总结18例大面积烧伤患者经创面边际行PICC置管的护理经验。针对本组患者穿刺部位无正常皮肤组织、固定困难、穿刺点易污染、易发生导管相关性感染等问题,构建护理实践方案：置管部位远离感染创面,首选上肢静脉,腋静脉作为次选,小片孤岛型皮肤不宜选择;碘消毒剂替代含酒精消毒剂减少创面刺激;应用心电定位技术在置管过程中实时监测PICC导管尖端位置;缝合联合纱布敷料交叉固定导管;建立针对性的维护措施,关注创面换药和负压引流对PICC带来的感染风险,积极防控导管相关性感染;通过静脉通路核查表及时发现护理问题。18例患者成功留置PICC,其中4例为休克期患者,最长留置时间为32 d,1例确诊为导管相关性血行感染。认为PICC既能满足大面积烧伤患者的输液需求,又有较低的感染率。
The nursing experience of PICC catheterization in 18 patients with massive burns was summarized. Aiming at the problems of no normal skin tissue,difficulty in fixation,easy contamination of puncture points,and susceptibility to catheter-related infections at the puncture sites in this group of patients,a nursing practice plan was constructed. The catheter indwelling site was located away from the infected wound,and the upper extremity vein was preferred,and with the axillary vein as the secondary choice,small pieces of isolated skin should not be selected. Iodine disinfectant was used to replace alcohol disinfectant for reducing wound irritation. ECG localization technology was applied to monitor the tip position of the peripheral central venous catheter in real time during intubation. Stitching in combination with sterile gauze dressing was used to cross-fix catheters. We established targeted maintenance measures and focused on the risk of infection of PICC caused by wound dressing replacement and VSD drainage to prevent catheter related infection. We identified care problems timely through intravenous access checklists. 18 patients were successfully indwelled with PICC,of which 4 were shock patients,and the maximum indwelling time was 32 days. One case was confirmed as a catheter-associated hematogenous infection. PICC can meet the infusion needs of patients with massive burns and has a low infection rate.
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