唐錦梅x
[摘要] 目的 探討惡性腫瘤患者PICC置管的并發(fā)癥原因及護理效果。 方法 選取我院2017年2月~2018年2月接診的100例惡性腫瘤且接受PICC置管的患者進行研究,根據(jù)患者的入院資料進行分析整理,對患者PICC置管后出現(xiàn)的并發(fā)癥發(fā)生情況進行分析記錄,并研究出并發(fā)癥的預防措施及發(fā)生的主要原因。 結果 所有患者中出現(xiàn)靜脈炎5.00%,血栓形成1.00%,感染1.00%,導管堵塞2.00%,導管脫落1.00%,滲血6.00%,100例患者有16.00%發(fā)生并發(fā)癥,經(jīng)分析調(diào)查,惡性腫瘤患者PICC置管的并發(fā)癥原因與靜脈時穿刺的選擇、護理方式有著密切的關系。 結論 惡性腫瘤患者PICC置管主要是由導管相關性感染與靜脈炎引起的多種并發(fā)癥,應對患者實施貴要靜脈進行穿刺,并采取醫(yī)院相關性的護理措施,降低并發(fā)癥的發(fā)生。
[關鍵詞] 惡性腫瘤;PICC置管;并發(fā)癥;護理
[中圖分類號] R473.73? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701(2019)04-0135-03
[Abstract] Objective To investigate the causes of complications and nursing effects of PICC catheterization in patients with malignant tumors. Methods A total of 100 patients with malignant tumors who underwent PICC catheterization from February 2017 to February 2018 in our hospital were enrolled in the study. The patient's admission data were analyzed and organized. The occurrence of complications after PICC catheterization was analyzed and recorded. And the preventive measures for complications and the main causes of the complications were studied. Results In all patients, phlebitis accounted for 5.00%, thrombosis 1.00%, infection 1.00%, catheter occlusion 2.00%, catheter detachment 1.00%, oozing 6.00%. 16.00% of 100 patients had complications. After analysis and investigation, the causes of complications of PICC catheterization in patients with malignant tumors were closely related to the choice of venous puncture and the way of nursing. Conclusion The complications of PICC catheterization in patients with malignant tumors are mainly caused by catheter-related infections and phlebitis. Patients should be punctured with basilic vein and hospital-related nursing measures should be taken to reduce complications.
[Key words] Malignant tumor;PICC catheterization;Complications;Nursing
PICC置管是采用導管經(jīng)外周手臂靜脈進行穿刺置管,使導管尖端位于鎖骨下靜脈的方法,在惡性腫瘤化療中比較常見的治療方法,因該病需要長期接受靜脈輸液和化療[1]。所以應用PICC置管對患者實施治療,PICC置管能夠降低穿刺靜脈次數(shù),提高治療依從性,防止化療藥物對血管及其他器官帶來不同的損傷,改善部分程度疼痛[2]。雖然PICC置管對惡性腫瘤患者的效果明顯,可惡性腫瘤屬于高消耗性疾病,導致患者防御能力差,而在臨床上采取PICC置管的患者常出現(xiàn)諸多并發(fā)癥,對患者的身體恢復與護理增加了嚴重的影響[3]。所以對加強PICC置管的惡性腫瘤患者的護理干預十分關鍵[4]。采用護理模式可有效降低并發(fā)癥的發(fā)生,改善患者的心理壓力,其具有幫助患者提高治療效果的作用。本研究對我院接診的100例惡性腫瘤患者PICC置管并發(fā)癥原因及護理效果進行分析,旨在探討惡性腫瘤PICC置管后并發(fā)癥原因及護理效果,現(xiàn)報道如下。
1 資料與方法
1.1 一般資料
選取我院2017年2月~2018年2月接診的100例惡性腫瘤且接受PICC置管的患者進行研究,所有患者經(jīng)病理切片檢查確診患有腫瘤,其中男58例,女42例,年齡26~68歲,平均(53.7±3.09)歲。其中乳腺癌患者20例,大腸癌患者19例,肝癌患者18例,胃癌患者22例,肺癌患者16例,其他腫瘤類型患者5例。所有患者使用的導管均采取PICC置管,并對患者采用藥物化療進行輸注。
1.2方法
綜上所述,惡性腫瘤患者PICC置管的并發(fā)癥主要是由靜脈炎、滲血、感染、血栓形成等造成,而發(fā)生并發(fā)癥的主要原因與患者靜脈穿刺時的選擇和采取的護理方法有關。因此,對惡性腫瘤患者PICC置管時應選擇貴要靜脈,在護理方面應選擇住院護理,可有效提高臨床療效,降低并發(fā)癥的發(fā)生率,值得廣泛應用及推廣。
[參考文獻]
[1] 馮月清,吳偉仙,潘印,等. 腫瘤患者PICC導管相關性感染的危險因素及護理對策[J]. 中國現(xiàn)代醫(yī)生,2017, 55(7):146-148,152.
