基于FMEA理论护理对PICC置管后深静脉血栓预防效果研究
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摘要
目的探讨基于失效模式与效应分析(FMEA)理论护理对经外周静脉置入中心静脉导管(PICC)置管后深静脉血栓的预防效果。方法选取2015年7月至2017年8月就诊于该院的恶性肿瘤患者共82例作为研究对象,82例患者分为试验组(41例)和对照组(41例)。所有患者均行PICC置管化疗,化疗期间给予对照组常规护理干预,试验组在常规护理基础上实施基于FMEA理论护理,比较两组护理效果。结果两组失效模式的危急值(RPN)比较,试验组均低于对照组(P<0.05),提示对照组患者发生深静脉血栓等并发症的风险明显高于试验组;深静脉血栓及其他并发症发生率比较,试验组明显低于对照组(P<0.05);护理干预前,两组患者血管扩张反应(FMD)、内皮微粒(EMCs)水平比较差异无统计学意义(P>0.05),护理后对照组FMD水平均明显低于护理前和试验组(P<0.05),EMCs明显高于护理前和试验组(P<0.05);护理总满意率比较,试验组明显高于对照组(P<0.05)。结论给予PICC置管患者基于FMEA理论护理,可明显降低深静脉血栓等并发症发生率,减少患者血管损伤,提升护理满意度,值得推广。
Objective To investigate the effect of nursing care on the prevention of deep venous thrombosis after PICC catheterization based on FMEA theory.Methods A total of 82 patients with malignant tumors who visited the hospital from Jul 2015 to Aug 2017 were selected as study subjects.82 patients were divided into experimental group(41 cases)and control group(41 cases).All patients received PICC catheterization chemotherapy.During the chemotherapy period,the control group received routine nursing intervention.The experimental group performed FMEA theoretical nursing on the basis of routine nursing care and compared the nursing effects.Results The RPN values of the two groups of failure modes were lower in the experimental group than in the control group(P<0.05),suggesting that the risk of complications such as deep vein thrombosis was significantly higher in the control group than in the experimental group;The incidence of deep venous thrombosis and other complications was significantly lower in the experimental group than in the control group(P<0.05).There was no significant difference in FMD and EMCs levels between the two groups before the nursing intervention(P>0.05).After the nursing,the control group was FMD.The average level of the patients was significantly lower than that of the pre-care and experimental groups(P<0.05),and the EMCs were significantly higher than those of the pre-care and experimental groups(P<0.05).The total nursing satisfaction rate was significantly higher in the experimental group than in the control group(P<0.05).Conclusion According to FMEA theoretical nursing,PICC catheterization can significantly reduce the incidence of complications such as deep vein thrombosis,reduce vascular injury,and improve nursing satisfaction.It is worth promoting.
Objective To investigate the effect of nursing care on the prevention of deep venous thrombosis after PICC catheterization based on FMEA theory.Methods A total of 82 patients with malignant tumors who visited the hospital from Jul 2015 to Aug 2017 were selected as study subjects.82 patients were divided into experimental group(41 cases)and control group(41 cases).All patients received PICC catheterization chemotherapy.During the chemotherapy period,the control group received routine nursing intervention.The experimental group performed FMEA theoretical nursing on the basis of routine nursing care and compared the nursing effects.Results The RPN values of the two groups of failure modes were lower in the experimental group than in the control group(P<0.05),suggesting that the risk of complications such as deep vein thrombosis was significantly higher in the control group than in the experimental group;The incidence of deep venous thrombosis and other complications was significantly lower in the experimental group than in the control group(P<0.05).There was no significant difference in FMD and EMCs levels between the two groups before the nursing intervention(P>0.05).After the nursing,the control group was FMD.The average level of the patients was significantly lower than that of the pre-care and experimental groups(P<0.05),and the EMCs were significantly higher than those of the pre-care and experimental groups(P<0.05).The total nursing satisfaction rate was significantly higher in the experimental group than in the control group(P<0.05).Conclusion According to FMEA theoretical nursing,PICC catheterization can significantly reduce the incidence of complications such as deep vein thrombosis,reduce vascular injury,and improve nursing satisfaction.It is worth promoting.
引文
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[3]王莉,田静,杜凌艳,等.肿瘤患者PICC置管后发生静脉血栓的影响因素分析及护理对策[J].中华现代护理杂志,2016,22(21):2992-2995.
[4]季艳,甄云,曾云香.失效模式和效果分析在降低重型颅脑损伤患者非计划性拔管率中的应用[J].中国实用护理杂志,2017,33(6):450-453.
[5]李力,曾从容,杨春雪,等.失效模式与效果分析用于新生儿PICC置管风险管理的研究[J].护理学杂志,2015,30(3):7-9.
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[7]吴俊梅,周兴梅,朱瀛,等.综合ICU患者不同PICC置管方式发生导管异位情况分析[J].上海护理,2017,17(4):52-55.
[8]关晨阳,廖海涛,高文,等.肿瘤病人PICC导管相关性血栓的危险因素分析[J].护理研究,2017,31(10):1211-1215.
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[10]韩玲,王蓓,王莉莉,等.上臂不同穿刺部位留置PICC导管对置管相关并发症的影响[J].护理研究,2017,31(19):2394-2396.
