预防神经外科重症患者PICC相关性静脉血栓的循证护理实践

doi:10.16460/j.issn1008-9969.2022.11.036

摘要/Abstract

摘要： 目的基于最佳证据制定预防神经外科重症患者PICC相关性静脉血栓的循证实践方案,在临床应用并评价其有效性和安全性。方法采用JBI循证护理中心的证据应用模式开展证据应用,通过查看护理记录单和现场观察的方式收集资料。在证据应用前后分别对75例患者以及36名护士进行审查,讨论分析证据应用的障碍因素并采取措施针对性改进。结果本研究共形成4条质量审查指标。证据应用后,4条审查指标执行率均上升至100%,其中3条审查指标的执行情况较证据应用前差异具有统计学意义（P<0.05）;PICC相关性静脉血栓发生率由44.0%下降到25.3%（P<0.05）。结论基于证据制定的预防神经外科重症患者PICC相关性静脉血栓的最佳循证实践方案可规范护士临床实践,提高护士对证据的依从性,有效降低神经外科重症患者PICC相关性静脉血栓发生率。

关键词: 神经外科, 重症患者, PICC相关性静脉血栓, 预防, 循证实践

Abstract: Objective To develop standardized strategies for the prevention of PICC-related venous thrombosis in critically ill neurosurgical patients based on the best evidence, and to evaluate its effectiveness and safety in clinical practice. Methods The JBI mode was adopted for evidence implementation. Data were collected through on-site observation and nursing records review. The obstacles to evidence application were analyzed and targeted improvement was taken when 75 patients and 36 nurses were reviewed before and after the application of evidence. Results Four audit criteria were determined in this study. After the application of evidence, the implementation rate of all audit criteria increased to 100%. The implementation difference of three of the four audit criteria showed statistical significance (P<0.05). The incidence of PICC-related venous thrombosis decreased from 44.0% to 25.3% (P< 0.05). Conclusion Evidence-based practice for preventing PICC-related venous thrombosis in critically ill neurosurgical patients is effective for standardizing nurses' clinical practice, improving their compliance with evidence, and reducing the incidence of PICC-related venous thrombosis.

Key words: neurosurgery, critically ill patient, PICC-related venous thrombosis, prevention, evidence-based practice

中图分类号:

R473.74

邓瑛瑛, 裴华清, 任英, 殷春梅, 文梅, 张小玲. 预防神经外科重症患者PICC相关性静脉血栓的循证护理实践[J]. 护理学报, 2022, 29(11): 36-40.

DENG Ying-ying, PEI Hua-qing, REN Ying, YIN Chun-mei, WEN Mei, ZHANG Xiao-ling. Evidence-based Practice of Prevention of PICC-related Venous Thrombosis in Critically Ill Neurosurgical Patients[J]. Journal of Nursing, 2022, 29(11): 36-40.

