| Objective:To analyze the risk factors conspiring to cause unplanned removal of a PICC catheter in critically ill patients,exlpore the application of color doppler ultrasound in vessel monitoring,investigate the effect of bundles of nursing intervention measures.Aims to reduce catheter related complications and unplanned removal.To provide the basis for making patients feel more comfortable,extending the catheter indwelling time and satisfying the special therapy needs of critically ill patients. Methods:This study combined a prospective cohort study with a randomized controlled trail, drawn convenience samples,choosing patients which were hospitalized in ICU and other four special ICU in a public hospital in nanchang from January 2013 to October 2013, analyze related risk factors of unplanned removal of the PICC catheter.Then choose patients hospitalized from October 2013 to October 2014,devided them into two groups.Respectively taking rousing care and bundles of nursing intervation.Compare the incidence of cather related compliations and unplanned removal of the catheter of these two groups.Results:1.There were 33 virables that were related to PICC catheter of ICU patients.Through statistical analysis,there are 18 indicators that were considered closely related to unplanned removal of the catheter.Including age,APACHEⅡ score,selected vein,catheter tip location,catheterization times,frequency of ultrasound examination,sticking species,the patients’ temperature,the WBC and D-Dimer count when catheter indwelling,status of vascular,ultrasonography results, the catheter tip and the peripheral blood culture results,the status of the skin around the puncture site,et al.2.The logistic regression analysis of unplanned removal of a PICC catheter of ICU patients shows that there were 8 indications have statistically significant including age,APACHEⅡ score,the WBC and D-Dimer count when catheter indwelling,the patients’ temperature,status of vascular,ultrasonography results and the catheter tip and the peripheral blood culture results.3.Compared the catheter related complications of the intervention group with the control group,the result shows that after the implementation of the intervention, the incidence of PICC blocked tubes, catheter-related bloodstream infections,thrombosis, phlebitis, and catheter tip displacement were significantly lower than the control group(P<0.05).The incidence of unplanned removal of the catheter of the intervention group is 12.7%, also significantly lower than the control group(P<0.05).The average catheter indewelling time of the intervention group is(80.56±13.27)days,significantly longer than the control group(P<0.05). Conclusion:1.Age,selected vein,catheter tip location,status of vascular,the patients’ temperature and catheterization times are risk factors of unplanned removal of a PICC catheter of ICU patients.2.By color doppler ultrasonography,we can accurately observe the status of blood vessels and catheters, early detect thrombosis and phlebitis.3.Bundles of nursing intervention measures are effective to reduce catheter related complications and the incidence of unplanned removal of a PICC catheter. |
PDF Full Text Request