[2] Sharp R,Cummings M,F(xiàn)ielder A,et al.The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter(PICC):A prospective cohort study[J].Int J Nurs Stud,2015,52(3):677-685.
[3] 楊萌,楊方英.腦腫瘤患者PICC置管后發(fā)生靜脈炎的影響因素分析及處理對策[J].中國現(xiàn)代醫(yī)生,2018,56(19):89-92.
[4] 唐蕊,金珊珊,陳新新.非腫瘤科護士對腫瘤護理知識認知的調(diào)查分析[J].中國現(xiàn)代醫(yī)生,2018,56(1):133-135.
[5] 丁小娣,盧倩林.腫瘤化療患者出院后護理隨訪管理對策[J].中國現(xiàn)代醫(yī)生,2017,55(31):154-156.
[6] Refaei M,F(xiàn)ernandes B,Brandwein J,et al.Incidence of catheter-related thrombosis in acute leukemia patients: a comparative,retrospective study of the safety of peripherally inserted vs. centrally inserted central venous catheters[J].Ann Hematol,2016,95(12):2057-2064.
[7] 周冬蓮,劉清霞,曾小燕.低分子肝素鈉同步全程抗凝對肺癌患者PICC置管后的護理觀察[J].中國現(xiàn)代醫(yī)生,2017,55(24):144-147.
[8] 楊莉.健康教育干預對腫瘤外科PICC置管患者依從性及自我護理能力的影響[J].中國現(xiàn)代醫(yī)生,2015,53(4):155-157.
[9] 岑朝蕾,董曉武.優(yōu)質(zhì)護理干預對PICC置管腫瘤患者依從性及心理健康狀況的影響[J].中國現(xiàn)代醫(yī)生,2015, 53(3):149-151,154.
[10] Bertoglio S,F(xiàn)accini B,Lalli L,et al.Peripherally inserted central catheters(PICCs) in cancer patients under chemotherapy:A prospective study on the incidence of complications and overall failures[J].J Surg Oncol,2016, 113(6):708-714.
[11] 程瑾璇.新式護理在老年婦科腫瘤合并糖尿病圍手術期中的護理效果探討[J].中國現(xiàn)代醫(yī)生,2015,53(8):147-149.
[12] 鄭科武.腫瘤患者PICC置管并發(fā)上肢靜脈血栓的危險因素分析[J].中國現(xiàn)代醫(yī)生,2018,56(7):76-78.
[13] 羅錦菊,孫成暉,洪鳳娟,等. 精準管理法減少惡性腫瘤患者PICC置管后并發(fā)癥的應用研究[J]. 中國實用醫(yī)藥,2018,13(9):161-162.
[14] 陳蓓. 消化道腫瘤PICC置管患者負面情緒發(fā)生與相關并發(fā)癥的關系及護理干預分析[J]. 現(xiàn)代消化及介入診療,2016,21(2):277-279.
[15] Borretta L,MacDonald T,Digout C,et al.Peripherally Inserted Central Catheters in Pediatric Oncology Patients:A 15-Year Population-based Review From Maritimes,Canada[J].J Pediatr Hematol Oncol,2018,40(1):e55-e60.
(收稿日期:2018-10-15)