中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (04): 310-315.doi: 10.3969/j.issn.1671-4091.2023.04.014

• 护理研究 • 上一篇    下一篇

血液透析安装预冲护理操作全国现状调查

王 颖  梁俊卿   苏 默   高菊林  苟晶绮   耿同会   耿 野  侯鲜桃   罗 莉   刘 瑶   刘永玲  毛嘉艳   申 鹏    武素珍    杨 京    杨家慧    杨文君    岳晓红   杨振华   周 琳  朱亚梅   朱月萍   甘良英    左 力
  

  1. 100044 北京，1北京大学人民医院肾内科
    100029 北京，2 北京中日友好医院肾病科血液净化中心
    710061 西安，3西安交通大学第一附属医院重症肾脏病•血液净化科
    810000 西宁，4青海省人民医院血液净化中心
    050011 石家庄，5河北医科大学第四医院肾内科
    110001 沈阳，6中国医科大学第一附属医院血液净化中心
    014010 包头，7内蒙古科技大学包头医学院第一附属医院血液透析室
    102206 北京，8北京大学国际医院透析中心
    100034 北京，9北京大学第一医院肾内科血液净化中心
    610072 成都，10四川省人民医院肾内科 
    030012 太原，11山西省人民医院血液净化中心
    010050 呼和浩特，12内蒙古医科大学附属医院肾内科血液透析室
    300211 天津，13天津医科大学第二医院肾内科血液净化科
    210029 南京，14南京医科大学第一附属医院血液净化中心
    830000 乌鲁木齐，15新疆医科大学第一附属医院血液透析中心
    450052 郑州，16郑州大学第一附属医院血液净化中心
    200024 上海，17上海交通大学医学院附属瑞金医院肾脏科
    410001 长沙，18中南大学湘雅二医院血液净化中心
    750004 银川，19宁夏医科大学总医院肾内科血液透析室
  • 收稿日期:2022-11-23 修回日期:2023-01-12 出版日期:2023-04-12 发布日期:2023-04-12
  • 通讯作者: 左力 E-mail:zuoli@bjmu.edu.cn

Investigation on the nursing operation of hemodialysis installation and pre-flush in China

WANG Ying, LIANG Jun-qing, SU Mo, GAO Ju-lin, GOU Jing-qi, GENG Tong-hui, GENG Ye, HOU Xian-tao, LUO Li, LIU Yao, LIU Yong-ling, MAO Jia-yan, SHEN Peng, WU Su-zhen, YANG Jing, YANG Jia-hui, YANG Wun-jun, YUE Xiao-hong, YANG Zhen-hua, ZHOU Lin, ZHU Ya-mei, ZHU Yue-ping, GAN Liang-ying, ZUO Li   

  1. Department of Nephrology, Peking University People’s Hospital, Beijing 100044, China; 2Blood Purification Center, Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China; 3Department of Severe Renal Diseases and Blood Purification, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; 4Blood Purification Center, Qinghai Provincial People's Hospital, Xi'ning 810000, China; 5Department of Nephrology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; 6Blood Purification Center, The First Affiliated Hospital of China Medical University, Shenyang 110001, China; 7Hemodialysis Room, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, China; 8Dialysis Center, Peking University International Hospital, Beijing 102206, China; 9Blood Purification Center, Department of Nephrology, Peking University First Hospital, Beijing 100034, China; 10Department of Nephrology, Sichuan Provincial People's Hospital, Chengdu 610072, China; 11Blood Purification Center, Shanxi Provincial People's Hospital, Taiyuan 030012, China; 12Department of Nephrology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China; 13Department of Blood purification, Department of Nephrology, the Second Hospital of Tianjin Medical University, Tianjin 300211, China; 14Blood Purification Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; 15Hemodialysis Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China; 16Blood Purification Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; 17Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200024, China; 18Blood Purification Center, the Second Xiangya Hospital of Central South University, Changsha 410001, China; 19Department of Nephrology, Ningxia Medical University General Hospital, Yinchuan 750004, China
  • Received:2022-11-23 Revised:2023-01-12 Online:2023-04-12 Published:2023-04-12
  • Contact: 100044 北京，1北京大学人民医院肾内科 E-mail:zuoli@bjmu.edu.cn

