降低癌症病人週邊置入中心靜脈導管合併症發生率改善方案

本專案旨在降低癌症病人週邊置入中心靜脈導管合併症發生率。經資料收集及現況分析，確立問題為無標準化的照護作業、護理人員對週邊置入中心靜脈導管專業知識及換藥技能缺乏相關教育訓練、醫師插置經驗不足、感染防護措施不正確、病人自我照護認知不足。改善對策包含制定PICC照護標準、推動PICC在職教育及實務訓練、錄製PICC插置及換藥技術影片、監測導管插置與換藥過程、製作衛教單張等改善措施後，週邊置入中心靜脈導管合併症發生率由38％降至4.1％。本專案發現經由導管插置及換藥過程的稽核、專業教育訓練、多媒體教材、衛教單張的應用，不但能增加護理人員及病人的認知與照護技能外，且能降低導管合併症的發生。

關鍵字

週邊置入中心靜脈導管；合併症；癌症病人

並列摘要

The purpose of this project is to reduce complications in cancer patients with PICC by implementing an educational program in a medical ward of a medical center in Taiwan. The educational program included a series of training and demonstration of the standard care of PICC with a video developed by experts. Staff who were new and had limited experience in PICC care were invited and it aimed to improve staff's knowledge and skill, establish a standard care procedure for patients in hospital and at home, and lastly to reduce complications of PICC in patients with cancer. This project found out that PICC-related complications rate sharply decreased and the rate dropped from 38% to 4.1%. The educational program, the video tape and establishment of the standards were approaches that effectively improved staff's knowledge and thus, improved the quality of care and reduced complications of PICC.

並列關鍵字

peripherally inserted central catheter ； complication ； cancer patients

參考文獻

岳志瑛、李俊英、余春華、趙淑珍、符琰（2010）‧ 成都市某醫學中心週邊置入中心靜脈導管合併症的現況及其相關護理‧ 護理雜誌，57 (3)，79-85。doi: 10.6224/JN.57.3.79

張黎露、張濪文、周文珊、林思岑（2011）‧ 癌症病人常用中心靜脈導管臨床照護指引‧腫瘤護理雜誌，11 ，15-40。

Advani, S., Reich, N. G., Sengupta, A., Gosey, L., & Milstone, A. M. (2011). Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: Extending risk analyses outside the intensive care unit. Clinical Infectious Disease, 52(9), 1108- 1115. doi: 10.1093/cid/cir145

Berenholtz, S. M., Pronovost, P. J., Lipsett, P. A., Hobson, D., Earsing, K., Farley, J. E., … Perl, T. M. (2004). Eliminating catheterrelated bloodstream infections in the intensive care unit. Critical Care Medicine, 32(10), 2014-2020. doi: 10.1097/01. CCM.0000142399.70913.2F

Bishop, L., Dougherty, L., Bodenham, A., Mansi, J., Crowe, P., Kibbler, C., ... Treleaven, J.(2007). Guidelines on the insertion and management of central venous access devices in adults. International Journal of Laboratory Hematology, 29(4), 261–278. doi: 10.1111/j.1751-553X.2007.00931.x

延伸閱讀

陳淑梅、師慧娟、王琳華、董道興（2014）。降低門診化學治療病人週邊置入中心靜脈導管照護異常之改善專案。台灣癌症醫學雜誌，1(2)，113-123。https://doi.org/10.6323/JCRP.2014.1.2.03
高潘福（2018）。癌症患者在[氟-18]去氧葡萄糖正子電腦斷層造影中呈現的中心靜脈植入式導管的植入率和異常發生率研究〔博士論文，中山醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0003-1607201815244000
張黎露、王淑卿（2004）。某癌症專科醫院週邊置入中心靜脈導管的照護成果。腫瘤護理雜誌，4(2)，35-41。https://doi.org/10.6880/TJON.200412_4(2).04
李靈、高竹林、郭亮（2020）。Comfort Status and Its Influencing Factors in Patients With Gastrointestinal Cancer After PICC Catheterization。護理雜誌，67(6)，32-39。https://doi.org/10.6224/JN.202012_67(6).06
Liou, J. D., Yang, Y., Yan, M. Y., Wen, Y. K., & Chang, C. C. (2006). The Comparison of Clinical Outcomes between Percutaneous Catheter Drainage and Surgical Drainage in Perinephric Abscesses. Acta Nephrologica, 20(1), 28-32. https://www.airitilibrary.com/Article/Detail?DocID=10131671-200601-20-1-28-32-a

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降低癌症病人週邊置入中心靜脈導管合併症發生率改善方案

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