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

摘要：

目的 调查血液科中心静脉血管通路的使用与管理现状，并分析存在问题，为制订针对性的管理措施、完善相关标准提供依据。方法 自行设计调查问卷，采用便利抽样法，于2023年10月对19个省（自治区、直辖市）48所医院93个血液科的护理管理者或静脉治疗负责人进行调查。结果 共回收91份有效问卷，有效问卷回收率为97.85%。91个血液科中，开展PICC、中心静脉导管、完全植入式静脉输液港置入技术的分别有91个（100%）、73个（80.22%）和68个（74.73%）。在中心静脉血管通路置入前血液检验指标评估中，评估比例较高的项目为血小板计数（100%）和D-二聚体浓度（87.91%），其余项目的评估比例均<85%；在置入PICC时，97.80%的血液科首选贵要静脉，83.52%使用区域置入法，95.60%皮肤消毒范围直径≥20 cm，98.90%采用超声引导下穿刺置管，67.03%、96.70%分别采用术中心腔内电图或超声辅助定位、术后X线定位，开展隧道式置管和钝性分离扩皮技术的血液科分别占12.09%和53.85%；在中心静脉血管通路维护方面，82.42%的血液科使用一次性专用维护包，61.54%使用透明敷贴固定PICC，45.21%使用缝线固定中心静脉导管，24.18%使用棉签消毒输液接头，60.44%未使用一次性输液接头消毒帽，74.73%使用纱布敷料加压固定的方式预防穿刺点渗血，仅6.59%的血液科使用含氯己定的抗菌敷料预防穿刺点感染；在中心静脉血管通路质量管理方面，94.51%和86.81%的血液科定期进行质量检查和相关数据的收集、统计与分析，50.55%进行并发症风险评估，10.99%建立了静脉治疗信息化管理系统。结论 血液科PICC置入技术的开展比例较高，置入操作基本符合规范要求，中心静脉血管通路置入前评估内容较完善，维护和管理较规范。然而，中心静脉血管通路置入前血液检验指标评估内容亟待规范、统一，置入PICC时应重视新技术的应用，静脉治疗信息化管理有待加强。

关键词: 血液病, 导管插入术, 中心静脉, 横断面研究, 护理