目的 探讨中心静脉通路装置（central venous access device，CAVD）相关性皮肤损伤(CAVD-associated skin impairment,CASI)预防方案在门诊经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）患者中的应用效果。方法 便利抽样法选取苏州市、无锡市8所三级综合医院门诊行PICC维护的1043例患者为研究对象并采用整群随机对照试验。其中4所医院为对照组，给予PICC常规护理；4所医院为试验组，在常规护理基础上予以CASI预防方案。干预6个月后，比较两组患者CASI发生率、医用粘胶相关性皮肤损伤(medical adhesive-related skin injury，MARSI)及医疗器械相关压力性损伤(medical device related pressure ulcers，MDRPU)发生率和严重程度、血管导管相关感染率和非计划拔管率的差异。结果 试验组CASI、MARSI及MDRPU发生率均低于对照组（均P＜0.05），两组MARSI、MDRPU严重程度及非计划拔管率无统计学差异（均P＞0.05）。两组均未发生血管导管相关感染。结论 实施CASI预防方案有利于降低PICC门诊患者CASI的发生率，为临床护士预防CASI提供实践指导。

Objective To explore the effect of application of a prevention programme on central venous access device-associated skin impairment among PICC Outpatients.Methods From September 2020 to March 2021,a total of 1043 patients who underwent PICC maintenance in the PICC clinics of eight tertiary hospitals in Suzhou and Wuxi were selected as the objects of a cluster randomized controlled trial.Four hospitals were used as the control group,and patients recruited in the control group were given PICC routine care;four hospitals as the intervention group,given CASI prevention programme based on routine care.After six months of intervention,the incidence of central venous access device-associated skin impairment (CASI),the incidence and severity of medical adhesive-related skin injury (MARSI),medical device-related pressure ulcers (MDRPU),PICC unplanned removal rate and catheter-related infections were compared between the two groups.Results The incidence of CASI,MARSI,and MDRPU in the intervention group and the control group were statistically significant (all P＜0.05).There were no significant differences between the severity of MARSI,MDRPU,and unplanned removal rates of the two groups.No catheter-related infections happened in either group.Conclusions Implementing evidence-based CASI prevention programme significantly reduces the incidence of CASI in PICC outpatients and provides a reference for clinical nurses to prevent CASI.

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苏州市科技发展计划项目（SYSD-2019098）；苏州大学附属第一医院护理科研项目（HLYJ-2020-03）