关键词: 血液病, 导管插入术, 中心静脉, 横断面研究, 护理

Abstract:

Objective To investigate the status of application of the central venous access in the departments of hematology to develop targeted administrative strategies and provide evidence for management. Methods A self-designed questionnaire was applied and convenience sampling was adopted in 93 hematology departments from 48 hospitals in 19 provinces（autonomous regions，municipalities）. Results A total of 91 valid questionnaires were collected，with a valid questionnaire response rate of 97.85%. Among the 91 hematology departments，91（100%），73 （80.22%），and 68（74.73%） carried out PICC，central venous catheter，and totally implantable access port catheterization，respectively. In the evaluation of blood test indicators before central venous access，the items with a higher evaluation proportion were platelet count（100%） and D-dimer concentration（87.91%），while the evaluation proportion of other items was <85%. When PICC catheterization，97.80% of hematology departments prefer basilic vein；83.52% of hematology departments used zone insertion method；95.60% of hematology departments had a skin disinfection range of ≥20 cm；98.90% of hematology departments had catheterization under ultrasound guidance；67.03% and 96.70% of hematology departments used the intracardiac electrocardiogram method or ultrasound assisted localization，postoperative X-ray localization；12.09% and 53.85% of hematology departments carried out tunnel catheterization and blunt separation expansion techniques，respectively. In terms of maintenance of central venous access devices，82.42% of hematology departments used disposable specialized maintenance kits；61.54% of hematology departments used transparent patches to fix PICC；45.21% of hematology departments used suture to fix central venous catheters；24.18% of hematology departments used cotton swabs to disinfect infusion joints；60.44% of hematology departments did not use disposable infusion joint disinfection cap；74.73% of hematology departments used gauze compression to prevent puncture site bleeding；only 6.59% hematology departments used antibacterial dressings containing chlorhexidine to prevent puncture site infections. In terms of quality management of central venous access devices，94.51% and 86.81% of hematology departments regularly conducted quality inspections of central venous access，and collected，calculated and analyzed relevant data. 50.55% of hematology departments conducted complication risk assessments，and 10.99% of hematology departments had established information management systems for venous therapy. Conclusion The implementation rate of PICC catheterization in the hematology department was relatively high，and the insertion operation basically meets the standard requirements. The evaluation before central venous access catheterization was relatively completed，and the maintenance and management are relatively standardized. However，the evaluation of blood test indicators before the placement of central venous access urgently needs to be standardized and unified. When PICC catheterization，attention should be paid to the application of new technologies，and the information management of venous therapy needs to be improved.

Key words: Hematologic Diseases, Catheterization, Central Venous, Cross-Sectional Study, Nursing Care