Chemotherapy patients; PICC catheter insertion; Reasons for refusal; Intervention countermeasures
Chemotherapy is an important measure to treat various hematological diseases, which requires repeated courses of treatment. Due to the characteristics of high irritation and osmotic pressure of chemotherapy drugs, chemical and thrombophlebitis of different degrees are often caused, and extravasation of blood vessels can also lead to tissue necrosis. Peripheral central venous catheterization (PICC) has become a safe and effective infusion method to reduce phlebitis and extravasation of chemotherapy drugs. However, some patients still refuse PICC catheterization. Our department conducted an investigation on 58 patients who refused PICC catheterization during hospitalization chemotherapy from September to October, 2009. The investigation results are reported as follows.
1 objects and methods
1. 1
In this group, 58 patients who needed chemotherapy but refused to put tubes, including 20 cases of lymphoma, 23 cases of myeloma 15, and 23 cases of leukemia, including 32 males and 26 females, aged 17 ~ 83 years, and their educational level varied from primary school to undergraduate. All the 58 patients in this group have complete cognitive and behavioral abilities, and all meet the requirements of PICC, but they refuse to put tubes.
1.2 survey method
A self-made questionnaire was used to investigate the reasons why patients refused PICC catheterization. Take the way of distributing questionnaires on the spot and taking them back immediately. Before distribution, briefly introduce the contents and filling methods of the questionnaire to patients. Those who have the ability to fill in the questionnaire fill it out by themselves, and those who have no ability to fill it out on their behalf. 58 questionnaires were distributed and 58 questionnaires were collected, with an effective rate of 100%.
Two results
The reasons why hematological patients refused PICC catheterization were: 49 cases (84.5%) had high risk and many complications; The maintenance of discharge tube is difficult, accounting for 79.3%; 43 cases (74.65438 0%) had difficulty in moving after catheterization; 38 cases (65.5%) had higher cost of catheterization and nursing.
3 Cause analysis
3. 1 The operation of placing the pipe is risky.
The survey results show that patients are more concerned about the risk of catheterization itself and become the first reason to refuse catheterization. Patients with hematological diseases have both physical pain and psychological pain, and they are even more afraid of the adverse reactions caused by treatment. Traditional venipuncture uses metal needle or indwelling trocar, which is relatively easy for patients to accept, but they are not familiar with PICC catheter. In addition, medical staff will inform patients of possible risks and complications before catheterization, such as phlebitis, catheter blockage, catheter displacement and so on. After hearing about many complications, patients and their families have invisibly increased their psychological burden, so they are discouraged from PICC.
3.2 Maintenance of discharge tube is difficult.
A series of maintenance problems, such as long-term tube sealing and dressing change caused by tube placement, also plague patients. Local patients are worried that no one will go back to the hospital for maintenance after discharge, and foreign patients are worried that there is no corresponding medical condition in the local area and it is inconvenient to go back to the hospital for maintenance, which has become the second biggest reason for refusing to put the tube in the investigation.
3.3 After placing the tube, it is inconvenient to move and affect the appearance.
Patients are worried that the limited movement of catheter will bring inconvenience to daily life. I am worried that the catheter will be pulled out unintentionally, or the catheter will be abnormal due to lack of self-care experience.
3.4 The cost of catheterization and nursing is high.
The high cost of catheterization and nursing care is indeed an insurmountable difficulty for patients with hematological diseases with poor economic conditions, and patients are more willing to spend limited resources on examination and medication. 4 countermeasures
4. 1 Carry out systematic health education
4. 1. 1 Building a harmonious and trusting nurse-patient relationship
Most of the patients who refused to put the catheter were newly diagnosed patients, and their doubts about putting the catheter came from their distrust and ignorance of the operating level of medical staff. Therefore, medical staff should first strengthen communication with patients, try their best to help patients solve various difficulties, and show excellent operational skills to patients through their usual operations, so as to build a trusted and harmonious doctor-patient relationship.
4. 1.2 Objectively evaluate the advantages and risks of PICC catheterization.
58 patients who are going to be intubated can't ensure safe medication because of the need to inject strong irritating drugs and poor peripheral vein conditions. Therefore, publicity and education inform patients of the possible adverse consequences of taking drugs from peripheral veins, and explain in detail the advantages of taking drugs from central veins to prevent phlebitis, avoid puncture pain and reduce dosage. Please ask the patients who have been intubated to attend the lecture. As long as the precautions given by medical staff are followed, catheter will not bring too much inconvenience to daily life, thus deepening patients' understanding of catheterization and putting an end to catheterization. At the same time, clearly tell patients that there are some risk problems in catheterization, but a series of measures will be taken to avoid them as much as possible and enhance patients' confidence.
4. 1.3 Health education of catheter knowledge
Patients who agree to catheterization should be educated throughout the whole process. Before catheterization, the operator should communicate with the patient personally and guide the patient how to cooperate with catheterization. Catheterization is a strong stressor for the first-time patients, which will make them feel scared and nervous. At this time, we should create a quiet and comfortable environment, communicate with patients in a gentle and friendly tone and divert their attention. When the intubation is not smooth, the patient may need to change his position to cooperate with the intubation. At this time, effective communication to reduce the patient's nervousness is an important guarantee for the success of intubation. After intubation, we should carefully explain the matters needing attention and closely observe the changes of the condition after intubation.
4.2 Strengthen the management of catheter placement process
4.2. 1 personnel training
First of all, urethral catheterization operators must have a strong sense of responsibility and undergo special PICC urethral catheterization training and assessment to ensure the success rate of urethral catheterization. Organize all nurses in the department to carry out pipeline maintenance knowledge training, strictly standardize pipeline maintenance, master the treatment methods of complications after catheterization, and seriously educate patients about daily precautions after catheterization.
4.2.2 Improve the process
Formulate the integrated operation process of tube placement, nursing and discharge maintenance, refine the responsibility requirements and ensure the quality of the link. Especially for patients discharged from hospital with tube, strengthen relevant knowledge education; For patients who are inconvenient to go back to the hospital for maintenance, a leaflet on central venous maintenance will be issued when they leave the hospital, explaining in detail the methods, steps and precautions of sealing, flushing and dressing change, guiding patients to a nearby conditional hospital for maintenance, making a maintenance plan for patients who go back to the hospital for maintenance, guiding patients to arrange according to the plan, and having a special person responsible for reception when they return to the hospital in time.
5 abstract
After the above-mentioned reasons analysis and nursing countermeasures, 56 patients accepted and successfully placed tubes, and there were no complications in the use and maintenance process after placing tubes, and 2 patients gave up placing tubes due to lack of expenses. Through the above research, it is found that active and effective nursing intervention can eliminate patients' concerns and make them accept and successfully place PICC tubes. After all, PICC catheterization is the safest and most effective infusion method for chemotherapy patients, and it is also an important measure in the process of chemotherapy treatment. At the same time, it is found that the risks and complications of central venous catheterization can be controlled and prevented as long as medical staff pay attention to every link of catheterization.
refer to
[1] Yilong, Du. Study on the effect of psychological intervention in external jugular vein catheterization [J]. Journal of Qiqihar Medical College, 2009,30 (12):1430-1431.