参考文献

[1] Maneval RE, Clemence BJ.Risk Factors Associated with Catheter-related Upper Extremity Deep Vein Thrombosis in Patients with Peripherally Inserted Central Venous Catheters: A Prospective Observational Cohort Study: Part 2[J]. J Infus Nurs, 2014,37(4):260-268.DOI:10.1097/NAN.0000000000000042.
[2] Zhang X, Huang JJ, Xia Y, et al.High Risk of Deep Vein Thrombosis Associated with Peripherally Inserted Central Catheters in Lymphoma[J]. Oncotarget, 2016,7(23):35404-35411.DOI:10.18632/oncotarget.8639.
[3] 石芸, 赵锐祎, 盛叶. PICC导管相关性血栓的护理研究进展[J].护士进修杂志,2018,33(23):2142-2144.DOI:10.16821/j.cnki.hsjx.2018.23.008.
[4] Duwadi S, Zhao Q, Budal BS.Peripherally Inserted Central Catheters in Critically Ill Patients-complications and Its Prevention: A Review[J]. Int J Nurs Sci, 2019,6(1):99-105.DOI:10.1016/j.ijnss.2018.12.007.
[5] 张志彬, 刘芳. 神经重症患者经外周静脉置入中心静脉导管置管引起局部静脉血栓的研究进展[J]. 解放军护理杂志, 2018,35(23):54-56.DOI:10.3969/j.issn.1008-9993.2018.23.012.
[6] 邓瑛瑛,裴华清,文梅,等. 神经外科重症患者PICC相关性血栓物理预防的最佳证据总结[J]. 护理学报, 2021,28(8):28-32.DOI:10.16460/j.issn1008-9969.2021.08.028.
[7] 赵娟,孙迎红,李卫峰,等. 成人恶性肿瘤患者PICC血栓预防的最佳证据总结[J].护士进修杂志, 2020,35(13):1197-1202.DOI:10.16821/j.cnki.hsjx.2020.13.010.
[8] Gorski LA.The 2016 Infusion Therapy Standards of Practice[J]. Home Healthc Now, 2017,35(1):10-18.DOI:10.1097/NHH.0000000000000481.
[9] 田婷, 黄锐娜, 戚熠, 等. 肿瘤患者PICC置管相关静脉血栓形成危险因素Meta分析[J].护理学报, 2019,26(11):49-54.
[10] Dennis M, Caso V, Kappelle L J, et al.European Stroke Organisation (Eso) Guidelines for Prophylaxis for Venous Thromboembolism in Immobile Patients with Acute Ischaemic Stroke[J]. Eur Stroke J, 2016,1(1):6-19.DOI:10.1177/2396987316628384.
[11] 劳月文, 陈香萍, 汪萍, 等. 握拳运动对预防PICC相关性静脉血栓形成效果的Meta分析[J]. 中国实用护理杂志, 2019, 35(36):2869-2874. DOI:10.3760/cma.j.issn.1672-7088.2019.36.015.
[12] Kearon C, Akl EA, Comerota A J, et al.Antithrombotic Therapy for Vte Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9Th Ed: American College of Chest Physicians Evidence-based Clinical Practice Guidelines[J]. Chest, 2012,141(2 Suppl):e419S-e496S.DOI:10.1378/chest.11-2301.
[13] Liu K, Zhou Y, Xie W, et al.Handgrip Exercise Reduces Peripherally-inserted Central Catheter-related Venous Thrombosis in Patients with Solid Cancers: A Randomized Controlled Trial[J]. Int J Nurs Stud, 2018,86:99-106.DOI:10.1016/j.ijnurstu.2018.06.004.
[14] 专家委员会中国血栓性疾病防治指南. 中国血栓性疾病防治指南[J]. 中华医学杂志, 2018,98(36):2861-2888.DOI:10.3760/cma.j.issn.0376-2491.2018.36.002.
[15] Nicolaides A, Hull R, Fareed J.Prevention and Treatment of Venous Thromboembolism:International Consensus Statement (Guidelines According to Scientific Evidence)[J]. Clin Appl Thromb Hemost, 2013, 19(2):116-118.DOI:10.1177/1076029612474840.
[16] 张晓菊, 陆箴琦, 胡雁. 经外周静脉置入中心静脉导管置管临床实践指南解读[J]. 上海护理, 2017,17(3):9-13.DOI:10.3969/j.issn.1009-8399.2017.03.002.
[17] 袁光华. 《超声诊断基础与临床检查规范》一书专业名词术语技术概念的选定与修订[J]. 中华医学超声杂志(电子版), 2004(1):287. DOI:10.3969/j.issn.1672-6448.2004.06.016.
[18] 田婷, 黄锐娜, 戚熠, 等. 肿瘤患者PICC置管相关静脉血栓形成危险因素Meta分析[J]. 护理学报, 2019,26(11):49-54.DOI:10.16460/j.issn1008-9969.2019.11.049.
[19] 卢婷,应燕萍,赵慧函,等. 不同性别肿瘤病人PICC置管侧肢体握球运动最佳力度研究[J]. 护理研究, 2021,35(12):2214-2217.DOI:10.12102/j.issn.1009-6493.2021.12.029.
[20] 杨丹. 综合康复护理联合中频电疗对脑卒中后肌张力增高患者肌张力及生活自理能力的影响[J].医疗装备, 2019,32(24):189-190.DOI:10.3969/j.issn.1002-2376.2019.24.127.
[21] 陈群,黄秀菊,韦咏,等. 防治胃癌患者术后下肢深静脉血栓的护理效果研究[J]. 当代护士(中旬刊), 2019,26(12):42-43.
[22] 刘焕发,台中惠,王晓岚. 中频电疗法结合康复锻炼预防脊髓损伤后深静脉血栓形成[J]. 中医正骨, 2013,25(9):53-54.DOI:10.3969/j.issn.1001-6015.2013.09.018.
[23] Wu Y, Brettle A, Zhou C, et al.Do Educational Interventions Aimed at Nurses to Support the Implementation of Evidence-based Practice Improve Patient Outcomes? A Systematic Review[J]. Nurse Education Today, 2018,70:109-114.DOI:10.1016/j.nedt.2018.08.026.

