预防中心静脉置管发生非计划性拔管的新技术

目的研究有效预防中心静脉置管患者非计划性拔管的新方法，应用肩扣式病号服，探讨该新技术的优势，及其临床应用价值。方法制作肩扣式病号服，选取从2014年9月至2015年月中2留置中心静脉置管术（CVC）的病例200例，随机分为肩式病号服组和对照组，各100例，通过观察两组患者CVC导管的敷料开裂情况、CVC导管固定缝线局部皮肤的炎症反应情况以及敷料更换的次数，评估CVC导管可能存在的移位或脱落，非计划性拔管的发生率。结果通过应用统计学配对 t检验和χ2检验方法，对比两组患者的敷料开裂程度、皮肤炎症反应、敷料更换次数、导管移位脱管、非计划性拔管、患者满意度与医生满意度的差异，P＜0．05提示差异具有统计学意义。结果显示：CVC留置后第1、3、5、7天，肩式病号服组患者CVC导管的敷料开裂程度评分明显低于对照组，两组患者比较差异具有显著性（P＜0．05）；肩式病号服组患者CVC导管固定缝线局部皮肤的皮肤炎症反应评分明显低于对照组，两组患者比较差异具有显著性（P＜0．05）；肩式病号服组患者敷料更换次数明显少于对照组，两组患者比较差异具有显著性（P＜0．05）；肩式病号服组导管移位脱管的发生率与非计划性拔管的发生率明显低于对照组，两组患者比较差异具有显著性（P＜0．05）；肩式病号服组患者满意度明显高于对照组，两组患者比较差异具有显著性（P＜0．05）；肩式病号服组医生满意度明显高于对照组，两组患者比较差异具有显著性（P＜0．05）；表明肩扣式病号服在CVC护理中应用效果良好，降低了置管过程中不安全因素的发生率。结论肩扣式病号服能有效减少和预防因中心静脉置管护理意外而引发的非计划性拔管。该新技术操作简单、实用，能很好的应用于临床。

A New Technology For Prevention of unplanned extubation of central venous catheters

Objective To research on a new method to effectively prevent the unplanned extubations by the application of gowns of the home-made style named "button-on-shoulder"on the patients with the central venous catheter ,and discusses the advantages of the new technology ,and its value in the clinical application .Methods By making gowns of "button-on- shoulder" style ,from September 2014 to February 2015 ,200 cases retained CVC were chosen ,and were randomly divided into experimental group and control group ,100 cases each group .The number of the inflammatory response was observed in two groups of patients with CVC catheter dressing cracking ,CVC catheter fixation sutures and dressing change of local skin evaluation of CVC catheter ,the possible existence of shift or fall off ,the incidence of unplanned extubation of the occurrence and the satisfaction of doctors ,patientsand oth-er indicators .Results Through the statistical methods of paired t test and χ2 test methods ,the cracking degree of dressing ,skin in-flammation degree of the two groups were compared with the number of replacement ,incidence of catheter heterotopia off tube ,inci-dence of unplanned extubation ,the patients satisfaction and doctors′satisfaction ,P<0 .05 showed having a statistically significant difference ,the result showed :after CVC lien ,1 ,3 ,5 ,7 days the CVC catheters in patients with shoulder type hospital gown group of dressing craze degree score significantly lower than the control group ,two groups of patients compared with significant difference (P<0 .05);Shoulder group hospital gown CVC catheter fixed suture topical skin skin inflammation score significantly lower than the control group ,two groups of patients compared with significant difference (P<0 .05);Shoulder hospital gown dressing change significantly less than the control group ,two groups of patients compared with significant difference (P<0 .05);Shoulder hospital gown group the incidence of catheter shift to take off the tube and the incidence of unscheduled decannulation significantly lower than the control group ,two groups of patients compared with significant difference (P< 0 .05);Patient satisfaction button-on-shoulder group was obviously higher than that of control group ,two groups of patients compared with significant difference (P<0 . 05);Shoulder doctor satisfaction hospital gown group was obviously higher than that of control group ,two groups of patients com-pared with significant difference (P<0 .05);that gowns of "button-on-shoulder"style in CVC care and good application effect ,re-duce the incidence of catheter as well as the unsafe factors in the process .Conclusion The style of gowns named "button-on-shoul-der"is an application of the new technology on CVC .Through the pipeline placed on the shoulder buckle ,unsafe factors can effec-tively reduce and prevent for central venous catheter nursing accidents caused by .The new technology is simple ,practical ,and can be applied to clinical use .