罗文英 孙岚 龙小翠 田芸芸 胡娇

[摘要] 目的 通過根因分析法查找早产儿PICC置管过程中存在的问题，找出解决问题的方法，提高置管的成功率，降低置管并发症的发生率。 方法 方便选取云南省红河州第一人民医院从2014年11月—2017年12月收治的60例早产儿PICC置管中，运用根因分析法对新生儿每一次PICC置管过程中遇到的难题和置管后出现的并发症进行回顾性分析，找出存在的问题，提出改进措施。结果 对每一次置管存在问题均进行分析和总结，并加以改进，置管的成功率提高了，存在的问题和置管后发生并发症的问题明显减少，问题发生率由80.00%下降至12.89%，并发症发生率由80.00%下降至0.00%。同时，静脉营养通道的顺利建立，提高了患儿治疗效果，缩短了住院时间，医生和家长对护理的满意度提高了。结论 根因分析法找出了导致PICC置管存在问题的原因，即：穿刺技术的熟练程度，护士对PICC的维护技能， PICC技术维护及培训不到位，护士对PICC这种新技术的认识及心理接受程度，以及医生对此项技术的支持与配合均有很大关系。找出这些影响因素对持续改进提供了依据和帮助，收到了很好的效果，明显的提高了置管的成功率，降低了置管并发症的发生率。

[关键词] 根因分析法；早产儿；PICC置管

[中图分类号] R473.72 [文献标识码] A [文章编号] 1674-0742（2018）08（b）-0117-03

Application of Root Cause Analysis in PICC Catheterization of Premature Infants

LUO Wen-ying， SUN Lan， LONG Xiao-cui， TIAN Yun-yun， HU Jiao

Department of Pediatrics， First People's Hospital of Honghe Prefecture， Mengzi， Yunnan Province， 661199 China

[Abstract] Objective To find out the problems existing in the PICC catheterization of preterm infants by root-cause analysis， find out the methods to solve the problems， increase the success rate of catheterization， and reduce the incidence of catheter complications. Methods A total of 60 cases of premature infant PICC catheterization from November 2014 to December 2017 were convenient selected from the First People's Hospital of Honghe Prefecture， Yunnan Province. The root cause analysis method was used to solve the problems and problems encountered in each PICC catheterization process. A retrospective analysis of the complications that occurred after the tube was performed to identify existing problems and propose improvements. Results Analyzed and summarized the problems of each tube insertion， and improved them. The success rate of tube insertion was improved， and the problems and complications after tube insertion were significantly reduced. The incidence of problems decreased from 80.00% to 12.89%， the incidence of complications dropped from 80.00% to 0.00%. At the same time， the successful establishment of the intravenous nutrition channel has improved the therapeutic effect of children and shortened the hospitalization time. Doctors and parents have increased their satisfaction with nursing care. Conclusion The root cause analysis method has identified the causes of problems in the PICC catheterization， namely： the proficiency of the puncture technique， the maintenance skills of the nurses for the PICC， the technical maintenance and training of the PICC， and the nurses' understanding of the new PICC technology. The degree of psychological acceptance and the doctor's support and cooperation in this technology are all very important. Finding out these influencing factors has provided basis and help for continuous improvement， and it has received very good results， apparently improving the success rate of catheterization， and reducing the incidence of catheter complications.

[Key words] Root cause analysis； Preterm infants； PICC catheter

根因分析（root cause analysis，RCA）作为一种质量管理模式，其核心是一种基于团队的、系统的、回顾性的不良事件分析法，找出系统和流程中的风险和缺点并加以改善，通过与同行从错误中反思，学习及分享经验，可以做到改善流程，事先防范，从多角度、多层次提出针对性预防性措施[1]。……