尤雅华 冯永娟

【摘要】 目的：觀察失效模式和效果分析（failure mode and effect analysis，FMEA）护理管理模式下新生儿经腋静脉、肘静脉进行外周穿刺中心静脉导管（peripherally inserted central catheters，PICC）的应用效果。方法：以笔者所在医院新生儿科2017年1-12月收治的经腋静脉、肘静脉PICC置管的35例新生儿作为对照组，以2018年1月-2019年3月收治的经腋静脉、肘静脉PICC置管的31例新生儿作为观察组。对照组患儿给予常规风险管理护理模式，观察组患儿给予FMEA护理管理模式。比较两组患儿失效模式优先风险数值及PICC一次置管成功率、导管相关感染发生率与家属护理满意度。结果：无菌操作不规范、操作规程欠缺、置管技术不熟练、导管维护技术不规范等4项失效模式PRN值由对照组的336、240、392、378分别降低至观察组的96、75、100和36。观察组患儿一次置管成功率显著高于对照组，而PICC相关感染发生率显著低于对照组，差异均有统计学意义（P<0.05）。观察组家属护理满意度为（91.25±4.72）分，高于对照组的（78.67±7.12）分，差异有统计学意义（P<0.05）。结论：FMEA护理管理模式能够针对新生儿经腋静脉、肘静脉PICC置管的风险因素进行分析和改进，显著降低PICC相关感染发生率，提高输液安全。

【关键词】 失效模式和效果分析 腋静脉 肘静脉 外周穿刺中心静脉导管

doi：10.14033/j.cnki.cfmr.2019.29.056 文献标识码 B 文章编号 1674-6805（2019）29-0-03

[Abstract] Objective： To compare the application effect of peripherally inserted central catheters （PICC） in axillary vein and elbow vein of newborn under failure mode and effect analysis （FMEA） nursing management mode. Method： A total of 35 neonates with axillary vein and elbow vein PICC catheterization admitted in the neonatology department of the our hospital from January to December 2017 were selected as the control group， and 31 neonates with axillary vein and elbow vein PICC catheterization admitted from January 2018 to March 2019 were selected as the observation group. The control group was given routine risk management nursing mode， while the observation group was given FMEA nursing management mode. The priority risk ??value of failure mode， success rate of PICC catheterization， incidence of catheter-related infection and family nursing satisfaction were compared between the two groups. Result： The PRN values ??of four failure modes， such as non-standard aseptic operation， lack of operation procedures， unskilled catheterization techniques， and non-standard catheter maintenance techniques， were reduced from 336， 240， 392， and 378 in the control group to 96， 75 ，100 and 36 in the observation group， respectively. The success rate of one-time catheterization in the observation group was significantly higher than that in the control group， and the incidence of PICC-related infection was significantly lower than that in the control group， the differences were statistically significant （P<0.05）. The nursing satisfaction of the family in the observation group was （91.25±4.72） points， which was higher than （78.67±7.12） points in the control group， and the difference was statistically significant （P<0.05）. Conclusion： The FMEA nursing management mode can analyze and improve the risk factors of PICC catheterization in axillary vein and elbow vein in neonates， significantly reduce the incidence of PICC-related infection and improve the safety of infusion.

[Key words] Failure mode and effect analysis Axillary vein Elbow vein Peripherally inserted central catheters

First-authors address： Mindong Hospital Affiliated to Fujian Medical University， Fuan 355000， China

外周穿刺中心靜脉导管（peripherally inserted central catheters，PICC）在新生儿救治中发挥着重要作用，能够减轻反复穿刺造成的疼痛，减轻药物引起的组织水肿、瘢痕、坏死和挛缩[1]。但PICC也存在一定缺点，其中最为常见的就是导管相关性感染、PICC置管失败、移位，而这些问题在早期均可预防或者避免[2-3]。失效模式和效果分析（failure mode and effect analysis，FMEA）属于前瞻性的风险管理分析模式，最早应用于航空工业中的阿波罗任务，近年来在临床医学检验、静脉输注、气管插管等医疗活动中被广泛应用[4-6]。笔者所在医院新生儿科于2018年1月在新生儿经腋静脉、肘静脉PICC置管中护理中引入FMEA，取得了良好效果，现报告如下。……