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临床用药研究2026年第2卷第2期第26-29页,pISSN 3105-6741、eISSN 3105-675X 发布者:Quest Press 发布日期:2026/9/3
Open Access 浏览41

 

肾衰竭透析患者中心静脉导管非计划拔管的原因分析 及干预对策


张霞,宗政,蔡康琴

自贡市第一人民医院,四川自贡, 643000

摘要:目的:分析终末期肾病维持性血液透析患者留置中心静脉导管后发生非计划拔管(UEX)的各类 危险因素,结合临床实际制定分层落地干预方案,为降低导管脱出风险、保障透析连续开展提供循证依 据 [4]。方法:收集 2021 年 1 月 —2024 年 12 月我院肾内科留置中心静脉透析导管患者临床资料,选 取 32 例发生非计划拔管患者为拔管组,同期 64 例未发生导管脱出患者为对照组;采用 Barthel 指数 评估自理能力,回顾性根因分析法(RCA)梳理拔管诱因,结合 χ2 检验、二元 Logistic 回归筛选独 立危险因素 [6]。结果:2021—2024 年留置导管共 892 例,UEX 发生率 3.59%,四年发生率逐年下降, 依次为 4.52%、3.91%、3.15%、2.87%。单因素分析显示意识障碍、Barthel 指数≤60 分、导管固定不 规范、未有效约束、宣教不足、床护比>1:4 均为相关危险因素(P<0.05);多因素 Logistic 回归证 实意识障碍(OR=6.28,95% CI:2.41~16.37)、Barthel 指数≤60 分(OR=5.12,95% CI:1.95~13.44)、 导管固定不规范(OR=4.75,95% CI:1.72~13.11)、宣教不到位(OR=4.36,95% CI:1.58~12.03)为独 立高危因素(P<0.05)。根因分类显示患者因素占 62.5%,医护管理因素 28.13%,耗材环境因素 9.37%。 结论:透析导管非计划拔管由多重因素叠加所致,意识异常、自理能力差、固定操作不标准、宣教流于 形式是核心风险点;通过分层评估、标准化三重固定、闭环宣教、人力优化、耗材与环境精细化管理可 显著降低拔管发生率,提升透析专科护理质量 [7]。

关健词:肾衰竭;血液透析;中心静脉导管;非计划拔管;根因分析;护理干预
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


参考文献
[1] Kicka P,Ancu D,Panait E,et al. Central venous catheter embolism critically in adults: clinical review [J]. Nutr Clin Pract,2018,33: 125-130.
[2] 赵娜,田金英.高通量透析对尿毒症患者中分子毒素清 除效果及生活质量的影响 [J]. 山东医药,2022,62 (18):77-179.
[3] Moon P,Soh K,De Beuck W,et al. Development of a risk assessment tool for dialysis self-exhaustion in intensive care patients [J]. Intensive Care Med,2012, 38 (7): 1446-1455.
[4] 中国医院协会血液净化中心管理分会血液透析通路 学组。中国血液透析用血管通路专家共识(第 2 版) [J]. 中国血液净化,2019,18 (6):365-383.
[5] 李丽,陈静.血液透析中心静脉导管非计划拔管危险因 素及护理对策研究 [J]. 护士进修杂志,2020,35 (11):1006-1009.
[6] 刘芳,马迎春.根因分析法在透析导管滑脱不良事件管 理中的应用 [J]. 护理管理杂志,2021,21 (5): 364-367.
[7] 王莉.分层护理干预对降低透析患者中心静脉导管非 计划拔管发生率的效果观察 [J]. 当代护士,2023, 30 (4):112-114.
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