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題名 | 降低兒科病患靜脈注射後靜脈炎的發生率=Reducing the Incidence of Phlebitis Related to Intravenous Injection in Pediatric Patients |
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作者 | 卓燕華; 葉麗玲; 于凱齡; 張鈞竹; 陳雪玲; Cho, Yen-hua; Yen, Li-ling; Yu, Kai-ling; Chang, Chun-chu; Chen, Hsuen-ling; |
期刊 | 護理雜誌 |
出版日期 | 20150600 |
卷期 | 62:3(附冊) 2015.06[民104.06] |
頁次 | 頁49-57 |
分類號 | 419.75 |
語文 | chi |
關鍵詞 | 週邊靜脈注射; 靜脈炎; 兒科病患; Peripheral venous catheter; Phlebitis; Pediatric patients; |
中文摘要 | 背景 住院兒童經常接受到週邊靜脈導管的治療,用以提供營養與藥物的輸注。經由統計資料顯示,本醫學中心的兒童內科病房,90%以上的住院兒童接受週邊靜脈導管留置。然而,週邊靜脈導管的留置經常伴隨靜脈炎的發生,其發生率在兒童內科病房約為5.07%。評估後發現,靜脈炎的導因可能為:消毒時間不足、注射部位固定方法不合宜、注射處的固定物易鬆脫、重新固定注射部位比率高、與導管移除後傷口照護不佳等。目的 此專案的目的為減少兒童靜脈炎的產生,且發生率能由5.07%降為2.5%。解決方案 2012年4月至7月期間,經文獻查證與為期一週的臨床評估後,初步制定降低靜脈炎發生之策略,並請相關領域之專家(如:感染科醫師、感控師,與專業護理師)針對此策略提出建議。經修正後,解決策略包括:改變消毒溶液為2% chlorhexidine克菌寧消毒、制定靜脈注射固定標準、製作多規格的安全且方便的靜脈注射固定板、擬定靜脈導管移除後傷口照護標準、移除導管預洗澡時使用無菌卡通防水膜。結果 此專案執行三個月後,本單位的兒童靜脈注射靜脈炎發生率已由5.07%下降至2.08%。結論 本專案在推行後,變更消毒溶液以達足夠消毒時間,制定靜脈固定標準與開發新制固定板,以減少重新固定之機會,制訂導管移除後傷口照護標準,進而降低兒童經由靜脈注射後產生靜脈炎的機率,用以提升護理品質及兒童安全。 |
英文摘要 | Background & Problems: Peripheral venous catheter (PVC) is commonly used to provide nutrition and medicine to pediatric inpatients. Phlebitis is a common side effect of PVC insertion. Over 90% of pediatric patients in the paediatric medical ward at the Chang Gung Memorial Hospital (CGMH) receive PVC insertion, with an incident rate of phlebitis of 5.07%. Common cause factors of phlebitis are: insufficient sterilization time, inappropriate methods used to fix the PVC, the use of fixtures that loosen easily, high re-fix rates, and inadequate wound care after catheter removal. Purpose: The purpose of this project was to reduce the incidence rate of PVC-insertion-related phlebitis in children from 5.07% to 2.5%. Resolution: A one-week clinical observation identified the re-inserting / re-fixing of existing PVCs as the principal cause of phlebitis in the CGMH paediatric ward. Therefore, the researchers modified the catheter care bundle based on a review of the literature and the suggestions of clinical pediatric experts. Modifications included applying 2% chlorhexidine to sterilize the insertion site; using a new, non-woven fabric splint to fix the PVC site; providing cartoon- themed waterproof dressings for the first bath after the removal of the PVC; and setting standard operating procedures (SOPs) for PVC insertion and catheter removal. Results: After applying these modifications, the incident rate of phlebitis in children with PVC insertions decreased from 5.07% to 2.08%. Conclusion: The application of 2% chlorhexidine reduces the waiting time for sterilization; the purpose-designed splint strengthens the fixation of the PVC; and the development of the SOPs for PVC insertion and post-removal catheter care reduces the risk of phlebitis. The combination of these strategies effectively reduces the incidence of phlebitis and improves the nursing care quality. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。