中华临床营养杂志
中華臨床營養雜誌
중화림상영양잡지
CHINESE JOURNAL OF CLINICAL NUTRITION
2013年
1期
58-60
,共3页
肠瘘%经外周血管置人中心静脉导管%护理
腸瘺%經外週血管置人中心靜脈導管%護理
장루%경외주혈관치인중심정맥도관%호리
Intestinal fistula%Peripherally inserted central catheter%Nursing
目的 总结l例肠瘘患者长期应用经外周血管置人中心静脉导管(PICC)的护理方法,探讨8根导管在1例肠瘘患者应用中的护理经验和教训.方法 对l例应用8根PICC的患者运用护理程序进行系统整体护理,观察其临床应用效果.结果 8根导管留置时间最短3个月,最长14个月.第1、3、5、7根导管分别应用12、13、11、14个月,第1根由于经验不足,严格按照说明书导管留置时间拔管,第3根由于滴入不畅拔管,第5根患者强烈要求拔管,第7根则是患者洗头时不慎拔管；第2根导管留置6个月时患者体温升高达38.7C,考虑为导管原因拔管,因缺少经验未作培养,拔管后患者体温恢复正常；第4根导管使用3个月时患者体温39℃,考虑导管相关性血流感染,拔出导管,尖端培养为真菌阳性；第6根留置7个月,由颈内静脉穿刺到上腔静脉,拔管原因是穿刺点局部化脓；第8根应用了8个月,拔管原因是堵管,应用尿激酶溶栓效果不佳.结论 对肠瘘患者应用PICC可减轻患者痛苦,充分提高生活质量.
目的 總結l例腸瘺患者長期應用經外週血管置人中心靜脈導管(PICC)的護理方法,探討8根導管在1例腸瘺患者應用中的護理經驗和教訓.方法 對l例應用8根PICC的患者運用護理程序進行繫統整體護理,觀察其臨床應用效果.結果 8根導管留置時間最短3箇月,最長14箇月.第1、3、5、7根導管分彆應用12、13、11、14箇月,第1根由于經驗不足,嚴格按照說明書導管留置時間拔管,第3根由于滴入不暢拔管,第5根患者彊烈要求拔管,第7根則是患者洗頭時不慎拔管；第2根導管留置6箇月時患者體溫升高達38.7C,攷慮為導管原因拔管,因缺少經驗未作培養,拔管後患者體溫恢複正常；第4根導管使用3箇月時患者體溫39℃,攷慮導管相關性血流感染,拔齣導管,尖耑培養為真菌暘性；第6根留置7箇月,由頸內靜脈穿刺到上腔靜脈,拔管原因是穿刺點跼部化膿；第8根應用瞭8箇月,拔管原因是堵管,應用尿激酶溶栓效果不佳.結論 對腸瘺患者應用PICC可減輕患者痛苦,充分提高生活質量.
목적 총결l례장루환자장기응용경외주혈관치인중심정맥도관(PICC)적호리방법,탐토8근도관재1례장루환자응용중적호리경험화교훈.방법 대l례응용8근PICC적환자운용호리정서진행계통정체호리,관찰기림상응용효과.결과 8근도관류치시간최단3개월,최장14개월.제1、3、5、7근도관분별응용12、13、11、14개월,제1근유우경험불족,엄격안조설명서도관류치시간발관,제3근유우적입불창발관,제5근환자강렬요구발관,제7근칙시환자세두시불신발관；제2근도관류치6개월시환자체온승고체38.7C,고필위도관원인발관,인결소경험미작배양,발관후환자체온회복정상；제4근도관사용3개월시환자체온39℃,고필도관상관성혈류감염,발출도관,첨단배양위진균양성；제6근류치7개월,유경내정맥천자도상강정맥,발관원인시천자점국부화농；제8근응용료8개월,발관원인시도관,응용뇨격매용전효과불가.결론 대장루환자응용PICC가감경환자통고,충분제고생활질량.
Objective To summarize our experiences in the long-term continuous maintenance of the peripherally inserted central catheter (PICC) in a patient with intestinal fistula.Method The systematic holistic nursing care has been provided according to the nursing practices to a patient with intestinal fistula since 2006,during which eitht PICCs were used successively.Results The eight PICCs were placed for 3-14 months.The 1 st,3rd,5th,and 7th cathers were retained for 12,13,11,and 14 months.The second catheter was retained for 6 months,and then removed due to increased body temperature (38.7℃).The 4th cather was retained for 3 months,then catheter-related bloodstream infection was suspected due to high body temperature (39℃) ; culture for fungi at the tip showed positive results.The 6th catheter was retained for 7 months,inserting from jugular vein to the superior vena cava; however,it was removed due to puncture point local purulent changes at the puncture site.The 8th catheter was applied for 8 months,but was rmoved due to tube occlusion,which responded poorly to urokinase.Conclusion The application of PICC in patients with fistula can relieve the pain and improve the quality of life.
