的护理问题，针对这些问题进行分析及干预，制订相应的对策，确保患者留置PICC带管的安全性。方法 选择2012年3月～2013年9月于广西科技大学第二附属医院行超声引导下改良PICC置管化疗患者92例为研究对象。对所有患者带管居家期间进行持续跟踪随访，对导管相关并发症、自我维护问题、日常生活问题等进行及时干预及健康教育，分析第1次和第2次随访结果 。结果 经过护理干预及健康教育后，第2次随访除静脉炎外，局部感染（4．3％）、导管部分脱出（2．2％）及并发症总发生率（7．6％）均较第1次随访（13．0%、9．8％、26．1％）明显下降，差异均有统计学意义（P〈0．05或P〈0．01）；第2次随访导管维护〉7d、不换贴膜、提重物及过度活动等导管自我维护问题发生率分别为4．3％、3．3％、3．3％、1．1％，较第1次随访（17．4％、12．0％、10．9％、9．8％）明显下降，差异均有统计学意义（P〈0．05或P〈0．01）：限制家务、沐浴减少、只擦身日常生活问题发生率（9．8％、7．6％、14．1％）均较第1次随访（42．4％、18．5％、30．4％）明显下降，差异均有统计学意义（P〈0．05或P〈0．01）。结论 通过电话随访对带管患者居家期间的护理问题进行分析及干预．改变患者的不良行为，降低并发症的发生，保证导管的安全性。

Nurse question analysis and intervention on cancer patients with PICC during at home

Objective To investigate the nurse question of cancer patients with chemotherapy by PICC indwelling during at home, analysis and intervention for these question, analyze and intervene these question, and make corresponding countermeasures to ensure the security of cancer patients with PICC indwelling. Methods 92 cases with chemotherapy by ultrasonographic guidance improve PICC indwelling from March 2012 to September 2013 in the Second Affiliated Hospital of Guangxi University of Science and Technology were selected as study objects. All patients were followed up real-time during at home, and self-maintenance problem of catheter-related complications, daily life common problems were timely intervened and health educated, results of the first and the second follow-up were analyzed. Results After nursing interventions and health education, the rate of complication except phlebitis in the second follow-up such as lo cal infection （4.3%）, part of the catheter out （2.2%）, total incidence of complications （7.6%） were significantly lower than that in the first follow-up （13.0%, 9.8%, 26.1%）, the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. The second follow-up, catheter self-maintenance problems incidence such as catheter maintenance 〉7 d, without change of the sticker, heavy lifting and excessive activities were 4.3%, 3.3%, 3.3%, 1.1% respectively, which were significantly lower than the first follow-up （17.4%, 12.0%, 10.9%, 9.8%）, the differences were statistically significant （P 〈 0.05 or P 〈 0.01）; and the incidence of day-to-day problems such as limit the housework, reducing bathe, only clean the body were 9.8%, 7.6%, 14.1% respectively, which were significantly lower than the first follow-up （42.4%,18.5%, 30.4%）, the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. Conclusion Analyzing and interven- ing the nurse question of patients with by PICC indwelling during at home by telephone follow-up can change the bad behavior of patients, and reduce the happen of complications, ensure the safety of catheter.