PICC catheter unplanned extubation and nursing Analysis33334.doc

picc catheter unplanned extubation and nursing analysis标签:作者标签:来源标签:时间 abstract objective: to evaluate the peripherally inserted central venous catheter (picc) because of unplanned extubation and nursing. methods: 136 patients with picc catheter care of patients were retrospectively analyzed and summarized the reasons for unplanned extubation analysis and countermeasures. results: 136 patients unplanned extubation occurred in 18 cases, accounting for 13.2%. conclusion: picc provides a safe and reliable venous access and reduce the pain stimulation, is worthy of clinical use. keywords: picc, unplanned extubation, reason, care central venous catheter (picc) is used widely in the intravenous infusion channel for long-term intravenous infusion, chemotherapy, parenteral nutrition, and repeated blood transfusion in elderly patients, those who enter the blood products 1. picc can reduce peripheral intravenous stimulation, protection of blood vessels, reduce leakage, reduce the frequency puncture to the patient the pain and improve the success rate and reduce the nursing workload 2-3. but often appears in the clinical application of unplanned extubation, increased the patients pain and treatment costs. our hospital in december 2005 -2009 in december-line picc136 cases, unplanned extubation occurred in 18 cases, accounting for 13.2%, are the reasons for extubation were analyzed, and nursing. 1 clinical data our hospital in december 2005 -2009 in december of 136 cases of patients with picc, 92 patients were male, female 44 cases, aged 36-74 years, mean age 55 years. 2 results catheter blockage occurred in this group 8 cases, 44.4%, suspected catheter-related infections in 5 cases, 27.8%, vein in 3 cases, 16.7%, catheter loss in 2 cases, accounting for 11.1%. 3 analysis and nursing 3.1 catheter blockage: plugging in the picc catheter highest incidence of complications, and with increased retention time. performance of infusion slowed or stopped when the resistance of injection increased, not back to the blood pumping. 3.1.1 cause: the tube distortion, discount, drug crystal deposition, caused by foreign particles clogging or blocking of non-thrombotic reflux in the lumen of blood clot formation or thrombosis. 3.1.2 nursing: correct red tube and sealed tube technology is the key to prevention of catheter blockage. using pulse tube method for closure sealing solution can generate swirl in the lumen, clean and rinse the wall, familiar with all ph value and concentration of the drug to avoid the drugs cause crystallization and precipitation after mixing, infusion of total parenteral nutrition or calvin, it must be 4h red tube 1, to maintain catheter patency. meanwhile, patients and their families were related knowledge mission, to avoid excessive intraoperative limb and spurts of activity, severe cough is best to use infusion pumps, always observe the liquid drops, such as liquid drops slow down, red vascular resistance increase, the timely processing of incomplete occlusion catheter. in the event of catheter blockage, avoid injection or by pushing red tube, or catheter rupture or thrombosis occurs off organs and other more serious consequences of thrombosis, you should first check the external factors and the position, in the case of catheter distortion caused by the blockage discount multi-site in vitro part of the catheter to relieve the distortion of tube, to release the blocked part of the discount and avoid blind extubation caused regret. reposted elsewhere in the research papers download http:/ 3.2 suspected catheter-related infections 3.2.1 cause: infections, or dressing as strict aseptic causes such as not timely. 3.2.2 nursing: physical therapy, hot packs, strengthen local care, dressing, etc., if necessary, oral antibiotics, generally do not need to pull out the catheter. regardless of catheter tube during operation or after the catheter care, must be strictly aseptic technique. secondly, we should regularly dressing, dressing changes 2-3 times per week with iodine can be effective in preventing infection. in addition, the catheter port cap bacterial culture and heparin should be replaced 1 time per week. 3.3 phlebitis 3.3.1 cause: the puncture technique is not enough skilled, repeated delivery pipes, conduits too rough, leading to intimal injury occurred late catheter thrombophlebitis in patients with chemical stimulation and physical related. nursing strategy 3.3.2: strengthen the training of those who puncture, puncture before select the appropriate blood vessels and catheters, to avoid small blood vessels, thick tube, to avoid catheter contact with talcum powder on the gloves to improve the success rate of a puncture. control of both the puncture technique after successful puncture, push the top of the puncture site when the needle tip to avoid to the top 2cm tip is appropriate to avoid intimal injury caused by pressing the tip. 3.4 catheter off 3.4.1 cause: the film is not strong and fixed-slip pull out their own patient agitation weak constraints. 3.4.2 nursing: to make a full-time qualified nurses catheter maintenance, replacement of film by the distal end to the proximal end torn off, to avoid the tear film when the catheter out, record the time and length of catheter , the fixed film is good or bad is particularly important for the stability of the catheter, for the confusion, irritability of the patient, the choice of effective binding manner, be fixed puncture body and ward visits to observe the fixed catheter, to enhance communication with patients, obtain patient cooperation, emotional support for patients. 4 summary picc infusion is a safe and effective method, while reducing pain due to intravenous stimulation, worthy of study, and actively used in clinical. picc catheter during the detailed needs of nursing staff, effective maintenance, fully understand the cause of non-plan extubation reasons, attention to all potential risk factors