[11]梁苾瑜.PICC置管后血栓形成的危险因素和护理体会[J].血栓与止血学,2017,23(4):682-684.
[12]蔡华,陈春梅,吴宏,等.延续护理服务对PICC置管患者护理效果的研究[J].实用临床医药杂志,2016,20(12):56-58,69.
[13]闻曲,成芳,鲍爱琴,等.多维度关怀措施在肿瘤患者PICC置管中的实践与体会[J].护理管理杂志,2015,15(2):120-122.
[14]JAISWAL S,LIU X B,WEI Q C,et al.Effect of corticosteroids on atrial fibrillation after catheter ablation:a meta-analysis[J].J Zhejiang Univ Sci B,2018,19(1):57-64.
[15]王丽荣,王亚丽,成志勇,等.急性白血病患者PICC不同置管时期对并发症的影响[J].医学临床研究,2015,32(9):1849-1851.
[16]刘阿敏,荣加.PICC导管穿刺,维护和使用过程中出现静脉血栓的相关因素与护理[J].血栓与止血学,2017,23(4):709-710.
[17]周芳,张春华,王梅新,等.失效模式-效果分析法在PICC置管质量管理中的应用[J].护士进修杂志,2017,32(1):34-37.
[18]吴丽芬,刘恋,胡德英.失效模式和效果分析法在儿童PICC安全管理中的应用及效果评价[J].护理研究,2016,30(28):3524-3526.
[19]WU M K,LUO X Y,ZHANG F X.Incidence and risk factors of deep venous thrombosis in asymptomatic iliac vein compression:aprospective cohort study[J].Chinese medical journal,2016,129(18):2149-2152.
[20]LI Q C,CHENG Y F,ZHANG H W,et al.Simulating the effect of hydrate dissociation on wellhead stability during oil and gas development in deepwater[J].J Ocean Univ China,2018,17(1):35-45.
[2]王淑花.失效模式与效应分析在控制PICC相关性导管感染中的应用[J].医学临床研究,2016,33(5):977-979.
[3]王莉,田静,杜凌艳,等.肿瘤患者PICC置管后发生静脉血栓的影响因素分析及护理对策[J].中华现代护理杂志,2016,22(21):2992-2995.
[4]季艳,甄云,曾云香.失效模式和效果分析在降低重型颅脑损伤患者非计划性拔管率中的应用[J].中国实用护理杂志,2017,33(6):450-453.
[5]李力,曾从容,杨春雪,等.失效模式与效果分析用于新生儿PICC置管风险管理的研究[J].护理学杂志,2015,30(3):7-9.
[6]中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南[J].中华普通外科杂志,2008,23(3):235-238.
[7]吴俊梅,周兴梅,朱瀛,等.综合ICU患者不同PICC置管方式发生导管异位情况分析[J].上海护理,2017,17(4):52-55.
[8]关晨阳,廖海涛,高文,等.肿瘤病人PICC导管相关性血栓的危险因素分析[J].护理研究,2017,31(10):1211-1215.
[9]丁海燕.专科护理门诊在PICC置管患者的应用[J].江苏医药,2015,41(7):866-867.
[10]韩玲,王蓓,王莉莉,等.上臂不同穿刺部位留置PICC导管对置管相关并发症的影响[J].护理研究,2017,31(19):2394-2396.
[11]梁苾瑜.PICC置管后血栓形成的危险因素和护理体会[J].血栓与止血学,2017,23(4):682-684.
[12]蔡华,陈春梅,吴宏,等.延续护理服务对PICC置管患者护理效果的研究[J].实用临床医药杂志,2016,20(12):56-58,69.
[13]闻曲,成芳,鲍爱琴,等.多维度关怀措施在肿瘤患者PICC置管中的实践与体会[J].护理管理杂志,2015,15(2):120-122.
[14]JAISWAL S,LIU X B,WEI Q C,et al.Effect of corticosteroids on atrial fibrillation after catheter ablation:a meta-analysis[J].J Zhejiang Univ Sci B,2018,19(1):57-64.
[15]王丽荣,王亚丽,成志勇,等.急性白血病患者PICC不同置管时期对并发症的影响[J].医学临床研究,2015,32(9):1849-1851.
[16]刘阿敏,荣加.PICC导管穿刺,维护和使用过程中出现静脉血栓的相关因素与护理[J].血栓与止血学,2017,23(4):709-710.
[17]周芳,张春华,王梅新,等.失效模式-效果分析法在PICC置管质量管理中的应用[J].护士进修杂志,2017,32(1):34-37.
[18]吴丽芬,刘恋,胡德英.失效模式和效果分析法在儿童PICC安全管理中的应用及效果评价[J].护理研究,2016,30(28):3524-3526.
[19]WU M K,LUO X Y,ZHANG F X.Incidence and risk factors of deep venous thrombosis in asymptomatic iliac vein compression:aprospective cohort study[J].Chinese medical journal,2016,129(18):2149-2152.
[20]LI Q C,CHENG Y F,ZHANG H W,et al.Simulating the effect of hydrate dissociation on wellhead stability during oil and gas development in deepwater[J].J Ocean Univ China,2018,17(1):35-45.