運用多元策略降低周邊置入中心靜脈導管相關併發症之發生率

Multiple Strategies to Reduce the Incidence of Peripherally Inserted Central Catheter-Related Complications

周邊置入中心靜脈導管（peripherally inserted central catheter, PICC）雖然感染率低且使用效期長，但若是缺乏良好照護，極容易產生導管併發症。本單位2017年至2020年，PICC導管併發症發生率為57. 9%，包括阻塞、移位與感染。原因分析發現護理師在PICC教育訓練與照護認知不足，缺乏導管實務訓練，單位無PICC品管稽核政策，未說明固定器裝置時機與操作方法，未提供足量的固定器更換設備，缺乏PICC導管操作標準流程。策略：舉辦教育訓練、拍攝導管沖洗教學影片、設計海報結合記憶口訣「沖、乾（肝）、不、拔」、自創導管固定貼與擬真手臂、製作簡易照護流程圖、評核表與品管稽核機制。結果：PICC導管併發症之發生率，由57.9%下降至8.3%，達專案設定目標11.6%，導管照護正確率與認知完整度亦明顯提升。

Although peripherally inserted central catheters (PICCs) have a low infection rate and can be left in place for a long time, inadequate care can lead to significant complications. From 2017 to 2020, the incidence of PICC complications in our unit was 57.9%, including obstruction, displacement and infection. Through cause analysis, it was identified that nurses had insufficient knowledge and awareness in PICC education and care, lacked practical training in catheter insertion, lacked a PICC quality control and auditing policy, there were no clear guidelines on the timing and methods of securing the catheter, insufficient supply of securement device replacement was provided, and there was a lack of standardized procedures for PICC catheter operation. To address these issues, improvement strategies were implemented, including organizing educational training sessions, creating instructional videos on catheter flushing, designing posters with mnemonic devices (“Flush, Dry (the liver), No, Pull􀞵), developing catheter dressing and simulating arm, creating simplified care flowcharts, checklist, and implementing quality control and auditing mechanisms. As a result, the incidence of PICC complications decreased from 57.9% to 8.3%, achieving the project’s goal. The accuracy of catheter care and overall knowledge also significantly improved.