建立并实施由护士主导的中心静脉导管维护跨学科管理策略：单中心经验
Establishment and implementation of a nurse-led interdisciplinary management strategy for central line maintenance: A single-center experience.
作者信息
Yin Yuxin, Tang Changhua, Zhang Lijie, Wu Di, Sun Qing
机构信息
Vascular Access Specialist Team (Urology), No.971 Hospital of the PLA Navy, Qingdao, China.
Department of Rehab-Physiotherapy, No.971 Hospital of the PLA Navy, Qingdao, China.
出版信息
Int J Nurs Sci. 2023 Jun 30;10(3):345-350. doi: 10.1016/j.ijnss.2023.06.014. eCollection 2023 Jul.
OBJECTIVES
This study aimed to establish and implement an interdisciplinary management strategy led by senior nurses via a vascular access specialist team (VAST) at a teaching hospital.
METHODS
In 2021, the hospital established and implemented a nurse-led VAST management strategy to improve the quality of clinical central line maintenance. The VAST comprised senior nurses specialized in intravenous therapy, ultrasound/radiology technologists, medical doctors with central venous catheterization certificates, central line maintenance nurses, and administrative coordinators. The management strategy mainly included systemic on-the-job training for VAST members, the establishment of an interdisciplinary central line emergency "green channel," the formation of a VAST-based, nurse-led standardized clinical rounding system, and the standardization of central line self-care instructions for patients. During the pre- (July 2020 to April 2021) and post- (May 2021 to May 2022) of the implementation the interdisciplinary management strategy, overall patients' self-care ability, the success rate of catheterization at first time, central line management compliance rate, and patients' satisfaction with catheter maintenance were investigated and compared.
RESULTS
The results showed the score self-care ability was increased from 74.75 18.4 (pre-VAST) to 99.10 23.65 (post- VAST); the success rate for catheterization at first time was improved to 100% (225/225), compared to 92.9% (209/225) at pre-VAST; the central line management compliance rate was also increased to 99.6% (224/225) at post-VAST from 93.3% (210/225) at pre-VAST. A patient satisfaction survey on catheter maintenance showed improvements in all five indicators were compared to the pre- VAST ( < 0.05).
CONCLUSIONS
The nurse-led VAST interdisciplinary strategy can effectively improve the quality of clinical central line management and should be used to reinforce clinical catheterization and maintenance of central lines.
目的
本研究旨在通过教学医院的血管通路专家团队（VAST）建立并实施由高级护士主导的跨学科管理策略。
方法
2021年，该医院建立并实施了由护士主导的VAST管理策略，以提高临床中心静脉导管维护质量。VAST由专门从事静脉治疗的高级护士、超声/放射技术人员、持有中心静脉置管证书的医生、中心静脉导管维护护士和行政协调员组成。管理策略主要包括对VAST成员进行系统性在职培训、建立跨学科中心静脉导管紧急“绿色通道”、形成以VAST为基础、由护士主导的标准化临床查房系统以及对患者中心静脉导管自我护理指导进行标准化。在实施跨学科管理策略前（2020年7月至2021年4月）和后（2021年5月至2022年5月），对患者的总体自我护理能力、首次置管成功率、中心静脉导管管理合规率以及患者对导管维护的满意度进行调查和比较。
结果
结果显示，自我护理能力得分从VAST实施前的74.75±18.4提高到VAST实施后的99.10±23.65；首次置管成功率提高到100%（225/225），而VAST实施前为92.9%（209/225）；中心静脉导管管理合规率也从VAST实施前的93.3%（210/225）提高到VAST实施后的99.6%（224/225）。一项关于导管维护的患者满意度调查显示，与VAST实施前相比，所有五项指标均有改善（P<0.05）。
结论
由护士主导的VAST跨学科策略可有效提高临床中心静脉导管管理质量，应用于加强临床中心静脉导管置管和维护。
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