Establishment And Research Of A Risk Assessment Indicator System Of PICC Before Placement

ObjectiveBy collecting the clinical information of peripherally inserted central catheter(PICC),to clear the current situation of PICC assessment before placement.Using systematic review to analyze the risk factors of PICC complications,especially the factors associated with patients' condition,identify the risk factors of complications,provide the basis of the risk assessment of PICC before placement.According to literature analysis and expert consultation,establish reasonable assessment indexes and nursing interventions.Build risk assessment indicator system of PICC before placement,to help medical staff to systematically assess the situation of patients,and judge the possibility of related complications.Methods1.Design questionnaires,one is about the operators' evaluation of PICC before placement,the other is about patients' complications and satisfaction,collecting the existing information about PICC complications and assessment,operators' qualification and relevant information in hospital.Analyze the present condition of operators' assessment in the clinical work and patients' evaluation,to find out the deficiencies and focus of building assessment index system.2.Collect system reviews or Meta analyses related to risk factors of PICC complications and literature related to the assessment before PICC placement.Use systematic review method to analyze the literature about risk factors of PICC complication which is not summarized by others,Meta analyze the related data.Us e content analysis to sort out the risk factors that can be assessed before placement,and summarize its main complications and prevention measures.3.Classify PICC complications associated risk factors,build up evaluation indexes through grading.Use Delphi method to select and evaluate indexes,determine the basic items and contents of risk assessment.Calculate the weights of related risk factors,an d finally establish the risk assessment indicator system of PICC before placement.ResultsThrough the survey in patients and PICC operators,it was found that12.9% of the patients who were investigated had PICC complications in the past.In the investiga tion of patients' satisfaction about PICC operators' work,satisfaction scores of items related to the operators' assessment were in the bottom 10,such as “Provide written or other forms of health education material”,“fully understand the patients' situation”,“pay attention to the information provided by patient”,“fully evaluate patients' situation before making decision”,“the prevention of PICC complications”.Among operators,87% of them thought assessment before the catheter placement had important effect on the incidence of complications.30% of them thought the current assessment was not perfect,8% of them suggested to build an evaluation sheet.After the literature searching,there were 9 Meta analyses or system reviews aiming at risk factors such as obstruction,infection,thrombosis and catheter heterotopia,and 3 literature about the research of the evaluation.In this study,we found that the risk factors for the occurrence of phlebitis were the choice of insertion vein,puncture times,the w ay of puncture,nursing quality,and so on.Content analyzed the relevant literature,sorting out 48 risk factors and evaluation indicators,and drafting the evaluation indicator system.Consulted 18 experts by modified Delphi method.After modifying the draft,4 first class indicators and 41 secondary class indicators of risk assessment system of PICC before placement was established.The first class indicators included basic situation of patient(16 secondary indicators),inserted body condition(12 secondary indicators),vessels and catheter(8 secondary indicators)and patient compliance(5 secondary indicators).ConclusionPICC complications will affect the patient's catheter indwelling time and normal use,prevention of complications is the key content of PICC nursing work.PICC complications are associated with multiple risk factors,a lot of which can be evaluated before placement.Clinical evaluation of PICC before placement is still not perfect,without special attention to the existence of risk factors of complications nor referable index system.On the basis of literature collection,expert consultation by Delphi method and the selection and weight calculation of the risk factors of different complications,risk assessment indicators of PICC before placement were established.The risk assessment of PICC before placement can help to make targeted nursing plan,prevent and reduce the occurrence of PICC complications as much as possible.