医护一体PDCA护理模式对新生儿PICC护理的效果观察

  目的  本研究旨在通过探讨医护一体PDCA护理模式在新生儿PICC护理中的应用效果，从而总结更为安全有效的重症新生儿PICC护理管理相关措施。  方法  选取从2018年1月1日—2019年12月31日入住淮北市妇幼保健院儿科并进行PICC置管的59例重症新生儿为研究对象。其中2018年1—12月置管的23例作为对照组，采用常规质量管理；2019年1—12月置管的36例作为观察组，采用医护一体PDCA护理模式，比较医护一体PDCA护理模式应用前后PICC相关性血流感染发生率与PICC并发症的发生率。  结果  对照组23例重症新生儿PICC置管，带管总日数426 d，其中发生PICC相关性血流感染4例，感染率为9.30‰；观察组36例重症新生儿PICC置管，带管总日数714 d，发生PICC相关性血流感染仅1例，感染率为1.40‰，且2组PICC置管相关血流感染率差异有统计学意义(P < 0.05)。对照组重症新生儿PICC置管后发生静脉炎2例(8.69%)，渗血3例(13.04%)，堵管1例(4.34%)，无断管发生；观察组重症新生儿PICC置管后发生静脉炎1例(2.78%)，无堵管、断管及渗血发生；且2组PICC置管后的相关并发症比较差异有统计学意义(P < 0.05)。  结论  医护一体PDCA护理模式能够有效降低新生儿PICC相关性血流感染发生率与并发症的发生率，保证新生儿治疗的安全性，提高了护理依从性，值得在临床推广。 

Observation on the effect of PDCA nursing model of integrated medical and nursing on newborn PICC nursing

  Objective  To explore the effects of the integrated PDCA nursing model of medical and nursing in the application of PICC nursing in newborns, so as to summarise safer and more effective measures related to PICC nursing management of severely ill newborns.  Methods  From January 1, 2018 to December 31, 2019, 59 severely ill newborns who were admitted to the Department of Pediatrics and PICC in Huaibei Maternal and Child Health Hospital of Anhui Province were selected as the research objects. Amongst them, 23 cases intubated from January to December 2018 were used as control group (using routine quality management), and 36 cases intubated from January to December 2019 were used as observation group (using the integrated PDCA nursing model of medical and nursing). The incidence of PICC-related bloodstream infection and PICC complications before and after model application was compared.  Results  In the control group, 23 severely ill newborns were placed with PICC, and the total number of days with the tube was 426 days. Amongst them, 4 cases of PICC-related bloodstream infection occurred, and the infection rate was 9.30‰; 36 cases of severely ill newborns with PICC were placed in the observation group, and the total number of days with the tube was 714 days. On the same day, only 1 case of PICC-related bloodstream infection occurred, with an infection rate of 1.40‰, and a statistical difference was observed in the rate of PICC-related bloodstream infection between the two groups (P < 0.05). In the control group, 2 cases (8.69%) of severe neonatal phlebitis (8.69%), 3 cases (13.04%) of bleeding and 1 case (4.34%) of tube block were observed. No broken tube was noted. In the observation group, 1 case (2.78%) of phlebitis without tube blockage, broken tube and blood oozing was observed. The related complications after PICC catheterization in the two groups were statistically different (P < 0.05).  Conclusion  The integrated PDCA nursing model of medical and nursing can effectively reduce the incidence of PICC-related bloodstream infections and complications in newborns, ensure the safety of neonatal treatment and improve nursing compliance. It is worthy of clinical promotion.