Analysis of Causes and Intervention Countermeasures for Unplanned Extubation of Central Venous Catheters in Patients with Renal Failure Undergoing Dialysis
Xia Zhang,Zheng Zong,Kangqin Cai
Zigong First People’s Hospital,Zigong Sichuan 643000,China
Abstract:Objective:To analyze risk factors of unplanned extubation(UEX)of central venous catheters in maintenance hemodialysis patients with renal failure,and to develop targeted intervention strategies combined with clinical practice,so as to provide evidence-based support for reducing catheter shedding risk and guarantee continuous dialysis treatment [4] . Methods:Clinical data of hemodialysis patients with indwelling central venous catheters admitted to the nephrology department of our hospital from January 2021 to December 2024 were collected. 32 patients with UEX were set as extubation group,and 64 patients without catheter shedding in the same period were selected as control group. Barthel Index Scale was used to assess activities of daily living,retrospective Root Cause Analysis(RCA)was adopted to sort outinducements of UEX,and chi-square test and binary Logistic regression were applied to screen independent risk factors[6]. Results:A total of 892 patients received indwelling central venous catheters from 2021 to 2024,with an overall UEX incidence of 3.59%. The annual incidence decreased year by year:4.52%,3.91%,3.15%,2.87%. Univariate analysis showed consciousness disturbance,Barthel Index ≤60 points,non-standard catheter fixation,ineffective protective restraint,inadequate health education,nurse-patient ratio>1:4 were relevant risk factors(P<0.05). Multivariate Logistic regression indicated consciousness disturbance(OR=6.28,95%CI: 2.41~16.37),Barthel Index ≤60 points (OR=5.12,95%CI:1.95~13.44),non-standard catheter fixation(OR=4.75,95%CI:1.72~13.11)and inadequate health education(OR=4.36,95%CI:1.58~12.03)were independent risk factors (P<0.05).Root cause classification showed patient-related factors accounted for 62.5%,medical management factors 28.13%,material and environmental factors 9.37%. Conclusion :Unplanned extubation of dialysis catheters is caused by multiple overlapping factors. Abnormal consciousness,poor self-care ability,irregular fixation and superficial health education are core risks. Hierarchical assessment,standardized triple fixation,closed-loop health education,optimized staffing and refined management of supplies and ward environment can effectively reduce UEX incidence and improve specialized nursing quality of blood purification[7].
Keywords : renal failure;hemodialysis;central venous catheter;unplanned extubation;root cause analysis;nursing intervention
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