Implementation And Evaluation Of A Clinical Nursing Pathway For PICC Placed In Solid Cancer Patients With Chemotherapy

Objects: The aim of this paper is to study preparation, implementation and evaluationof the clinical nursing pathway（CNP）,when Clinical nursing pathway model used in theperipherally inserted central catheter (PICC) management of solid tumors patients withchemotherapy.Then the paper discusses application effect of clinical nursing pathway in thePICC management of solid tumors patients with chemotherapy. So as to standard the nursingmanagement of PICC, and provide certain guidance for clinical nursing works.Methods: This paper is a retrospective study to compare the effects before and afterCNP implementation.There are two groups, experimental group and controlld group.Experimental group choosed the solid cancer chemotherapy patients55cases from Augustto December in2010, which accord with the conditions and voluntarily participate in theresearch,implementing CNP of PICC. The controlld group choosed the solid cancerchemotherapy patients41cases from August to December in2009, which placed PICCsaccording to conventional PICC nursing.Then we collect statistics and clinical dataaccessing to electronic medical records and maintenance records of PICC， to havecomparison study.There are three stages in this research.The first stage is establishing the CNP of PICC.We established CNP management system (steering group and implementation group), andcleared respective duty. Then developed CNP text of PICC by using evidence-based, expertconsultation method. CNP text includes medical edition CNP, patient version CNP andvariation form. Medical edition CNP includes CNP for the placing tube day, CNP for duringhospitalization, CNP for during discharge. The preliminary study has been conducted.According to the result of the preliminary experiment,we revise and improve the CNP textof PICC. The second stage is implementing the CNP of PICC. Steering group organizedpersonnel training,then the clinical nursing pathway was implemented by implementationgroup. Demographic date and clinical catheter-related data were collected.The third stage isevaluating the CNP effect of PICC. Data was analyzed by statistical software SPSS18.0. Weevaluated effect through some indexes, such as incidence rate of PICC-relatedcomplications, successful rate of intra-venous PICC placement and PICC retainedtime,patients compliance, doctors satisfaction, nurses satisfaction and patients satisfaction.And we analyzed variation factor for perfecting CNP. Finally, it is also neededto perfect and argument CNP.Results: The gender, age, disease, cultural degree of research objects in experimentalgroup and controlled group are not statistical difference (P>0.05). The incidence rate ofPICC-related complications of experimental group is obviously lower than the controlldgroup (P <0.01). The most common complication due to PICC placement was wound bloodoozing (>3d), the experimental group has7cases, the control group has16cases.Thesuccessful rate of intra-venous PICC placement of experimental group is higher than ontrolldgroup (P <0.05).The PICC retained time of experimental group is3-254d，and in controlledgroup is4-194d.When compared average indwelling time in two groups, the averageindwelling time of experimental group is longer than controlld group (P <0.05).The patientscompliance of experimental group is apparently higher than the controlld group (P <0.01).In experimental group and controlld group we respectively surveyed the same doctors andnurses’ satisfaction，and after removed catheter surveyed patients satisfaction.The doctorssatisfaction, nurses satisfaction and patients satisfaction are all obviously higher than thecontrolld group (P <0.01).Conclusions: To take example by Clinical nursing pathway’s research methods andachievements in the domestic and foreign, we compiled CNP for PICC management ofsolid tumors chemotherapy patients. Clinical nursing pathway have a positive impact onoutcomes of patient with PICC,such as improved quality of care and increased satisfaction ofclinician, nurse and patient, also reduced the risk of PICC. So CNP has guiding significancefor the nursing management of PICC to medical care personnel.