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

Plan to Reduce Improper Care of Peripherally-inserted Central Venous Catheters in Outpatient Chemotherapy Patients

陳淑梅(Shu-Mei Chen) ； 師慧娟(Hui-Chuan Shih) ； 王琳華(Ling-Hua Wang) ； 董道興(William Tao-Hsin Tung)

《台灣癌症醫學雜誌》 1卷2期 (2014/09) Pp. 113-123

https://doi.org/10.6323/JCRP.2014.1.2.03

摘要

本專案目的是降低門診化療病人週邊置入中心靜脈管（Peripherally Inserted Central Venous Catheter; PICC）照護異常發生率，經收集2011年2-3月現況，發現導管照護異常發生率為16.8%。主要問題有：皮膚炎、導管阻塞、導管滑脫；分析原因為：缺乏PICC異常傷口照護規範、護理人員缺乏PICC照護知識與技能、病人及家屬對PICC居家照護知識不足。而執行改善方案包括：制定一般及異常PICC傷口照護規範與教學光碟、制定PICC導管正確沖洗及蝶翼固定方法、研發透明防水護套及居家照護手冊與衛教光碟。評值2011年9月至11月導管照護異常發生率為6.1%，已達專案目的。本專案實施後，不僅提升護理人員的專業知識及照護技能，病人也學會自我照顧。

關鍵字

化學治療 ； 週邊置入中心靜脈導管 ； 照護規範

並列摘要

This project aims at improving peripherally-inserted central venous catheter (PICC) care in chemotherapy outpatients. From February to March 2011, 16.8% of PICCs were not cared for properly. The main problems encountered were dermatitis, catheter obstruction and catheter slippage. These problems were caused by lack of wound care guidelines for the PICC, the nursing staff's lack of knowledge and skills for PICC nursing care, and patients and their families' lack of knowledge regarding PICC home care. Improvement plans included: 1. To establish norms for care of normal and abnormal PICC wounds and produce instructional videos; 2. To design correct flushing and butterfly fixation methods of the PICC. 3. To develop the transparent waterproof protective jacket and to produce a home nursing care manual and instructional video. After implementation of this project, the rate of improper PICC care decreased to 6.1% in September to November 2011, thus achieving the goals of this project. This PICC care project not only enhanced the professional knowledge and skills of nurses, but also the knowledge of patients regarding self-care.

並列關鍵字

chemotherapy ； peripheral inserted central venous catheter ； nursing care guidelines