神經外科加護病房病人發生周邊靜脈炎之相關因素

Abstract

背景：周邊靜脈導管是住院病人最常見給予治療的方式，但常見周邊靜脈炎等合併症，國內外相關研究甚多卻少有加護病房相關的研究。 目的：本研究旨在探討神經外科加護病房病人周邊靜脈炎之發生率，以及瞭解病人、素材及人員等三因素與周邊靜脈炎發生的相關性。 方法：採前瞻性觀察性研究，在2014年2月至5月於北部某醫學中心神經外科護病房住院病人以方便取樣方式選取個案，使用個案資料記錄表收集基本屬性、素材因素及人員因素等資料，以及使用美國靜脈輸液護理學會(Infusion Nursing Society, INS)周邊靜脈炎量表及Jackson視覺輸液周邊靜脈炎得分表(Jackson Infusion Phlebitis Score)每日觀察直到留置針移除滿48小時為止，觀察個案注射部位是否發生周邊靜脈炎，研究資料以SPSS 20.0進行統計分析。 結果：共收98位個案、196個注射部位，研究結果顯示(1)神經外科加護病人施打靜脈導管其周邊靜脈炎發生率為13.3%，(2)當疾病診斷有顱內出血(RR=6.67, p<0.05)、注射肢體水腫(RR=2.78, p<0.05)、施打部位在下肢(RR=2.94, p<0.05)或肘前(RR=2.63, p<0.05)、躁動(RR=4.20, p<0.05)、約束(RR=2.78, p<0.05)、給藥種類1~3種/天(RR=1.19, p<0.05)或給藥種類≥4種/天(RR=1.21, p<0.05）、給予鎮靜藥物(RR=3.33, p<0.05)、給予升/降壓藥物(RR=2.27, p<0.05)、給藥頻率1~3次/天（RR=1.29, p<0.05）或給藥頻率≥4次/天（RR=1.09, p<0.05），以及施打地點在急診室及病房者(RR=2.38, p<0.05)發生周邊靜脈炎的風險較高，(3)當疾病診斷有ICH、施打在下肢或肘前、躁動、約束、給藥種類≥4種/天、給予鎮靜藥物、給藥頻率1~3次/天及在急診室或病房施打者，發生周邊靜脈炎的勝算是沒有者的1.19倍(OR=1.19, 95%CI=0.13~0.21, χ2=494.20, p<0.01)。 結論：整體周邊靜脈炎發生率高於INS建議，周邊靜脈炎發生率與病人、素材及人員三因素有關。使用INS周邊靜脈炎量表評估有無發生周邊靜脈炎為嚴謹與適切的評估工具。研究結果可使臨床醫療人員瞭解神經外科加護病房病人放置靜脈留置針發生周邊靜脈炎的相關因素，提供照護上的參考， 藉適時評估及處置以促進病人舒適度、降低醫療成本，進而增加照護品質。

Background: Peripheral intravenous catheter is the fastest and most common ways of administering treatments to inpatients. However, this still poses the risk of complications such as phlebitis. Although factors of phlebitis have been widely investigated, uncertainties still remain on different researches, rarely appear in intensive care unit patients. Objective: The purpose of this study was to investigate the incidence rate and related factors of phlebitis in patients in neurosurgery intensive care unit (NICU). Methods: This study used a prospective observation research design and convenience sampling. Subjects were recruited from NICU of a medical center in Taipei from February to May 2014. Structured questionnaire which including personal-related, material-related and human-related factors, combined with Infusion Nursing Society (INS) phlebitis scale and Jackson Visual Infusion Phlebitis (VIP) Score were used for data collection. Catheter insertion sites were monitored every 24hours during catheter insertion and 48hours after removal of the catheter. Data were analyzed by SPSS version 20.0. Results: A total of 98 patients and 196 insertion sites were evaluated. The findings were as follows: (1)Incidence of phlebitis was 13.3% for NICU patients; (2)Diagnosis with Intracranial Hemorrhage(ICH) (Relative risk[RR]=6.67, p<0.05), insertion site with edema (RR=2.27, p<0.05), insertion site at lower limb(RR=2.94, p<0.05) or antecubital fossa (RR=2.63, p<0.05), agitation (RR=4.20, p<0.05), physical restraint (RR=2.78, p<0.05), medicine administered 1~3types/day(RR=1.19, p<0.05) or ≥4 types/day (RR=1.21, p<0.05), using sedatives (RR=3.33, p<0.05), inotropic or hypotensive agents (RR=2.27, p<0.05), medicine administered 1~3times/day (RR=1.29, p<0.05) or ≥4times/day (RR=1.09, p<0.05), catheter inserted at Emergency Room(ER) or ward (RR=2.38, p<0.05) had significant higher risk with phlebitis; (3)On the whole, the odd ratio of patients that were diagnosed with ICH, had catheter inserted at lower limbs or the antecubital fossa, were agitated, were physical restrained, were administered four or more types of medicine per day, were using sedatives, were administrated medicine 1~3times/day, and had catheter inserted at the ER or ward was 1.19 times than that of other patients (OR=1.19, 95%CI=0.13~0.21, χ2=494.20, p<0.01). Conclusions: Phlebitis rate of this study is higher than the recommended 5%. The results of this study reveal that personal-related, material-related and human-related factors are correlated with phlebitis incidence. In addition, the INS phlebitis scale is a rigorous, valid and reliable tool for the assessment of phlebitis. The results of this study provide reference for healthcare and shed light on the factors that contribute to phlebitis in NICU patients. With timely assessments and measures, medical personnel can increase the comfort of patients, reduce medical costs, and increase healthcare quality.