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摘要： 目的 调查血液透析安装预冲护理操作的现状，为日后临床护理操作的质量管理和专科培训提供抓手。 方法 本研究为面向全国的横断面调查。安装预冲过程以操作视频形式提交，制定该操作的评分表，由2位专家依据评分表评审操作并记录扣分原因，评分表主要包含手卫生时机及方法、评估与操作前、中、后安全核查，安装与连接，体外循环预冲原则4个维度。计算各条目及各维度得分率，是否为三甲医院、是否为教学基地的组间得分比较采用独立样本t检验；多分类变量如职称的比较采用单因素方差分析，以P＜0.05为差异有统计学意义。 结果 ①共收到操作视频270例，有效视频229例。其中华北地区66(28.8%)例，东北地区3(1.3%)例，华东地区23(10.0%)例，华南地区5(2.2%)例，华中地区71(31.0%)例，西南地区26(11.4%)例，西北地区35(15.3%)例。主管护师及以上89(38.8%)例，护师111(48.5%)例，护士29(12.7%)例；来自国家级血液净化护理培训基地42(18.3%)例，非基地187(81.7%)例；来自三甲医院113(49.3%)例，非三甲医院116(50.7%)例。②4个重点维度得分率：手卫生时机及方法76.62%，评估与操作前、中、后安全核查78.69%，安装与连接88.42%，体外循环预冲原则87.75%。③来自三甲医院者评分表总分高于非三甲医院者(t=3.918，P＜0.001)，来自教学基地者评分表总分高于非基地者(t=5.540，P＜0.001)，不同职称评分表总分比较差异无统计学意义(F=0.853，P=0.428)。 结论 本研究制定的“血液透析安装预冲评分标准”可助力各级单位规范化安装预冲护理操作。三甲医院及血液净化培训基地护士的安装预冲护理操作体现出较高的水平。总体操作显露出基本卫生行业规范/标准的应用实践不足，主要表现在手卫生时机及方法、评估与操作前、中、后安全核查的环节质量中，建议各级单位应加强对以上环节的培训和实践。

关键词: 血液透析, 安装预冲, 手卫生, 核查

Abstract: Objective  To investigate the status quo of hemodialysis installation and pre-flush operation, useful for the forthcoming quality management of clinical nursing operation and specialist training.  Methods This was a nationwide cross-sectional survey. The installation and pre-flush operations were surveyed in the form of video records. Two professionals reviewed the video records according to a scoring scale that was developed by literature review and expert consultation. The scoring tool included four dimensions: time and method of hand hygiene; evaluation and safety check before, during and after operation; installation and connection; and principles of pre-flushing. The scores of each item and each dimension were calculated. Independent sample t test was used to compare the scores among the groups. Professional title of the operators were analyzed by one-way ANOVA. P＜0.05 was considered statistically significant.  Results  ①A total of 270 operation video records were received in this survey, and 229 were valid. There were 66 (28.8%) cases in North China, 3 (1.3%) cases in Northeast China, 23 (10.0%) cases in East China, 5 (2.2%) cases in South China, 71 (31.0%) cases in Central China, 26 (11.4%) cases in Southwest China, and 35 (15.3%) cases in Northwest China. 89 (38.8%) operators were the titles of nurses in charge or above, 111 (48.5%) were nurses, and 29 (12.7%) were primary nurses. In the 229 nurses, 42 (18.3%) were from national blood purification nursing training bases, 113 (49.3%) were from the tertiary hospitals. ②The scoring rates of the four dimensions were: time and method of hand hygiene (76.62%), evaluation and safety check before, during and after operation (78.69%), installation and connection (88.42%), and pre-flush principles (87.75%). ③The total score was higher in the nurses from the tertiary hospitals than in those from non-tertiary hospitals (t=3.918,P＜0.001), and the score was higher in the nurses from teaching bases than in those from non-teaching bases (t=5.540,P＜0.001). There was no significant difference in the total score among different professional titles (F=0.853,P=0.428).  Conclusion  The scoring scale for hemodialysis installation and pre-flushing in this study can help standardize the nursing operation of installation and pre-flushing. Nurses from tertiary hospitals and training bases showed a higher level of the operation. This survey revealed that the application of basic norms/standards for health service professionals was insufficient, mainly in the time and method of hand hygiene, and quality evaluation and safety check before, during and after operation. We recommend that hemodialysis centers should reinforce the operation training for nurses.

Key words: Hemodialysis, Installation and pre-flush, Hand hygiene, Quality improvement

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