| ObjectiveThe purpose of this study was to generate evidence-based cluster intervention strategies for medical adhesive-related skin injury(MARSI)in elderly tumor patients undergoing peripherally inserted central venous catheter(PICC)placement,and evaluate its application effect,so as to provide reference for clinical prevention of MARSI in elderly tumor patients undergoing PICC catheterization and continuous improvement of nursing quality.Methods1.According to the evidence-based research method,relevant domestic and foreign evidence on the prevention and management of MARSI in elderly tumor patients undergoing PICC catheterization was screened,and the best evidence was summarized.2.Two rounds of consultation with 16 experts in the province was conducted by Delphi method to develop cluster intervention strategies for MARSI in elderly tumor patients undergoing PICC catheterization.3.A total of 106 elderly patients who underwent PICC catheterization for the first time and were admitted to a top three specialized cancer hospital in Hangzhou from January 2022 to June 2022 were selected as the research subjects.The patients were randomly divided into the control group and the intervention group by the envelope method with 53 patients in each group.The control group received routine nursing intervention,while the intervention group received cluster intervention strategies on the basis of routine nursing.The incidence rates of MARSI,unplanned extubation and complications were compared between the two groups.Nursing staffs awareness of MARSI was evaluated before and after the application of cluster intervention strategies.Results1.A total of 211 relevant literature was retrieved,and 11 were finally studied after screening,including 3 guides,3 evidence summaries,2 expert consensuses,1 randomized controlled trials,1 Descriptive research,and 1 cohort study.The cluster intervention strategies were produced preliminarily through screening and quality evaluation of the included literature.2.The questionnaire recovery rate in the two rounds of expert consultation was 100.00%,and the Cr was 0.886,indicating high expert authority.Finally,a set of cluster intervention strategies for MARSI in elderly patients with PICC catheterization were generated,including 4 grade I items and 20 grade Ⅱ items.3.No MARSI or unplanned extubation was observed in either group before catheterization(T0).At 1 month after catheterization(T2)and 3 months after catheterization(T3),the incidence rates of MARSI in the intervention group were lower than those in the control group(P<0.05).There was no statistically significant difference in the incidence of unplanned extubation between the two groups at T1-T3(P<0.05).The duration of first MARSI in the intervention group was significantly longer than that in the control group(P<0.05).Patients with MARSI in the two groups had different numbers of injuries(P<0.05).The TIS score of patients with MARSI in the intervention group was significantly lower than that in the control group(P<0.05),but there was no significant difference in STAR grading of skin lacerations between the two groups(P>0.05).The incidence rates of pain and itching of skin around the puncture site in the intervention group were lower than those in the control group(P<0.05).After the application of cluster intervention strategies,the nursing staffs awareness of the common types of medical adhesives,classification and preventive factors of MARSI,correct selection,correct use,correct removal and nursing methods of MARSI increased,and the time to learn MARSI knowledge was longer than that before application(P<0.05).ConclusionThe evidence-based cluster intervention strategies for MARSI in elderly tumor patients undergoing PICC catheterization can reduce the incidence rates of MARSI,unplanned extubation and complications such as skin laceration,contact dermatitis,skin pain and itching,and improve nursing staff s awareness of MARSI.It is worth promoting in clinical practice. |
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