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  • 學位論文

靜脈導管感染合併症危險因子的探討-個案對照研究

Infective Complications of Peripheral Intravenous Catheters:A Case-Control Study

指導教授 : 方啟泰

摘要


研究背景及目的 週邊靜脈導管引發的感染合併症是危險的,它不僅增加額外的醫療費用、延長住院日數,由此引發的法律糾紛也日漸增加。因此,確認其危險因子,並採取預防措施,是非常重要的,並且可以增進病人安全。 在之前所進行的世代研究,使用導管尖端培養作評估方式,發現維持導管方式之不同(間歇注射vs. 持續滴注),其感染率有顯著差異。但因導管尖端培養陽性之個案不一定會出現臨床感染症狀,尚需進一步釐清不同之維持導管方式是否確為出現感染合併症之預測因子。因感染合併症發生率極低,採取世代研究設計較不經濟,故本研究採取回溯性個案對照研究設計來探討此一問題。 材料與方法 在九十五年至九十七年期間,在北部兩家醫院,依美國疾病管制中心之定義,收集出現週邊靜脈導管感染合併症的病人,每位個案以病房和住院時間隨機配對4個對照,回溯性調閱病歷,比較個案組和對照組共23項與感染相關之變項,以multivariate conditional logistic regression方式分析資料。 結果 於三年期間,進行研究的兩家醫院,發生46位週邊靜脈導管感染合併症的病人,共配對188位對照組病人。經個案對照組之比較,調整其他干擾因子後,發現間歇注射(Odds ratio [OR]: 0.2)、注射在下肢(OR: 8.6)、使用輸液幫浦(OR: 4.6)以及腦神經內外科之病人(OR: 3.6),是發生週邊靜脈導管感染合併症之獨立預測因子。 結論與建議 間歇注射比起持續滴注有較少的感染合併症。我們建議減少不必要的靜脈輸液滴注,盡可能採取間歇注射方式來維持週邊靜脈導管,這是避免感染最簡單有效的方法。另外,避免注射在下肢、小心警慎的使用輸液幫浦、在病況較差以及無法表達之病人需更密集的觀察注射部位有無出現感染症狀,以防止病人發生嚴重的感染合併症,增進靜脈輸液之安全。

並列摘要


Introduction: Infective complications arising from peripheral intravenous catheters (PICs) are potentially serious, with associated increase in health care costs, hospitalization days, and malpractice lawsuits. To improve patient safety, it is important to identify preventable risk factors. This study aimed to use a density case-control study design to examine whether different methods to maintain PICs are risk factors for infective complications. Materials and Methods: We retrospectively identified 46 patients with peripheral intravenous infusion-related infective complications. Each case was randomly matched with four control subjects by ward and the day when infective complication arose. Multivariate conditional logistic regression was used to adjust for the effects of confounding factors. Results: The following factors independently predicted PICs-related infective complications: intermittent injection only (odds ratio [OR]: 0.2), insertion sites at lower extremities (OR: 8.6), use of infusion pump (OR: 4.6), and neurologist/neurosurgeon as attending physician (OR: 3.6). Conclusions: Minimizing unnecessary intravenous infusion, inserting PIC lines in upper extremities and avoiding the use of infusion pumps may help to prevent PIC-related infective complications.

參考文獻


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