降低使用中心靜脈導管癌症病童之醫療黏性產品相關皮膚損傷發生率

Reducing the Incidence of Medical Adhesive-Related Skin Injury at the Central Vein Catheterization Site in Children with Cancer

陳首蘭(Shou-Lan Chen) ； 林芳如(Fang-Ru Lin)

《臺大護理雜誌》 17卷2期 (2021/07) Pp. 142-156

https://doi.org/10.6740/NTUHJN.202107_17(2).0013

摘要

背景：醫療黏性產品造成皮膚損傷可能引發感染與延長住院天數，增加額外之醫療成本。本病房裝置中心靜脈導管癌症病童常因使用黏性產品而導致皮膚損傷，增加導管照護困難。經現況分析，主要原因包括：護理師不知如何選擇醫療黏性產品與認知不足；主要照顧者缺乏中心靜脈導管（central venous catheter, CVC）傷口照護觀念；病童對黏性產品過敏或害怕CVC換藥與化療藥物副作用；政策方面為缺乏醫療黏性產品的相關皮膚損傷（medical adhesive related skin injury, MARSI）照護標準等問題。目的：醫療黏性產品相關皮膚損傷發生率由5.8%降低至3.0%解決方案：透過舉辦MARSI教育訓練、執行MARSI皮膚照護標準、設計轉移病童注意力活動、建立傷口造口護理師照會機制與抗組織胺藥物使用標準與主要照顧者之個別輔導機制等措施實施。結果：醫療黏性產品相關皮膚損傷發生率由5.8%降低至2.2%，且護理師使用醫療黏性產品之正確率由54.4%提升至94.5%。結論：提升癌症病童之皮膚照護品質和提供適齡照護。

關鍵字

中心靜脈導管 ； 癌症病童 ； 醫療黏性產品相關皮膚損傷

並列摘要

Background: Using medical adhesive-related products often induces skin injury, which leads to infection, prolonged hospitalization, and increased medical cost. Medical adhesive-related skin injury (MARSI) also increases the difficulty in offering care for central venous catheterization (CVC) in children with cancer in our unit. After analysis, we identified the following main causes of MARSI in our unit: (1) lack of appropriate knowledge among nurses, preventing them from choosing the suitable product; (2) lack of awareness regarding CVC wound care among the main caregivers; (3) itchy skin around the CVC for the patients and fear of CVC dressing and the side-effects of medicine in the patients; and (4) lack of a clinical policy for MARSI care. Purpose: This study aimed to reduce the incidence of MARSI from 5.8% to 3% at our institution. Interventions: We arranged a training course for MARSI education for the nurses; arranged an individual tutor for the caregivers; distracted the patients' attention using toys, consulted with nurses specializing in wound and ostomy care, prescribed antihistamine to the patients, and formulated the guidelines and standard operating procedures for MARSI. Results: After these interventions, the incidence of MARSI decreased from 5.8% to 2.2%, and the accuracy rate of medical adhesive products increased from 54.4% to 94.5%. Conclusions: The quality of nursing care improved, and age-appropriate care was also provided for children with cancer.

並列關鍵字

central venous catheter ； children with cancer ； MARSI