Port-A導管敷料更換頻率對注射部位及血流感染之影響

Changing of Implanted Intravascular Device Dressing In Oncology Patients with CVC site infection and bloodstream infections

腫瘤科病人因週期性施打化學藥物治療，使用植入式血管內裝置（Port-A）是臨床常見的處置之ㄧ。2011年美國疾病管制中心的血管內導管相關感染之預防指引中，建議Port-A無菌透明敷料照護，應每7天更換；因此，某醫學中心血液腫瘤科於2012年4月將Port-A無菌透明敷料由3天延長為7天更換。本研究目的為比較敷料更換頻率改變前（2010年9月至2012年3月）與改變後（2012年4月至8月）之Port-A注射部位感染徵象及血流感染差異，採回溯性追蹤觀察研究法，以2010年9月至2012年8月腫瘤科所有住院移除Port-A病人為對象進行分析。研究結果：2010年9月至2012年8月住院移除Port-A者共71人次。接受每3天敷料更換病人共35人次，每7天敷料更換者共36人次；注射部位出現感染徵狀者分別為9人及6人；發生血流感染人次分別為13人及12人。每7天更換無菌透明敷料出現注射部位感染徵狀的風險是每3天的0.56倍（95%信賴區間0.163～1.928；p=0.358），每7天更換敷料發生血流感染的風險是每3天的0.13倍（勝算比0.132；95%信賴區間0.023～0.756；p=0.044）；另外女性發生血流感染風險是男性的0.14倍，並達統計學上顯著差異（95%信賴區間0.025～0.783；p=0.025）。結論：每7天更換Port-A注射部位無菌透明敷料不會增加注射部位感染及血流感染。Port-A為腫瘤科病人常用之導管，留置期間可能引發導管相關感染，因此，管路留置期間的照護及每日觀察注射部位感染徵象是非常重要。

The use of implantable intravascular devices (Port-A) is a common clinical disposition subsequently, due to chemotherapy in Oncology patients. intravascular catheter-related infection prevention guidelines in 2011 U.S. Centers for Disease Control, the Port-A sterile transparent dressing should be changed every 7 days. To compare the Port-A sterile transparent dressing change interval on the CVC site infection and bloodstream infections, the Port-A sterile transparent dressing change interval was prolonged from 3 days to 7 days in a medical center. Results: People who removed Port-A hospitalized were totally 71 persons during September 2010 to August 2012. 35 patients accepted the replacement of Port-A sterile transparent dressing every 3 days, 36 did the medical treat every 7 days. The patients who appeared infection symptoms on injection site were 9 and 6 persons respectively, who occurred bloodstream infection were 13 and 12 persons respectively.the risk of the cvc site infections in every 7 days changed the Port-A sterile transparent dressing is more than 0.56 times in every 3 days (95% CI 0.163-1.928; p = 0.358) and reduce of bloodstream infections (OR = 0.132；95% CI 0.023-0.756; p = 0.044). occurrence of bloodstream infections in women is more than 0.14 times that man and the difference was statistically significant (95% CI 0.025-0.783; p = 0.025). Conclusion:every 7 days changed the Port-A sterile transparent dressing does not increase the cvc site infections and bloodstream infection.