某癌症專科醫院週邊置入中心靜脈導管的照護成果

A Nurse-led PICC Insertion Service in a Cancer Center

張黎露(Li-Lu Chang) ； 王淑卿(Shu-Ching Wang)

《腫瘤護理雜誌》 4卷2期 (2004/12) Pp. 35-41

https://doi.org/10.6880/TJON.200412_4(2).04

摘要

週邊置入中心靜脈導管（Peripherally Inserted Central Venous Catheter；簡稱PICC）放置程序簡單、安全，只要在門診或一般病房放置即可，適用於需要中、長期化學治療的病人，而且所花的費用亦較一般長期導管少，可以訓練護理人員執行，對病人而言較不具侵略性。我們成立台灣第一個PICC護理小組，訓練專任的護理師執行PICC的放置和照顧。從2000年1月1日至2004年8月31日期間，我們共放置2046條PICC導管，放置成功率為96.14%；其中1785條因為治療結束而拔除，佔71%。資料統計期間尚有182條使用中。導管平均留置時間為95.5天（最長520天，中數為104.5天），導管相關感染率為1.75／千日。大部分病人表示對PICC導管在臨床治療的幫助是感到滿意，接近90%的癌症病人認同PICC讓他們在接受化學治療注射時感到較安心，80%的病人表示會將此導管推薦給相同需要的人。然而讓病人感到最困擾的問題是導管外露處的傷口照顧，因此如何增進病人自我照顧的意願和能力是影響病人對PICC導管接受與否以及放置後照護品質的重要關鍵。腫瘤護士應可以更積極、主動的為癌症病人選擇適當的靜脈導管和維護靜脈通路的品質，以提昇治療中癌症病人的生活品質。

關鍵字

週邊置入中心靜脈導管 ； 癌症病人 ； 化學治療

並列摘要

Peripherally inserted central venous catheters (PICCs) not only offer a safer, simpler and less expensive way to achieve central venous access for cancer patients but also have the potential to decrease the trauma associated with continual peripheral venous catheter insertion site rotation in patients requiring chemotherapy. P1CC lines can be inserted by trained nurses without physician supervision and could be associated with a low complication rate. During the period from January 2000 to August 2004, 2046 PICC lines were placed by trained nurses in our center. The success rate of insertion was 96.14; 71% of lines (1785) were removed following completion of treatment. The mean PICC indwelling time was 95.5 days and median time was 104.5 days (range:1 to 520 days); catheter-associated infection rate was 1.75 per 1000 days. No serious procedure-related complications were recorded. The majority of patients in whom PICC was inserted expressed their satisfaction toward the lines used throughout the period of chemotherapy; 80% of them said that they will recommend this procedure to other patients. However, what troubled these patients most was the wound care of PICC insertion site. The patient's ability and willingness to take care of the wound site is crucial to the success of PICC. Oncology nurses can now be more actively involved in improving the quality of venous access for cancer patients. With careful management of PICCs will make the administration of chemotherapy not only more reliable but also more comfortable for cancer patients during the process of chemotherapy.

並列關鍵字

PICC ； cancer patients ； chemotherapy