重庆市部分区县医院静脉治疗质量现况调查及对策
[摘要] 目的 探討重庆市区县级医院静脉治疗质量现况，为临床开展相关培训和质量改进提供依据。 方法 2016年3月21日，通过横断面调查重庆市江津区中心医院、三峡中心医院、梁平县人民医院的所有住院患者静脉输液治疗目前所处的水平和存在问题。调查重点为输液工具的选择、输液穿刺部位的选择、各种导管的维护情况、导管的固定及并发症。 结果 ①共计住院患者3232例，其中输液患者2680例，输液率为82.9%。最终纳入1954例输液患者作为研究对象。②穿刺工具的使用情况：头皮针占46.0%，留置针占49.0%，CVC占3.7%，PICC占1.3%。③穿刺部位的选择：手背占61.0%，前臂占24.0%，其他部位占15.0%。④敷料的选择和固定：透明敷料占98.9%，纱布敷料占1.1%。敷料固定和维护不规范共计384例，其中标识不规范共计183例，占47.6%；敷料固定不当共计81例，占21.1%；敷贴内有积血或渗液共计72例，占18.8%；敷料卷边共计48例，占12.5%。⑤导管的维护：导管/接头内有陈旧性积血/回血占15.0%。⑥输液相关并发症：并发症共计126例，穿刺点发红最多见，占51.6%。 结论 所调查医院关于穿刺部位的选择及敷贴固定操作比较规范，但在输液工具的选择及导管维护方面，仍存在许多不足。护理管理者应针对现状进行分析，开展相关培训和指导，进一步规范操作行为，保证患者输液安全，防止输液并发症发生。
[关键词] 静脉治疗；护理管理；对策
[中图分类号] R473 [文献标识码] A [文章编号] 1673-7210（2018）02（c）-0044-04
[Abstract] Objective To discuss the present situation of the quality of venous treatment in the county hospitals of Chongqing， in order to provide the basis for the clinical training and quality improvement. Methods On March 21， 2016， through a cross-sectional survey， the current level and problems of intravenous infusion treatment for all hospitalized patients in Jiangjin Central Hospital of Chongqing， Three Gorges Central Hospital， and Liangping County People′s Hospital were investigated. In this study， the investigation focuses on the selection of infusion tools， selection of infusion puncture site， maintenance of various catheters， fixation and complications of catheter. Results ①Among a total number of 3232 patients in hospital， 2680 patients have been treated with infusion， accounting for 82.9%， among which， 1954 patients were chosen and recorded in research database. ②The use of the puncture tool was as follows： scalp needles accounted for 46.0%， the retention needle accounted for 49.0%， CVC accounted for 3.7%， and PICC accounted for 1.3%. ③The selection of puncture sites was as follows： 61.0% were conducted on the back of hands， 24.0% were in the forearm， and 15.0% were in other parts. ④The choice of dressing and fixation： 98.9% were transparent dressings， 1.1% were gauze dressings. There were 384 cases of nonstandard fixation and maintenance of dressings， including 183 nonstandard cases， accounting for 47.6%； 81 improper cases， accounted for 21.1%； 72 cases of hematocele or leakage in the wound dressing， accounting for 18.8%； 48 cases of edge curl， which accounted for 12.5%. ⑤Catheter maintenance： hematocele in catheter or joint， accounted for 15.0%. ⑥Related complications of infusion： 126 cases on complications where red points were mostly occurred in puncture sites， accounted for 51.6%. Conclusion According to the investigation， the surveyed hospitals operate quite well in choosing puncture sites and fixation， but there exist many defects in the selection and maintenance of catheter infusion tools. Nursing staff should analyze the current situations and carry out the relevant training and guidance to further standardize the operation behaviors so as to ensure the safety of transfusion and to prevent the occurrence of transfusion complications.