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血液系统肿瘤患者经外周静脉置入中心静脉导管相关性皮肤损伤预防及管理的循证实践

Evidence-based practice in the prevention and management of peripherally inserted central catheter-associated skin injury in patients with tumors of hematologic system

    摘要
  • 摘要:
    目的 观察血液系统肿瘤患者经外周静脉置入中心静脉导管(PICC)的导管相关性皮肤损伤(CASI)预防及管理的循证实践效果。
    方法 遵循乔安娜布里格斯研究所(JBI)临床证据实践应用模式，总结前期血液系统肿瘤PICC置管患者CASI预防证据，制订相应的临床审查指标，逐条审查并进行障碍因素分析，将其应用于临床实践。以2020年5月—2021年5月证据应用前纳入的57例血液系统肿瘤PICC置管患者为证据应用前组，以2021年6月—2022年6月证据应用后纳入的63例血液系统肿瘤PICC置管患者为证据应用后组。比较2组患者皮肤瘙痒、揭除敷料后疼痛及CASI发生情况。比较审查小组循证实践前后对CASI预防知识的知晓情况及证据应用后审查指标的执行情况。
    结果 证据应用后，皮肤瘙痒和揭除敷料后疼痛患者占比及CASI发生率低于证据应用前，差异有统计学意义(P < 0.05)。证据应用后，指标1执行达标率为93.33%, 指标2~7的达标率分别提升至81.67%、83.33%、86.67%、88.33%、78.33%、91.67%, 指标8~10的达标率均达到100.00%。证据应用后组护士的皮肤评估、皮肤保护、预防性敷料选择、操作手法、观察及维护评分以及总分高于证据应用前组，差异有统计学意义(P < 0.05)。
    结论 CASI预防及管理的循证实践可降低血液系统肿瘤患者CASI发生率，提高护士CASI预防知识知晓率和执行依从性。

     

    Abstract:
    Objective To observe the effect of the evidence-based practice in the prevention and management of peripherally inserted central catheter(PICC) catheter-associated skin injury (CASI) in patients with tumors of hematologic system.
    Methods According to the application model of Joanna Bfiggs Institute(JBI) clinical evidence practice, the evidence of CASI prevention in patients with tumors of hematologic system undergoing PICC catheterization was summarized in the early stage, the corresponding clinical review indexes were formulated. The detailed reviews and analysis of obstacle factors were conducted, and they were applied in clinical practice. A total of 57 patients with tumors of hematologic system undergoing PICC catheterization before evidence application were enrolled as evidence pre-application group between May 2020 and May 2021, while 63 patients after evidence application were enrolled as evidence post-application group between June 2021 and June 2022. The occurrence of skin pruritus, pain and CASI after dressing removal and CASI were compared between the two groups. The cognition of CASI prevention knowledge before and after evidence-based practice, and the implementation of review indexes after evidence application were compared.
    Results After the application of evidence, the proportion of patients with skin pruritus and pain after dressing removal and the incidence of CASI were lower than those before the application of evidence (P < 0.05). After the application of evidence, the reaching the standard rate of index 1 performance was 93.33%, and the reaching the standard rates of indexes performance 2 to 7 were increased to 81.67%, 83.33%, 86.67%, 88.33%, 78.33% and 91.67%, respectively, and reaching the standard rates of indexes 8 to 10 were increased to 100.00%.
    Conclusion Evidence-based practice in the prevention and management of CASI can reduce the incidence of CASI in patients with tumors of hematologic system, and improve nurses′ cognition rate to CASI prevention knowledge and implementation compliance.

     

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