不同的經皮中央靜脈導管照護方式對於導管感染率的影響

The effect of different methods of catheter care on percutaneous central venous catheters and catheter-related blood stream infection

經皮中央靜脈導管廣泛使用於新生兒，可提供輸液、靜脈營養，及藥物治 療；和周邊靜脈導管比較，它可用於施打較高濃度的輸液，因經皮中央靜脈導管 有長達一個月的置放時間，而周邊靜脈導管需每三天更換一次注射部位，故還可 減少病人打針次數，然而，經皮中央靜脈導管常見的併發症有感染、滲漏、靜脈 炎以及阻塞等問題，且導管感染會導致病人敗血症以及延長住院天數。此研究自 2019 年 3 月至 2019 年 10 月，比較介入措施前後經皮中央靜脈導管所引起的併 發症的差異，介入措施如下：施打前增加清潔皮膚步驟，水溶性優碘確實停留 2 分鐘，施打後固定每七天的消毒工作以最大無菌面防護方式進行。其結果顯示， 介入措施後的血流感染密度有顯著下降 ，從 2.7‰ 下降至 0‰ ，此研究的介入措 施可降低導管引起的血流感染率，進而減少住院天數及醫療支出，以及提升新生 兒加護病房中的照護品質。（感控雜誌 2020:30:228-238）

Fluid supplement, total parenteral nutrition, and medication necessitate an intravenous access for an extended period of time. Compared to peripheral intravenous accesses, PCVCs are better tolerated for hypertonic fluids and stimulating medications. In addition, the patients experience less puncture frequency than with peripheral intravenous accesses with an indwelling time of 3 days only. The complications of PCVC include catheter-related bloodstream infection (CRBSI), broken catheter, phlebitis, and occlusion. CRBSI may lead to sepsis and prolonged hospitalization. This study was conducted from March to October 2019. The incidence of the complications of PCVCs before and after the intervention was compared. The intervention was to clean the skin, followed by applying povidone iodine on the skin for at least 2 minutes, and to use maximum sterile barrier precautions during weekly dressings on the PCVC injection site. It was found that the incidence of CRBSI significantly decreased after the intervention during dressing change at the PCVC injection site, from 2.7/1,000 catheter-day to 0/1,000 catheter-day, which shortened the hospitalization days, reduced healthcare cost, and improved the quality of neonatal care in the NICU.