经胸心内导管患儿的抱持与活动能力
Holding and Mobility of Pediatric Patients With Transthoracic Intracardiac Catheters.
作者信息
Lisanti Amy Jo, Helman Stephanie, Sorbello Andrea, Fitzgerald Jamie, D'Amato Annemarie, Zhang Xuemei, Gaynor J William
机构信息
Amy Jo Lisanti is a nurse scientist - clinical nurse specialist, Cardiac Nursing and the Center for Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia and Adjunct Assistant Professor of Nursing, University of Pennsylvania, School of Nursing. She was a Ruth L. Kirschstein National Research Service Award Postdoctoral fellow, University of Pennsylvania School of Nursing, while this work was performed.
Stephanie Helman was a clinical nurse specialist in the cardiac intensive care unit, Children's Hospital of Philadelphia, while this work was performed. She is currently a doctoral student at the University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.
出版信息
Crit Care Nurse. 2020 Aug 1;40(4):16-24. doi: 10.4037/ccn2020260.
BACKGROUND
Nursing care of pediatric patients after cardiac surgery consists of close hemodynamic monitoring, often through transthoracic intracardiac catheters, requiring patients to remain on bed rest and limiting holding and mobility.
OBJECTIVES
The primary aim of this quality improvement project was to determine the feasibility of safely mobilizing pediatric patients with transthoracic intracardiac catheters out of bed. Once feasibility was established, the secondary aim was to increase the number of days such patients were out of bed.
METHODS AND INTERVENTIONS
New standards and procedures were implemented in July 2015 for pediatric patients with transthoracic intracardiac catheters. After initiation of the new policies, complications were tracked prospectively. Nursing documentation of activity and positioning for all patients with transthoracic intracardiac catheters was extracted from electronic health records for 2 fiscal years before and 3 fiscal years after the new policies were implemented. The Cochran-Armitage test for trend was used to determine whether patterns of out-of-bed documentation changed over time.
RESULTS
A total of 1358 patients (approximately 250 to 300 patients each fiscal year) had activity and positioning documented while transthoracic intracardiac catheters were in place. The Cochran-Armitage test for trend revealed that out-of-bed documentation significantly increased after the new policies and procedures were initiated (P < .001). No major complications were noted resulting from patient mobility with transthoracic intracardiac catheters.
CONCLUSION
Pediatric patients with transthoracic intracardiac catheters can be safely held and mobilized out of bed.
背景
小儿心脏手术后的护理包括密切的血流动力学监测，通常通过经胸心内导管进行，这要求患者卧床休息，并限制抱持和活动。
目的
本质量改进项目的主要目的是确定安全动员经胸心内导管小儿患者下床的可行性。一旦确定可行性，次要目的是增加此类患者的下床天数。
方法和干预措施
2015年7月对经胸心内导管小儿患者实施了新的标准和程序。新政策实施后，对并发症进行前瞻性跟踪。从新政策实施前2个财政年度和实施后3个财政年度的电子健康记录中提取所有经胸心内导管患者的活动和体位护理记录。采用趋势Cochran-Armitage检验来确定下床记录模式是否随时间变化。
结果
共有1358例患者（每个财政年度约250至300例患者）在经胸心内导管在位时记录了活动和体位。趋势Cochran-Armitage检验显示，新政策和程序实施后，下床记录显著增加（P < .001）。未发现经胸心内导管患者活动导致的重大并发症。
结论
经胸心内导管小儿患者可以安全地抱持并下床活动。
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