醫院社區一體化PICC維護技術推廣網絡的構建與實施*

□ 沈麗娟 SHEN Li-juan 董利英 DONG Li-ying 韓慧 HAN Hui 周勤學 ZHOU Qin-xue 施曉紅 SHI Xiao-hong溫秋月 WEN Qiu-yue 安向麗 AN Xiang-li

Objective To explore the construction and implementation of the integrated hospital-community network of PICC maintenance technology promotion.Methods The integrated hospital-community network of PICC maintenance technology promotion was established, and the main work contents of the network were determined. Integrated hospital-community management was adopted for discharged PICC patients. Results There were 22 member units in the network and 120 PICC maintainers at secondary sites. The network received over 200 telephone consultations, and solved more than 100 problems of catheterization and maintenance through QQ group. The service personnel went out for catheterization and maintenance consultations for 20 times.After the establishment of the network, the total incidence of catheter-related complications decreased from 24.7% to 11.7%, and the patient satisfaction rate increased by 7%. The difference was statistically significant (p＜0.05). Conclusion The construction of the integrated hospital-community network of PICC maintenance technology promotion reduces the health resources occupation in large hospitals and relieves the pressure on medical care system. It can help patients solve practical problems conveniently and quickly, therefore saving time and expenses.

經外周靜脈置入中心靜脈導管(Peripherally-inserted central catheter，PICC)是由外周靜脈穿刺，把靜脈導管置入上腔靜脈下三分之一近心房處的技術，導管由生物相容性良好的硅膠制成，柔軟無刺激，國外報道PICC可留置近2年[1]。國內研究顯示78%的患者能保留PICC6-8個月，最長留置時間為1年11個月[2]。PICC置管具有安全、方便、留置時間長的特點，在臨床得已廣泛應用。但置管后，導管維護的時間和技術直接影響到導管并發癥的發生和導管的留置時長[3-4]，如果在帶管期間護理不當或出院后維護困難，可能導致導管相關性感染的發生及堵管等情況，增加患者的痛苦和醫療費用。因此，患者攜管出院期間的維護一直困擾著臨床護理管理者及患者與家屬[5]。本研究通過建立以我院為中心的醫院社區一體化PICC維護技術推廣網絡(簡稱PICC維護網)，以保證帶管患者出院后能就近得到持續的導管維護服務。

資料與方法

1.一般資料。選取2016年1月至2016年12月在我院接受PICC置管并在維護網絡醫院接受維護的患者180例為觀察組，其中男82例，女98例，年齡18～70歲。乳腺癌27例、胃癌42例、食管癌18例、肺癌28例、白血病19例、大腸癌23例、肝癌15例、腦惡性腫瘤8例。2015年1月至2015年12月在我院接受PICC置管，但時間在維護網建立前的患者166例為對照組，其中男76例，女90例，年齡15～76歲。乳腺癌23例、胃癌35例、食管癌16例、肺癌22例、白血病15例、大腸癌22例、肝癌11例、腦惡性腫瘤6例，宮頸癌16例。兩組患者均需進行6～8個療程的化療，化療間隙期14～21天。兩組患者年齡、性別、置管位置、疾病等比較差異均無統計學意義(p＞0.05)?！?br>