目的 设计多边E型弹力宽胶带并探讨其应用效果。方法 多边E型胶带以25 cm×2.5 cm的弹力宽胶带为基础,选择任意一长边,每隔1 cm向胶带中心剪一个三角形缺口,并从三角形顶点继续向内延伸剪至1 cm处,形成多边E型。采用便利抽样法,选取2020年7月—2022年7月银川市某三级甲等综合医院重症医学科留置中心静脉导管280例患者为应用对象,采用随机数字表法分为试验组与对照组各140例。两组均按照标准导管维护流程进行维护,试验组用蝴蝶夹缝合+无边透明贴膜+多边E型弹力宽胶带固定;对照组用蝴蝶夹缝合+有边透明贴膜固定。观察两组导管移位、导管滑脱、局部感染、贴膜卷边及导管相关血流性感染情况。结果 试验组导管移位（χ2=7.578,P=0.006）、导管滑脱（χ2=4.632,P=0.031）、局部感染（χ2=6.637,P=0.010）和贴膜卷边发生率（χ2=73.736,P<0.001）均低于对照组,差异均有统计学意义（P<0.05）;两组导管相关血流感染比较,差异无统计学意义（P>0.05）;成本-效果分析结果显示,试验组固定方法成本低、效果好。结论 采用蝴蝶夹缝合+无边透明贴膜+多边E型弹力宽胶带固定深静脉导管在导管移位、导管滑脱、局部感染及贴膜卷边方面表现更优,且成本更低。
Objective To design polygonal E-shaped elastic wide tape,and evaluate its application effects. Methods The polygonal E-shaped tape was made based on a 25 cm × 2.5 cm elastic wide tape. We selected any long edge,cut a triangular notch towards the center of the tape every 1 cm,and continued to cut from the triangle‘s vertex inward to 1 cm,to form the polygonal E-shaped tape. Convenience sampling was employed to select 280 patients who underwent central venous catheterization in the intensive care unit of a tertiary Grade A comprehensive hospital in Yinchuan city from July 2020 to July 2022 as the subjects. Using a random number table,they were divided into experimental and control groups,with 140 cases each. Both groups underwent standard catheter maintenance procedures. The experimental group was fixed with butterfly clips,edgeless transparent film and polygonal E-shaped elastic wide tape,while the control group was directly fixed with butterfly clips and edged transparent film. Catheter displacement,catheter slippage,local infections,film rolling,and catheter-related bloodstream infections were observed in the both groups. Results Catheter displacement（χ2=7.578,P=0.006）,catheter slippage（χ2=4.632,P=0.031）,local infections（χ2=6.637,P=0.010）,and film rolling（χ2=73.736,P<0.001） were all lower in the experimental group than those in the control group,with statistically significant differences（P<0.05）. There was no statistically significant difference in catheter-related bloodstream infections between the two groups（P>0.05）. Cost-effectiveness analysis showed that the fixation method in the experimental group was cost-effective with good outcomes. Conclusion The use of butterfly clips,edgeless transparent film and polygonal E-shaped elastic wide tap to fix central venous catheters can reduce catheter displacement,catheter slippage,local infection,and film rolling occurrence rates. Furthermore,its cost was lower.
[1] 亚洲急危重症协会中国腹腔重症协作组. 重症患者中心静脉导管管理中国专家共识(2022版)[J]. 中华消化外科杂志,2022, 21(3):313-322.
Chinese Abdominal Intensive Care Collaboration Group of Asia Emergency and Critical Care Medicine Society. Chinese expert consensus on management of central venous catheters for critically ill patients(2022 edition)[J]. Chin J Dig Surg,2022, 21(3):313-322.
[2] Velasquez Reyes DC,Bloomer M,Morphet J.Prevention of central venous line associated bloodstream infections in adult intensive care units:a systematic review[J]. Intensive Crit Care Nurs,2017,43:12-22.
[3] 王霞,邵欣,旷璐,等. 183所三级医院ICU中心静脉导管相关血流感染防控护理实践的调查[J]. 中华护理杂志,2022,57(11):1371-1377.
Wang X,Shao X,Kuang L,et al.Investigation of nursing prevention and control practice of central line-associated bloodstream infections in ICU of 183 tertiary hospitals[J]. Chin J Nurs,2022,57(11):1371-1377.
[4] 李欣,王小云,方亮,等. 透明贴膜用于中心静脉导管留置的临床观察[J]. 护理实践与研究,2017,14(16):132-133.
Li X,Wang XY,Fang L,et al.Clinical observation of trans-parent film for central venous catheter[J]. Nurs Pract Res,2017, 14(16):132-133.
[5] 刘茳,刘佳,赵春玲. 带切口与不带切口Ⅳ3000贴膜用于ICU患者中心静脉导管固定的效果比较[J]. 现代中西医结合杂志,2019,28(23):2596-2599.
Liu J,Liu J,Zhao CL.Comparison of the effect of Ⅳ3000 film with and without incision in fixing central venous catheter in ICU patients[J]. Mod J Integr Tradit Chin West Med,2019,28(23):2596-2599.
[6] 彭慧,梁红. 3M透明敷贴联合体表导管固定装置或缝合固定双腔中心静脉导管的效果观察[J]. 实用医院临床杂志,2019,16(3):151-153.
Peng H,Liang H.The clinical effects of 3M Tegaderm com-bined with body surface catheter fixing device or suture for fixation of central venous catheter[J]. Pract J Clin Med,2019, 16(3):151-153.
[7] 陶雍,薛嵋,戴宏琴,等. 两种透明贴膜在肿瘤患者PICC留置期间应用效果研究及成本-效果分析[J]. 护理与康复,2022,21(9):27-29.
Tao Y,Xue M,Dai HQ,et al.Study on the application effect and cost-effectiveness analysis of two kinds of transparent film in PICC indwelling period of tumor patients[J]. J Nurs Reha-bil,2022,21(9):27-29.
[8] 蒋翠婷,张晓玲,钟冬梅,等. 重症患者血管导管相关感染危险因素的Meta分析[J]. 中国护理管理,2022,22(4):552-558.
Jiang CT,Zhang XL,Zhong DM,et al.Risk factors of Vessel Catheter-Associated Infection in critical patients:a Meta-analysis[J]. Chin Nurs Manag,2022,22(4):552-558.
