目的:探讨以专科护士为导向的经外周置人中心静脉导管(peripherally inserted central catheter,PICC)维护适宜技术"三段式"推广的可行性及效果.方法:以静脉输液专科护士为主要师资,对无锡市医联体街道卫生服务中心的护理人员采取专科理论培训、实践演练和实地指导的"三段式"模式推广PICC维护技术,观察街道卫生服务中心的护理人员在接受培训前后的理论和操作水平有无差异,比较"三段式"模式推广前后街道卫生服务中心PICC并发症的发生情况与患者满意度.结果:通过"三段式"推广,无锡市医联体街道卫生服务中心的护理人员,理论知识和维护技能有明显的提高(P＜0.01); PICC维护患者的并发症和不良事件的发生率从23.08％下降为6.25％;患者对街道卫生服务中心PICC维护的满意度较前提高(P＜0.01).结论:以专科护士为导向的PICC维护适宜技术"三段式"的推广,能提高医联体街道卫生服务中心护理人员PICC维护的技能水平,降低带管患者导管并发症的发生率,提高患者满意度,有益于基层医院卫生事业的发展.%Objective: To explore the feasibility and effect of the "three-stage" promotion for peripherally inserted central catheter (PICC) maintenance guided by clinical nurse specialist in the street health service center of Wuxi medical partnerships. Methods: For the nursing staff of the street health service center of Wuxi medical partnerships, with intravenous infusion nurses as the main teachers, they should be taken the "three-stage" model of specialized theory training, practical drills and a field guide to promote the PICC maintenance technology. Then the nursing staff of the street health service center should be observed if their theory and operation level have differences before and after the training. Meanwhile, the occurrence condition of PICC complications and patient satisfaction should be compared before and after the promotion of the "three-stage" model in the street health service center. Results: Through the promotion of "three-stage" model, the nursing staff of the street health service center in Wuxi medical partners; the theoretical knowledge and maintenance skills have been significantly improved(P＜0.01). The occurrence condition of complications and adverse events in PICC was decreased from 23.08％ to 6.25％. Patients were more satisfied with PICC maintenance of Street Health Service (P＜0.01). Conclusion: The promotion of the "three-stage" for PICC maintenance guided by clinical nurse specialist can improve the skill level of PICC maintenance of nursing staff in the street health service center, reduce the incidence of catheter complications, improve patient satisfaction, which is finally conducive to the development of primary medical career.
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