两种透明敷料更换频率对早产儿经外周静脉置入中心静脉导管相关性感染的影响
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摘要
目的探讨早产儿最佳经外周静脉置入中心静脉(PICC)透明敷料更换频率,为降低早产儿PICC导管相关性感染提供依据。方法将2014年8月-2015年10月新生儿科PICC置管的早产儿129例,采用随机对照法将其分为两组,实验组63例,对照组66例;置管后次日两组患儿均常规更换敷料1次,以后根据分组情况,对照组7天更换一次;实验组按需更换;比较两种透明敷料更换频率对早产儿PICC导管相关性感染的影响,包括导管相关性血流感染(CRBSI)、穿刺口部位感染、导管病原菌定植。结果实验组CRBSI发生率与穿刺口部位感染率均低于对照组(P<0.05),虽然两组导管病原菌定植种类数差异无统计学意义,但总病原菌定植数差异有统计学意义(P<0.05)。结论早产儿PICC置管后敷料按需更换比3天、5天、7天更换一次更安全、更有效;按需更换敷料对血流感染有保护作用,延长PICC留置的时间。
OBJECTIVE To explore the optimal replacement frequency of peripherally inserted central catheter(PICC)transparent dressings of premature infants so as to reduce the incidence of PICC-related infections in the premature infants.METHODS A total of 129 premature infants who were treated with PICC in neonatology department from Aug 2014 to Oct 2015 were enrolled in the study and randomly divided into the experimental group with63 cases and the control group with 66 cases.The two groups of infants were treated with conventional dressing change for one time the next day after the catheterization,then the control group was treated with the dressing change for 7days once,the experimental group was treated with dressing change according to need.The influence of the replacement frequency of two kinds of transparent dressings on PICC-related infections in the premature infants was observed and compared,including catheter-related bloodstream infection(CRBSI),puncture site infections,and colonization of pathogens on catheters.RESULTS The incidence rates of CRBSI and puncture site infection were lower in the experimental group than in the control group(P<0.05).There was no significant difference in the number of species of pathogens colonized on the catheters between the two groups,however,there was significant difference in the total number of species of pathogens colonized(P<0.05).CONCLUSION The dressing change according to the need is more effective and safer than the dressing change 3days,5days,and 7days once for the premature infants after the PICC catheterization.The dressing change according to the need plays a role in prevention of the bloodstream infection and extends the PICC indwelling time.
OBJECTIVE To explore the optimal replacement frequency of peripherally inserted central catheter(PICC)transparent dressings of premature infants so as to reduce the incidence of PICC-related infections in the premature infants.METHODS A total of 129 premature infants who were treated with PICC in neonatology department from Aug 2014 to Oct 2015 were enrolled in the study and randomly divided into the experimental group with63 cases and the control group with 66 cases.The two groups of infants were treated with conventional dressing change for one time the next day after the catheterization,then the control group was treated with the dressing change for 7days once,the experimental group was treated with dressing change according to need.The influence of the replacement frequency of two kinds of transparent dressings on PICC-related infections in the premature infants was observed and compared,including catheter-related bloodstream infection(CRBSI),puncture site infections,and colonization of pathogens on catheters.RESULTS The incidence rates of CRBSI and puncture site infection were lower in the experimental group than in the control group(P<0.05).There was no significant difference in the number of species of pathogens colonized on the catheters between the two groups,however,there was significant difference in the total number of species of pathogens colonized(P<0.05).CONCLUSION The dressing change according to the need is more effective and safer than the dressing change 3days,5days,and 7days once for the premature infants after the PICC catheterization.The dressing change according to the need plays a role in prevention of the bloodstream infection and extends the PICC indwelling time.
引文
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[5]吴晓琴,李兰云,郭晶,等.氯己定醇皮肤消毒液在预防导管相关血流感染中的效果研究[J].中华医院感染学杂志,2014,24(21):5312-5314.
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[10]林真珠,蒋玉蓉,刘映辉,等.更换敷料不同频率对新生儿PICC导管穿刺口感染的影响[J].中华护理杂志,2012,47(9):798.
[11]Sharpe E,Pettit J,Ellsbury DL.A national survey of neonatal peripherally inserted central catheter(PICC)practices[J].Adv Neonatal Care,2013,13(1):55-74.
[12]Sengupta A,Lehmann C,Diener-West M,et al.Catheter duration and risk of CLA-BSI in neonates with PICCs[J].Pediatrics,2010,125(4):648-653.
[13]Smith PB,Benjamin DK Jr,Cotten CM,et al.Is an increased dwell time of a peripherally inserted catheter associated with an increased risk of bloodstream infection in infants?[J].Infect Control Hosp Epidemiol,2008,29(8):749-753.
[2]帅春,封志纯,汪灏,等.极低出生体质量儿置入中心静脉导管相关血流感染的临床研究[J].临床儿科杂志,2015,33(1):9-11.
[3]周燕,汤晓敏,程晓微,等.PICC导管维护标准流程降低导管相关性感染的效果[J].解放军护理杂志,2012,29(2B):51-52.
[4]徐雪华,昌晓军,王继杰,等.透明敷料不同更换频率对新生儿导管相关性感染影响研究[J].中华医院感染学杂志,2014,24(24):6216-6217.
[5]吴晓琴,李兰云,郭晶,等.氯己定醇皮肤消毒液在预防导管相关血流感染中的效果研究[J].中华医院感染学杂志,2014,24(21):5312-5314.
[6]中华医学会重症医学专业委员会.血管内导管相关感染的预防与治疗指南(2007)[J].中华临床营养杂志,2012,20(6):384.
[7]陈秋玉,苏敏谊,张莉,等.早产儿PICC穿刺部位敷料更换时间与感染关系探讨[J].全科护理,2012,10(6):1642-1643.
[8]顾莺,袁洁,胡静,等.3种敷贴在儿科中心静脉维护中的效果与成本比较[J].中华护理杂志,2013,48(6):510-513.
[9]林琳,杨里颖.PICC在30例早产儿静脉营养的应用[J].心理医生杂志,2012(10),552.
[10]林真珠,蒋玉蓉,刘映辉,等.更换敷料不同频率对新生儿PICC导管穿刺口感染的影响[J].中华护理杂志,2012,47(9):798.
[11]Sharpe E,Pettit J,Ellsbury DL.A national survey of neonatal peripherally inserted central catheter(PICC)practices[J].Adv Neonatal Care,2013,13(1):55-74.
[12]Sengupta A,Lehmann C,Diener-West M,et al.Catheter duration and risk of CLA-BSI in neonates with PICCs[J].Pediatrics,2010,125(4):648-653.
[13]Smith PB,Benjamin DK Jr,Cotten CM,et al.Is an increased dwell time of a peripherally inserted catheter associated with an increased risk of bloodstream infection in infants?[J].Infect Control Hosp Epidemiol,2008,29(8):749-753.