The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.
BMC Med Educ. 2022 Jun 2;22(1):420. doi: 10.1186/s12909-022-03418-3.
In the intensive care unit (ICU), internal jugular vein puncture and catheterization are basic rescue operations that physicians need to complete quickly and independently. It is necessary to improve the first-attempt success rate of internal jugular vein catheterization, shorten the catheterization duration and reduce the incidence of complications for standardized training residents (STRs).
To improve first-attempt insertion success rates of internal jugular vein catheterization for STRs.
Based on the PDCA cycle management method and current situation investigation, the PDCA management objectives were set, and the implementation content, monitoring items and continuous improvement plan were formulated. The data of residents who were trained in the ICU of Fangcun Hospital, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, from January 2016 to April 2016 and managed by the PDCA cycle (PDCA group), were compared with the data of residents trained in the same department from August 2015 to November 2015 before the implementation of PDCA (historic control group), the first-attempt success rate of puncture and catheterization, the duration of puncture and catheterization, and the incidence of complications were analysed.
Thirty-six cases of internal jugular vein catheterization were performed by the PDCA group, 21 cases (58%) were performed by residents in the third year of standardized training, and 15 cases (42%) were performed by residents in the second year of standardized training. Compared with the historic control group, there was no significant difference in the seniority of residents (X = 0.240, P = 0.625) or the 'majors of the residents (X = 1.306, P = 0.835). The first-attempt success rate of puncture in the PDCA group was 94% (34/36), which was significantly higher than that of the historic control group (55% (11/20) (P = 0.001). In the PDCA group, the first-attempt success rate of puncture among third-year standardized training residents was 95% (20/21), and the first-attempt success rate in the second-year was 93% (14/15), which were significantly higher than the corresponding rates of 62% (8/13) and 43% (3/7) respectively, in the historic control group (all P = 0.021). The duration of catheterization was [4 (3,5)] min after PDCA, which was significantly shorter than that in the historic control group [9 (6.25,13.00)] min (Z = - 5.214, P < 0.001). The incidence rate of complications in the PDCA group was 0% (0 /36), which was significantly lower than the rate of 20% (4 / 20) in the historic control group (P < 0.013).
PDCA cycle management can help improve the first-attempt success rate of internal jugular vein puncture and catheterization, shorten the duration of puncture and catheterization, and reduce the incidence of complications. The idea and method of PDCA cycle management can be applied to other training and management protocols for STRs.
在重症监护病房（ICU）中，经颈内静脉穿刺置管术是医师需要快速且独立完成的基本抢救操作，需要提高规范化培训住院医师（STR）的颈内静脉首次穿刺置管成功率，缩短置管时间，减少并发症的发生。
提高 STR 颈内静脉首次穿刺置管成功率。
基于 PDCA 循环管理方法和现状调查，设定 PDCA 管理目标，制定实施内容、监测项目和持续改进计划。比较 2016 年 1 月至 2016 年 4 月在广州中医药大学第二附属医院芳村医院 ICU 接受 PDCA 循环管理（PDCA 组）的住院医师和 2015 年 8 月至 2015 年 11 月接受 PDCA 循环管理前在同一科室接受培训的住院医师（历史对照组）的穿刺置管首次成功率、穿刺置管时间和并发症发生率。
PDCA 组共进行 36 例颈内静脉穿刺置管术，其中 3 年规范化培训住院医师 21 例（58%），2 年规范化培训住院医师 15 例（42%）。与历史对照组相比，住院医师的资历（X²=0.240，P=0.625）或“住院医师专业（X²=1.306，P=0.835）差异无统计学意义。PDCA 组穿刺首次成功率为 94%（34/36），明显高于历史对照组的 55%（11/20）（P=0.001）。PDCA 组 3 年规范化培训住院医师穿刺首次成功率为 95%（20/21），2 年规范化培训住院医师穿刺首次成功率为 93%（14/15），明显高于历史对照组的相应成功率 62%（8/13）和 43%（3/7）（均 P=0.021）。PDCA 后置管时间为[4（3，5）]min，明显短于历史对照组[9（6.25，13.00）]min（Z=-5.214，P<0.001）。PDCA 组并发症发生率为 0%（0/36），明显低于历史对照组的 20%（4/20）（P<0.013）。
PDCA 循环管理有助于提高颈内静脉穿刺置管术的首次成功率，缩短穿刺置管时间，降低并发症发生率。PDCA 循环管理的理念和方法可应用于 STR 其他培训和管理方案。
