Schiks Ingrid, Schoonhoven Lisette, Verheugt Freek, Aengevaeren Wim, van Achterberg Theo
Heart Lung Centre, Cardiology, Radboud University Nijmegen Medical Centre, 6500 HB, Nijmegen, The Netherlands.
Eur J Cardiovasc Nurs. 2007 Sep;6(3):172-7. doi: 10.1016/J.EJCNURSE.2006.08.001. Epub 2006 Sep 25.
Sheath removal after PCI by registered nurses can improve patients' comfort and shorten immobilisation time. As sheath removal is not without risk, it is important to assure the quality of performance.
The aim was (a) to check if nurses' performance in 1999 and 2005 was in accordance with the protocol for arterial sheath removal and (b) to compare both measurements to explore differences in performance over time.
We trained registered nurses in sheath removal and observed them during sheath removal in elective uncomplicated PCI-patients. We developed and used a checklist, including 10 elements and 65 items.
Both in 1999 (n=43 observations with 13 nurses) and 2005 (n=42 observations with 16 nurses) the norm of more than 90% for the total score was not achieved: we found 82% and 80%, respectively. Four elements scored more than 90%, and three elements scored less than 80% at both points in time. The results on the other three elements differed significantly over time.
Registered nurses achieved the norm for good performance (80-89%) of removing arterial sheaths according to protocol after a training programme and this is stable in time. Since the norm for excellent performance (> or =90%) was not achieved, current performance could be improved, e.g. by yearly repetition of training and observation of skills. More research is needed, and could focus on the validation of the instrument. Also multi-centre studies with this checklist could test the association between the quality of arterial femoral sheath removal and the occurrence of vascular complications.
由注册护士在经皮冠状动脉介入治疗（PCI）后拔除鞘管可提高患者舒适度并缩短制动时间。由于鞘管拔除并非毫无风险，确保操作质量很重要。
目的是（a）检查护士在1999年和2005年的操作是否符合动脉鞘管拔除方案，以及（b）比较两次测量结果以探究不同时间操作的差异。
我们对注册护士进行鞘管拔除培训，并在择期非复杂性PCI患者鞘管拔除过程中对他们进行观察。我们制定并使用了一份包含10项要素和65个条目的检查表。
1999年（13名护士的43次观察）和2005年（16名护士的42次观察）的总分均未达到90%以上的标准：我们分别发现为82%和80%。四个要素得分超过90%，三个要素在两个时间点得分均低于80%。其他三个要素的结果随时间有显著差异。
注册护士在经过培训后，根据方案达到了动脉鞘管拔除良好操作（80 - 89%）的标准，且这一标准随时间保持稳定。由于未达到优秀操作（≥90%）的标准，当前操作可加以改进，例如通过每年重复培训和技能观察。需要更多研究，且可侧重于该工具的验证。使用此检查表的多中心研究也可检验股动脉鞘管拔除质量与血管并发症发生之间的关联。
