提升護理人員執行PICC管路周圍皮膚異常照護之改善專案

A Project to Enhance Nurse Staffs' Ability on Care of Peripherally Inserted Central Venous Catheter around Skin Damage

蔡麗珍(Li-Chen Tsai) ； 楊佩瑄(Pei-Hsuan Yang) ； 阮瓊慧(Chiung-Hui Juan) ； 蔡薰慧(Hsun-Hui Tsai)

《若瑟醫護雜誌》 14卷1期 (2020/07) Pp. 20-33

摘要

目的：週邊置入中心靜脈導管（Peripherally Inserted Central Catheter, PICC）置管後適當的傷口照護，及時發現合併症與處理，是決定個案留置PICC成功的關鍵。本專案為降低病人因PICC管路周圍皮膚異常而導致病人需提早移除管路，延遲治療時程，同時可提升護理人員正確照護認知與技能。方法：藉由現況分析及文獻查證設計制定「PICC管路周圍皮膚異常之照護標準」，舉辦教育訓練提高護理人員照護認知，以「PICC管路周圍皮膚異常評估與照護審核表」定期稽核落實護理人員管路照護技術，培養護理人員能依病人個別性選用適合的敷料的能力，並以「PICC管路照護正確率審核表」每月監測及檢討PICC管路周圍皮膚異常照護之正確率等改善對策。結果：PICC管路照護正確率從44.2%提升至91.6%，病人自我照護正確率達100%，達到專案目的。結論：本專案不僅提高護理人員自主性的照護能力，能主動發現照護問題與醫師討論適合病人的敷料及改變照護方式，也提高病人自我照護能力，得以提升醫療照護品質。

關鍵字

護理人員能力 ； 週邊置入中心靜脈導管 ； 皮膚異常 ； 正確率

並列摘要

Purposes: The key factors to determine a successful placement of peripherally inserted central catheter (PICC) include appropriate wound care, timely detection and treatment of complications after the PICC insertion. The project aimed to reduce the rate of early removal of the PICC line caused by patients' skin reactions and enhance nursing staffs' clinical knowledge and capabilities of PICC care. Methods: Based on the current situation analysis and literature review, we designed a standards protocol of skin care for PICC insertion,which comprised 1) educational training of nursing staff's care knowledge,2)audit system using ＂Checklist for regulating skin care procedures for PICC insertion＂ to assess nursing staff's care technique,3) staff empowerment to select most suitable dressing materials,4) review and planning to improve ＂correct rate of PICC care＂ and ＂correct rate of damaged skin care around PICC＂ monthly. Results: The accurate rate of caring has been increased from 44.2% to 91.6%. Moreover, the patients have accomplished 100% accurate rate in self-care, thereby achieving the goals of this project. Conclusions: The project not only improved nursing staffs' ability such as having active discussions with physicians for appropriate dressings and caring methods, but also improved patients' self-care ability to enhance health care quality.

並列關鍵字

staffs' ability ； peripherally inserted central catheter ； skin reaction ； accuracy

參考文獻

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張黎露、張文、周文珊、林思岑：癌症病人常用中心靜脈導管臨床照護指引。腫瘤護理雜誌 2011；11：15-40。

Kutzscher L: Management of Irritant Contact Dermatitis and Peripherally Inserted Central Catheters. Clinical Journal of Oncology Nursing 2012; 16(2): 48-55.

Grau D, Clarivet B, Lotthé A, Bommart S, Parer S: Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrobial Resistance & Infection Control 2017; 6(1):18.

岳志瑛、李俊英、余春華、趙淑珍、符琰：成都市某醫學中心周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2010；57(3)79-85。