静脉留置针在肿瘤内科的临床应用和护理

目的: 分析静脉留置针在肿瘤内科应用中的护理问题及原因,总结有效的护理措施。方法: 68例输液患者选用美国B-D公司生产的第4代封闭式单翼套管针为静脉留置针,A组采取大角度缓慢进针、直刺静脉法,B组采用头皮针穿刺法,比较两种穿刺方法与留置时间的关系;主静脉组选择颈外、肘窝及前臂两侧面静脉,分支静脉组选择四肢远端静脉,比较穿刺部位、药物性质与静脉炎的关系。结果: A组成功留置≥48h占88.64%,B组成功留置≥48h占33.33%(P<0.005)。输注含化疗药液体和不含化疗药液体时,主静脉组和分支静脉组静脉炎发生率分别为53.85%、87.50%和14.29%、58.33%(P<0.01和P<0.05)。静脉条件相同时,含化疗药液组和不含化疗药液组静脉炎发生率为66.67%和34.62%(P<0.01)。结论: 静脉留置针采取大角度、缓慢进针直刺静脉法能有效延长留置时间,选择主静脉组穿刺可减少静脉炎的发生,化疗药液对静脉的刺激较大,更易发生静脉炎。静脉留置针能部分取代头皮针,值得在肿瘤内科输液中推广应用。

The clinical application and nursing care of intravenous catheter system in the Department of Medical Oncology

Objective:To study the application of intravenous catheter system in the oncology department,and to explore an effective nursing method.Methods:The 4th generation intravenous catheter sealed with single-wing,made in America,was applied to 68 patients receiving infusion therapy.The large-angle,slow and direct inserting method was applied to Group A,and the scalp needle inserting method to Group B.The relationship between the inserting methods and retaining time was studied.The veins in the neck,cubital fossa and two sides of forearm were selected in main-vein group and peripheral veins of the limbs were selected in branch-vein group.The relationship between the inserting position,the medicine and phlebitis was studied.Results:Successful retaining for more than 48 hours accounted for 88.64% in Group A,and 33.33% in group B(P<0.005);When medicine containing chemotherapy was infused,phlebitis occurred in 53.85% of the cases in the main-vein group and 87.50% in the branch-vein group(P<0.01).When medicine containing no chemotherapy was infused,phlebitis developed in(14.29%) of the cases in the main-vein group and 58.33% in the branch-vein group(P<0.05).When the vein conditions were almost the same,phlebitis occurred in(66.67%) of the cases receiving medicine containing chemotherapy and 34.62% receiving medicine containing no chemotherapy(P<(0.01)).Conclusions:The large angle,slow and straight inserting method may effectively prolong the retaining time of intravenous catheter and decrease the occurrence of phlebitis.Medicine containing chemotherapy,which irritates the veins greatly,is more liable to cause phlebitis.The intravenous catheter system can partly take the place of scalp needle in the oncology department.