不同无损伤针摆放方法对胸壁完全植入式输液港患者维护效果的研究

doi:10.3761/j.issn.0254-1769.2020.10.020

摘要/Abstract

摘要：

目的观察无损伤针2种摆放方法对肿瘤患者胸壁完全植入式输液港维护效果的影响。方法通过体外实验对无损伤针正向摆放组和背向摆放组冲洗量的差异进行比较,然后选取193例首次植入输液港的肿瘤患者作为研究对象,随机分为正向摆放组和背向摆放组,比较两组输液速度和导管堵塞程度,以及胸壁输液港座不同位置时,2种摆放方法对无损伤针敷贴固定效果和患者舒适度的影响。结果体外实验背向摆放组冲洗量为（4.28±0.67） ml,显著低于正向组（6.51±0.92） ml,差异有统计学意义（P<0.05）。临床试验中正向摆放组输液速度（183.96±9.23）滴/min,显著高于背向组（151.02±10.11）滴/min,两组差异有统计学意义（P<0.001）。输液港底座靠近腋窝处时,正向摆放组无损伤针敷贴的固定效果优于背向组（P<0.001）,正向摆放组患者的舒适度也优于背向组（P<0.001）。输液港底座靠近锁骨中线处,两组无损伤针敷贴固定效果相似（P=0.416）,患者舒适度比较,差异无统计学意义（P=0.457）。结论针对肿瘤患者胸壁完全植入式输液港的维护,无损伤针背向摆放组在体外所需要的冲洗量较正向摆放组更少。当输液港底座靠近腋窝处时,正向摆放组敷贴的固定效果更好,患者的舒适度更高,输液速度更快。

关键词: 完全植入式静脉输液港, 无损伤针, 冲管效果, 护理

Abstract:

Objective To observe the effect of 2 placement methods of sphenoid needle on the maintenance of totally implantable access port（TIAP） on chest wall of tumor patients. Methods The differences of flushing amount between forward placement group of the injury-free needle and the back placement group were compared by in vitro experiment. 193 tumor patients who had been implanted into the infusion port for the first time were selected as the research subjects and were randomly divided into the forward placement group and the back placement group. The infusion speed and the degree of catheter blockage were compared between 2 groups. The differences of the fixation effect and the comfort degree of the injury-free needle between 2 groups were compared when they were implanted into the port seat at different positions. Results In vitro experiment,the amount of flushing in the back group was（4.20±0.67） ml,which was significantly lower than that in the forward group（6.51±0.92） ml（P<0.05）. In clinical trials the infusion speed in the forward group was（183.96±9.23） d/min,which was significantly higher than that in the back group（151.02±10.11） d/min（P<0.001）. The incidence of catheter blockage was similar in 2 groups（P=0.413）. When the access port seat was close to the armpit,the fixation effect of the injury-free needle in the forward placement group were better than that in the back placement group （P<0.001）,and the comfort of the forward placement group was better than it in the back placement group（P<0.001）. When the infusion port seat was close to the midline of the clavicle,there was no statistically significant difference in injury-free needle application and fixation effects between 2 groups（P=0.416）,and there was no statistically significant difference in patient comfort （P=0.457）. Conclusion For the maintenance of TIAP on the chest wall of tumor patients,less amount of flushing was required in vitro in the backward group than it in the forward group. When the infusion port seat is close to the axilla,the forward placement group is better for application and fixation with higher comfort degree,and the infusion speed is faster.

Key words: Totally Implantable Access Port, Injury-Free Needle, Flushing Effect, Nursing Care

朱雅文,冯月珍,肖爱华,谭丽萍. 不同无损伤针摆放方法对胸壁完全植入式输液港患者维护效果的研究[J]. 中华护理杂志, 2020, 55(10): 1554-1559.

ZHU Yawen,FENG Yuezhen,XIAO Aihua,TAN Liping. Research of injury-free needle placement method on the maintenance of totally implantable access port on the chest wall of tumor patients[J]. Chinese Journal of Nursing, 2020, 55(10): 1554-1559.

