提升護理人員執行PICC管路周圍皮膚異常照護之改善專案

A Project to Enhance Nurse Staffs' Ability on Care of Peripherally Inserted Central Venous Catheter around Skin Damage

蔡麗珍(Li-Chen Tsai)；楊佩瑄(Pei-Hsuan Yang)；阮瓊慧(Chiung-Hui Juan)；蔡薰慧(Hsun-Hui Tsai)

護理人員能力 ； 週邊置入中心靜脈導管 ； 皮膚異常 ； 正確率 ； staffs' ability ； peripherally inserted central catheter ； skin reaction ； accuracy

若瑟醫護雜誌

14卷1期（2020 / 07 / 01）

20 - 33

繁體中文

目的：週邊置入中心靜脈導管（Peripherally Inserted Central Catheter, PICC）置管後適當的傷口照護，及時發現合併症與處理，是決定個案留置PICC成功的關鍵。本專案為降低病人因PICC管路周圍皮膚異常而導致病人需提早移除管路，延遲治療時程，同時可提升護理人員正確照護認知與技能。方法：藉由現況分析及文獻查證設計制定「PICC管路周圍皮膚異常之照護標準」，舉辦教育訓練提高護理人員照護認知，以「PICC管路周圍皮膚異常評估與照護審核表」定期稽核落實護理人員管路照護技術，培養護理人員能依病人個別性選用適合的敷料的能力，並以「PICC管路照護正確率審核表」每月監測及檢討PICC管路周圍皮膚異常照護之正確率等改善對策。結果：PICC管路照護正確率從44.2%提升至91.6%，病人自我照護正確率達100%，達到專案目的。結論：本專案不僅提高護理人員自主性的照護能力，能主動發現照護問題與醫師討論適合病人的敷料及改變照護方式，也提高病人自我照護能力，得以提升醫療照護品質。

Purposes: The key factors to determine a successful placement of peripherally inserted central catheter (PICC) include appropriate wound care, timely detection and treatment of complications after the PICC insertion. The project aimed to reduce the rate of early removal of the PICC line caused by patients' skin reactions and enhance nursing staffs' clinical knowledge and capabilities of PICC care. Methods: Based on the current situation analysis and literature review, we designed a standards protocol of skin care for PICC insertion,which comprised 1) educational training of nursing staff's care knowledge,2)audit system using ＂Checklist for regulating skin care procedures for PICC insertion＂ to assess nursing staff's care technique,3) staff empowerment to select most suitable dressing materials,4) review and planning to improve ＂correct rate of PICC care＂ and ＂correct rate of damaged skin care around PICC＂ monthly. Results: The accurate rate of caring has been increased from 44.2% to 91.6%. Moreover, the patients have accomplished 100% accurate rate in self-care, thereby achieving the goals of this project. Conclusions: The project not only improved nursing staffs' ability such as having active discussions with physicians for appropriate dressings and caring methods, but also improved patients' self-care ability to enhance health care quality.

1. 崔海恩,簡錫新,王承宗(2011)。作業風險管理之風險決策工具探討。危機管理學刊，8(1)，51-62。
   連結：
2. 蔡守浦,張志成(2005)。健身運動行為之改變-認知取向理論的思維。大專體育，76，106-112。
   連結：
3. Chopra, V,Flanders, SA,Saint, S(2012).The Problem with Peripherally Inserted Central Catheters.The Journal of the American Medical Association,308(15),1527-1538.
4. Donovan, G(2012).We can improve the safety of PICC lines.The American Journal of Nursing,112(11),11.
5. Grau, D,Clarivet, B,Lotthé, A,Bommart, S,Parer, S(2017).Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study.Antimicrobial Resistance & Infection Control,6(1),18.
6. Kelly, LA(2013).practical guide to safe PICC placement.British Journal of Nursing,22(8),13-19.
7. Kutzscher, L(2012).Management of Irritant Contact Dermatitis and Peripherally Inserted Central Catheters.Clinical Journal of Oncology Nursing,16(2),48-55.
8. Leroyer, C,Lasheras, A,Marie, V,Le Bras, Y,Carteret, T,Dupon, M(2013).Prospective follow-up of complications related toperipherally inserted central catheters.Medecine & Maladies Infectieuses,43(8),50-355.
9. Nosbaum, A,Vocanson, M,Rozieres, A,Hennino, A,Nicolas, J F(2009).Allergic and irritant contact dermatitis.European Journal of Dermatology,19(4),325-332.
10. Tian, G,Zhu, Y,Qi, L,Guo, F,Xu, H(2010).Efficacy of multifaceted interventions in reducing complications of peripherally inserted central catheter in adult oncology patients.Support Care Cancer,18(10),1293-1298.
11. Widman, TJ,Oostman, H,Storrs, FJ(2008).Allergic contact dermatitis from medical adhesive bandages in patients who report having a reaction to medical bandages.Dermatitis,19(1),32-37.
12. Yap, YS,Karapetis, C,Lerose, S,Iyer, S,Koczwara, B(2006).Reducing the risk of peripherally inserted central catheter line complications in the oncology setting.European Journal of Cancer Care,15(4),342-347.
13. 古坦春,林春風,林傳成,廖方覩(2000).基層改善向上發展：團結圈活動進階篇.台北市:中衛發展中心.
14. 吳元暉(2006)。醫院引進工業管理技術，醫療服務效率大躍進。健康世界，244，9-9。
15. 岳志瑛,李俊英,余春華,趙淑珍,符琰(2010)。成都市某醫學中心周邊置入中心靜脈導管合併症的現況及其相關護理。護理雜誌，57(3)，79-85。
16. 洪恆莉,李麗傳(2001)。持續護理教育的課程評值。領導護理，20(1)，56-63。
17. 張黎露,王淑卿(2004)。某癌症專科醫院週邊置入中心靜脈導管的照護成果。腫瘤護理雜誌，4(2)，35-41。
18. 張黎露,張文,周文珊,林思岑(2011)。癌症病人常用中心靜脈導管臨床照護指引。腫瘤護理雜誌，11，15-40。
19. 陳昭惠,莊冠琪,林莉莉,李婉琳,藍伯媖,李雅惠(2016)。縮短住院化學治療病人等待化學藥物注射時間之改善專案。馬偕護理雜誌，10(2)，16-26。
20. 陳貴花,梁明娟,李沒燕(2006)。護理干預對外周置入中心靜脈導管置管術後之局部皮膚過敏反應的探討。實用醫技雜誌，13(19)，3366-3368。

1. (2023)。提升周邊血液幹細胞收集正確率。腫瘤護理雜誌，23卷增訂，41-55。