相关文章 15

[1]	魏利, 赵兴颖, 刘佳, 何雨璇, 陈晓梅, 杨雪, 鲜继淑, 杨燕妮. 神经外科重症住院患者家庭照顾者照顾负担及影响因素分析[J]. 护理学报, 2025, 32(2): 1-6.
[2]	夏碧芸, 陈瑜, 吴彦妍, 胡雁. 降低经桡动脉冠状动脉介入术后老年患者桡动脉闭塞发生的循证实践[J]. 护理学报, 2025, 32(2): 37-43.
[3]	李春萍, 张兰萍, 王晓辉, 钟乐欣, 杨薇, 赵青, 吕森森, 李嘉琪, 谢昀筠, 黄婉晴, 陈晓珊, 徐东. 实施理论—常态化过程理论的解读[J]. 护理学报, 2024, 31(5): 39-43.
[4]	胡杏娟, 张伦, 高钰琳, 高春凤, 陈妙燕, 李晓君, 陈烯琳, 洪笃云, 梁业基. 生成式人工智能辅助混合式教学在实习护生皮内针技术感染预防教学中的应用[J]. 护理学报, 2024, 31(18): 21-25.
[5]	张淑珍, 余文汝, 张俊峰, 江佳瑶, 罗美, 林碧玉, 麦敏雯, 杨梦婷. 肿瘤放疗患者放射性皮炎预防与管理的循证护理实践[J]. 护理学报, 2024, 31(16): 62-66.
[6]	刘瑶, 詹欣, 谢亭平, 陈炜, 胡依阳, 杨翠娜, 张国忠. 脑血管造影术后使用股动脉压迫止血器患者早期活动的循证实践[J]. 护理学报, 2024, 31(15): 29-33.
[7]	邓颖一, 程露颖, 龚喜燕, 王敏, 廖冬霞, 张翠翠, 丁娟, 古清鹭, 廖常菊. 临床护理交接班循证实践的范围综述[J]. 护理学报, 2024, 31(14): 57-62.
[8]	肖丽, 林桦, 杨青梅, 莫炳霞, 卢琳, 韦孙莉, 韦丽俏. 重症患者血液净化低血压预防及管理的最佳证据总结[J]. 护理学报, 2024, 31(13): 67-72.
[9]	. 静脉血栓栓塞症机械预防护理实践评价量表的研制与信效度检验[J]. 护理学报, 2024, 31(12): 7-12.
[10]	. 老年人咀嚼功能临床研究现状[J]. 护理学报, 2024, 31(12): 21-25.
[11]	纪媛媛, 王军, 俞洁, 张娜芹, 欧梦仙. 基于岗位胜任力构建神经外科新入职护士规范化培训指标体系[J]. 护理学报, 2024, 31(1): 27-30.
[12]	陈佳茵, 郭军, 刘宁. 护士职业暴露预防与管理的最佳证据总结[J]. 护理学报, 2023, 30(7): 53-58.
[13]	吕俭霞, 叶丽, 李彬, 吴波, 张含凤, 江庆华, 殷利. 头颈肿瘤放化疗患者吞咽困难预防性训练指导方案的最佳证据总结[J]. 护理学报, 2023, 30(2): 54-59.
[14]	侯亚甜, 陈思诺, 刘孟慧, 张博文, 安祥, 刘允, 徐文琪, 章明阳. 机械通气患者隐性误吸识别与预防的最佳证据总结[J]. 护理学报, 2023, 30(18): 36-41.
[15]	黄宇星, 刘宁, 黄婷. 基于核心能力构建适宜中低资源地区护理本科循证实践教学指标体系[J]. 护理学报, 2023, 30(13): 24-28.

Metrics

Viewed

Full text

Abstract

Cited

Shared