循证实践方案配合心房内心电监测对三向瓣膜PICC尖端定位效果的影响-现代医学

循证实践方案配合心房内心电监测对三向瓣膜PICC尖端定位效果的影响

单位：南通大学附属海安医院肿瘤科, 江苏海安 226600

分类号：R473.73

出版年·卷·期（页码）：2018·46·第八期（953-957）

摘要：

目的：分析循证实践方案配合心房内心电监测对三向瓣膜PICC尖端定位效果的影响。方法：收集我院肿瘤科自2016年1月~2017年10月收治的需行三向瓣膜PICC置管的患者100例作为观察对象，将其按随机数字表法分为观察组与对照组两组（各50例）。对照组给予常规护理干预配合常规体表定位方法进行PICC尖端定位，观察组则给予循证实践方案配合心房内心电监测即时定位技术进行PICC尖端定位。比较两组PICC置管定位准确率、定位耗时、置管成本以及患者对护理人员的满意度情况。结果：观察组PICC置管定位准确率高达98.00%，显著高于对照组的86.00%（χ²=4.891 3，P=0.027 0）。观察组心电图波形稳定率为90.00%，明显高于对照组的74.00%（χ²=4.336 0，P=0.037 3），观察组心电图波形不稳定的5例患者中，漂移波3例、粗波1例、不能辨别波1例。观察组定位耗时为（4.69±3.97）min、定位成本为（5.94±4.61）元，均分别显著低于对照组的（7.86±4.05）min、（41.72±8.68）元（t=3.952 4，P=0.000 1；t=25.742 4，P=0.000 0）。观察组护理满意度得分为（9.61±0.25）分，明显高于对照组的（7.12±0.19）分（χ²=56.072 0，P=0.000 0）。结论：循证实践方案配合心房内心电监测能够显著提升三向瓣膜PICC尖端定位效果，同时置管耗时短，操作简单，可节约医护人员操作时间，节省置管成本，具有较高的推广价值。

Objective:To analyze the effect of evidence-based practice combined with atrial electrocardiogram (ECG) monitoring on the three-dimensional valve PICC tip localization. Methods:100 cases of patients with three-dimensional valve PICC admitted during January 2016 to October 2017 in our department of oncology were divided into observation group and control group according to random number table, 50 in each group. The control group was given routine nursing intervention with conventional surface location method for PICC tip positioning, while the observation group was given evidence-based practice with atrial endocardial monitoring of real-time positioning technology for PICC tip positioning. PICC catheter positioning accuracy, positioning time, cost of catheterization and patient satisfaction with caregivers were compared between the two groups. Results:The PICC catheterization accuracy of the observation group was as high as 98.00%, significantly higher than that of the control group of 86.00%(χ²=4.891 3,P=0.027 0).The stability of electrocardiogram waveform in the observation group was 90.00%, which was significantly higher than 74.00% in the control group(χ²=4.336 0,P=0.037 3). Among the 5 patients with unstable ECG waveform in observation group, there were 3 cases of drift wave, 1 case of coarse wave and 1 case of wave discernment. The time spent in the observation group was (4.69±3.97) min and the localization cost was (5.94±4.61) Yuan, which were respectively significantly lower than those in the control group (7.86±4.05) min and (41.72±8.68) Yuan(t=3.952 4,P=0.000 1;t=25.742 4,P=0.000 0),respectively. The score of nursing satisfaction in the observation group was (9.61±0.25) points, which was significantly higher than that of the control group (7.12±0.19) points(χ²=56.072 0, P=0.000 0).Conclusion:Evidence-based practice combined with atrial electrocardiogram monitoring can significantly improve the three-dimensional valve PICC tip positioning with shorter catheterization time, easier operation, less operating time and cost, thus worthy of recommendation.

参考文献：

[1] 胡桂菊,张淑香,李晴,等.心房内心电监测引导三向瓣膜PICC尖端定位的临床应用[J].中华现代护理杂志,2015,21(33):4085-4087.
[2] 张婧,吴贤翠.心电监护定位技术在肿瘤化疗患者三向瓣膜式PICC置管中的应用效果[J].实用临床医药杂志,2016,20(12):17-19.
[3] JOHANSSON E,HAMMARSK F,LUNDBERG D,et al.A survey of the current use of peripherally inserted central venous catheter (PICC) in Swedish oncology departments[J].Acta Oncol,2013,52(6):1241-1242.
[4] 覃慧敏,冯毕龙.腔内心电图技术在三向瓣膜式经外周静脉置入中心静脉导管置管术中的应用[J].中华临床营养杂志,2015,23(6):384-386.
[5] 郑春华,吴贤翠.腔内心电图技术定位PICC导管尖端位置的临床应用研究[J].护理研究,2016,30(33):4208-4209.
[6] 黄芬,梅赣红,张玉红,等.自制心电连接转换器在PICC尖端定位的临床研究[J].护士进修杂志,2015,30(16):1518-1519.
[7] 周莲清,谌永毅,王佳丽,等.心房内心电图引导PICC尖端定位方法的临床应用研究[J].护士进修杂志,2013,28(22):2021-2023.
[8] 孙红,王蕾,聂圣肖,等.心电图引导PICC尖端定位的多中心研究[J].中华护理杂志,2017,52(8):916-920.
[9] PATEL G S,JAIN K,KUMAR R,et al.Comparison of peripherally inserted central venous catheters (PICC) versus subcutaneously implanted port-chamber catheters by complication and cost for patients receiving chemotherapy for non-haematological malignancies[J].Support Care Cancer,2014,22(1):121-128.
[10] 任晓敏,张萍,李丽,等.改进型心电定位系统用于PICC尖端定位的研究[J].护理学杂志,2016,31(14):1-4.
[11] 胡小艳,段盈芳,赵熙,等.静脉腔内心电图在PICC尖端定位中的应用进展[J].中华现代护理杂志,2016,22(3):440-444.
[12] 陈金凤,徐娜,姬伟,等.心房内心电图定位技术在老年患者PICC尖端定位中的应用[J].中华现代护理杂志,2015,21(16):1973-1974.
[13] KABSY Y,BAUDIN G,VINTI H,et al.Peripherally inserted central catheters (PICC) in onco-hematology.PICC line in onco-hematology[J].Bull Assoc Fr Etud Cancer,2010,97(9):1067-1071.
[14] 付小伟.腔内心电图定位经外周静脉置入中心静脉导管尖端的临床应用[J].中华临床营养杂志,2017,25(1):53-58.
[15] 周新华,陈莉,胡星澜,等.探讨EKG辅助PICC导管尖端定位技术存在的问题及对策[J].国际护理学杂志,2016,35(18):2580-2583.

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