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参考文献 16

[1]	Infusion Nurses Society. Infusion Therapy Standards of Practice[M]. Alphen aan den Rijn:Wolters Kluwer, 2016: 64-69.
[2]	王建荣. 输液治疗护理实践指南与实施细则[M]. 北京: 人民军医出版社, 2012: 107-110.
	Wang JR. Nursing practice guidelines and implementation rules for infusion therapy[M]. Beijing: Military Science Publishing House, 2012: 107-110.
[3]	中国医师协会介入医师分会. 植入式给药装置介入专家共识[J]. 中华医学杂志, 2019,99(7):484-490.
	Chinese College of Interventionalists, Chinese Medical Doctor Association. Expert consensus on the intervention of implan-table drug delivery devices[J]. Chin Med J, 2019,99(7):484-490.
[4]	乔爱珍, 马威, 朱秋红. 静脉输液港穿刺座冲洗量的体外实验[J]. 护理学杂志, 2006,21(7):51.
	Qiao AZ, Ma W, Zhu QH. In vitro experiment of flushing volume during delivery of implantable venous access port[J]. J Nurs, 2006,21(7):51.
[5]	临床护理实践指南[M]. 北京: 人民卫生出版社, 2011:63.
	Clinical Nursing Practice Guidelines[M]. Beijing: People’s Medical Pu-blishing House, 2011:63.
[6]	焦俊琴, 王建新, 谢艳丽, 等. 两种不同封管方法对植入式静脉输液港再通效果的研究[J]. 护士进修杂志, 2012,27(17):1541-1543.
	Jiao JQ, Wang JX, Xie YL, et al. Study on the effect of two different tube sealing methods on recanalization of implantable venous port[J]. Nurse Training J, 2012,27(17):1541-1543.
[7]	卞伶玲, 赵益. 应用双腔Power经外周中心静脉置管与深静脉导管的舒适度及活动度比较[J]. 解放军护理杂志, 2016,33(16):56-58.
	Bian LL, Zhao Y. Comparison of comfort and mobility between peripheral central venous catheters and deep venous catheters using dual-chamber Power PICC[J]. Nurs J of China PLA, 2016,33(16):56-58.
[8]	Guiffant G, Durussel JJ, Flaud P, et al. Flushing ports of totally implantable venous access devices,and impact of the Huber point needle bevel orientation:experimental tests and numerical computation[J]. Med Devices(Auckl), 2012,5(1):31-37.
[9]	Okamura N, Yamato T, Yamaoka I. Evaluation of the amount of residual lipid emulsion in chambers of flushed totally implantable venous access devices using fluorescence imaging[J]. Eur J Clin Nutr, 2019,73(7):1084-1087. DOI URL PMID
[10]	王卫星, 徐铭, 周守静. 颅脑手术中甘露醇输注速度对血钾浓度和颅内压的影响[J]. 上海医学, 2019,42(9):549-552.
	Wang WX, Xu M, Zhou SJ. The effect of mannitol infusion rate on serum potassium concentration and intracranial pressure during brain surgery[J]. Shanghai Medicine, 2019,42(9):549-552.
[11]	李晨晨, 胡明, 褚珺, 等. 外周穿刺中心静脉导管与完全植入式静脉输液港在儿童肿瘤的临床比较[J]. 介入放射学杂志, 2018,27(8):35-39.
	Li CC, Hu M, Chu J, et al. Clinical comparison of peripheral puncture central venous catheter and fully implanted intrave-nous port in childhood tumors[J]. J Intervent Radiol, 2018,27(8):35-39.
[12]	张银萍, 崔焱, 钱志慧, 等. 肺癌化疗患者PICC相关上肢深静脉血栓的危险因素分析[J]. 中华护理杂志, 2016,51(4):434-437.
	Zhang YP, Cui Y, Qian ZH, et al. Risk factors for PICC related upper extremity deep venous thrombosis in lung cancer patients undergoing chemotherapy[J]. Chin J Nurs, 2016,51(4):434-437.
[13]	Taxbro K, Hammarskjöld F, Thelin B, et al. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer:an open-label,randomised,two-centre trial[J]. Br J Anaesth, 2019,122(6):734-741. DOI URL PMID
[14]	Rickard CM, Marsh N, Webster J, et al. Dressings and securements for the prevention of peripheral intravenous catheter failure in adults(SAVE):a pragmatic,randomized controlled,superiority trial[J]. Lancet, 2018,392(10145):419-430. DOI URL PMID
[15]	栗英, 韩娜, 刘延锦, 等. 不同塑形方法在输液港无损伤无损伤针固定中的应用效果研究[J]. 中国实用护理杂志, 2016,32(16):1252-1255.
	Li Y, Han N, Liu YJ, et al. Study on the application effect of different shaping methods in butterfly wing non-injury needle fixation in infusion port[J]. Chin J Pract Nurs, 2016,32(16):1252-1255.
[16]	张兆顺, 崔桂香. 流体力学[M].3版. 北京: 清华大学出版社, 2015: 8-10.
	Zhang ZS, Cui GX. Hydrodynamics[M]. 3rd Edi. Beijing: Tsing-hua University Press, 2015: 8-10.