乳腺癌患者上臂植入式静脉输液港相关并发症的护理研究
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摘要
目的探讨乳腺癌患者上臂植入式静脉输液港相关并发症的预防和护理对策。方法收集2017年1月—12月在我院乳腺外科行上臂静脉输液港植入的98例患者临床资料,查阅上臂静脉输液港植入后住院期间护理记录及维护期护理记录,总结出现的并发症,分析发生的原因,探讨制订可行的护理对策。结果 98例患者随访时间为5-16个月,中位随访时间10个月,在上臂静脉输液港植入后2周内和出院维护期间,并发症发生率分别为24.49%(24/98),8.16%(8/98),两个时间段并发症发生率差异有统计学意义(P<0.05)。其中,常见的并发症包括港体处切口出血、切口愈合不良、局部肿胀、导管回抽障碍、港体处输液外渗、导管堵塞、导管移位和导管相关血栓。结论上臂静脉输液港植入后2周内的并发症明显高于维护期,其中港体处输液外渗、导管相关血栓形成、堵管、导管移位属于严重并发症,直接影响上臂输液港的使用;在上臂输液港植入和护理中严格操作规程,在置港前、中、后做好有效的健康宣教,使患者和家属了解并掌握上臂输液港相关护理知识,可降低并发症的发生率,保证上臂输液港的安全使用。
Objective To explore the prevention and nursing countermeasures of complications related to upper arm implanted intravenous infusion port in breast cancer patients. Methods The clinical data of 98 patients who underwent implantation of upper arm vein infusion port in breast surgery of our hospital from January to December, 2017 were collected, the nursing records during hospitalization and maintenance period after implantation of upper arm vein infusion port were consulted, the complications were summarized, the causes were analyzed, and feasible nursing countermeasures were explored and formulated. Results The follow-up time of 98 patients was 5-16 months, and the median follow-up time was 10 months. the complication rates were 24.49 %(24/98)and 8.16 %(8/98) within 2 weeks after implantation of upper arm venous port and during discharge maintenance, respectively, and the difference between the two time periods was statistically significant(P<0.05). Among them, common complications include incision bleeding in port area, poor wound healing, local swelling, catheter withdrawal obstruction, infusion extravasation in port area, catheter blockage, catheter displacement and catheter-related thrombosis. Conclusion The complications in 2 weeks after implantation of upper arm venous port are significantly higher than those in maintenance period, among which extravasation of transfusion at port body, catheter-related thrombosis, blocking of catheter and catheter displacement are serious complications, which directly affect the use of upper arm venous port. Strict operation rules in the implantation and nursing of upper arm infusion port,effective health education before, during and after the implantation of port, so that patients and their families can understand and master the related nursing knowledge of upper arm infusion port, which can reduce the incidence of complications and ensure the safe use of upper arm infusion port.
Objective To explore the prevention and nursing countermeasures of complications related to upper arm implanted intravenous infusion port in breast cancer patients. Methods The clinical data of 98 patients who underwent implantation of upper arm vein infusion port in breast surgery of our hospital from January to December, 2017 were collected, the nursing records during hospitalization and maintenance period after implantation of upper arm vein infusion port were consulted, the complications were summarized, the causes were analyzed, and feasible nursing countermeasures were explored and formulated. Results The follow-up time of 98 patients was 5-16 months, and the median follow-up time was 10 months. the complication rates were 24.49 %(24/98)and 8.16 %(8/98) within 2 weeks after implantation of upper arm venous port and during discharge maintenance, respectively, and the difference between the two time periods was statistically significant(P<0.05). Among them, common complications include incision bleeding in port area, poor wound healing, local swelling, catheter withdrawal obstruction, infusion extravasation in port area, catheter blockage, catheter displacement and catheter-related thrombosis. Conclusion The complications in 2 weeks after implantation of upper arm venous port are significantly higher than those in maintenance period, among which extravasation of transfusion at port body, catheter-related thrombosis, blocking of catheter and catheter displacement are serious complications, which directly affect the use of upper arm venous port. Strict operation rules in the implantation and nursing of upper arm infusion port,effective health education before, during and after the implantation of port, so that patients and their families can understand and master the related nursing knowledge of upper arm infusion port, which can reduce the incidence of complications and ensure the safe use of upper arm infusion port.
引文
[1]李喻岩,刘宝利盖百娟,等.乳腺癌患者术中经颈内静脉植入输液港的护理[J].中华现代护理杂志,2015.21(27):3305-3307.
[2]张元红,张洁,陈保云,等.乳腺癌患者PICC护理质量敏感指标的建立与实施[J].护理学杂志,2016,31(24):8-11.
[3]吴胜菊,全小明,赵文韬,等.上臂植入式输液港与中央静脉植入式输液港的应用比较[J].护理学报,2014,21(12):55-57.
[4]徐海平,王水,王珏,等.手臂输液港在乳腺癌化疗患者中应用及远程管理实践[J].中国实用护理杂志,2017,33(13):1009-1012.
[5]张元红,魏素芳,张洁,等.PICC护理团队的建设与管理[J].中华现代护理杂志,2014,20(6):703-705.
[6]De Jonge RC,Polderman KH,Gemke RJ.Central venous catheter use in the pediatric:mechanical and infections complications[J].pedi-catr Crit Care Med,2005,6(3):329-339.
[7]蔡永华,黎燕红,邓颖晖,等.上臂静脉与锁骨下静脉入路输液港应用于胃肠肿瘤化疗的并发症比较[J].中华胃肠外科杂志,2015,(10):1002-1005.
[8]肖玲,姜傲,李茁,等.植入式静脉输液港相关并发症的护理对策[J].中华现代护理杂志,2016,22(34):4952-4954.
[2]张元红,张洁,陈保云,等.乳腺癌患者PICC护理质量敏感指标的建立与实施[J].护理学杂志,2016,31(24):8-11.
[3]吴胜菊,全小明,赵文韬,等.上臂植入式输液港与中央静脉植入式输液港的应用比较[J].护理学报,2014,21(12):55-57.
[4]徐海平,王水,王珏,等.手臂输液港在乳腺癌化疗患者中应用及远程管理实践[J].中国实用护理杂志,2017,33(13):1009-1012.
[5]张元红,魏素芳,张洁,等.PICC护理团队的建设与管理[J].中华现代护理杂志,2014,20(6):703-705.
[6]De Jonge RC,Polderman KH,Gemke RJ.Central venous catheter use in the pediatric:mechanical and infections complications[J].pedi-catr Crit Care Med,2005,6(3):329-339.
[7]蔡永华,黎燕红,邓颖晖,等.上臂静脉与锁骨下静脉入路输液港应用于胃肠肿瘤化疗的并发症比较[J].中华胃肠外科杂志,2015,(10):1002-1005.
[8]肖玲,姜傲,李茁,等.植入式静脉输液港相关并发症的护理对策[J].中华现代护理杂志,2016,22(34):4952-4954.