摘要
目的 探讨迷你中线导管置管后皮下瘀斑形成的危险因素，为临床优化操作提供依据。方法 采用单中心回顾性研究设计，收集2023年11月至2024年04月西安医学院第一附属医院泌尿外科成功置入迷你中线导管的304例患者资料，其中符合纳入标准的110例患者。通过电子病历系统获取患者临床资料（性别、年龄、BMI等）及置管相关数据（穿刺次数、止血带时间、患者配合度等），通过单因素χ2 检验和多因素logistic回归模型分析筛选皮下瘀斑的独立危险因素。结果 皮下瘀斑发生率为42.73%（47/110），其中轻度22例（20.00%），中度14例（12.73%），重度11例（10.00%）。多因素分析结果显示：穿刺次数＞1次（OR=9.281，95%CI：3.624-23.770）、第一针失败后未按压（OR=0.108，95%CI：0.042-0.276）、穿刺时间＞10分钟（OR=2.348，95%CI：1.084-5.086）、止血带时间＞36秒（OR=3.611，95%CI：1.630-7.997）、VAS疼痛评分＞3分（OR=18.406，95%CI：6.537-51.826）及患者不配合（OR=15.500，95%CI：5.756-41.741）为皮下瘀斑的独立危险因素（p＜0.05）。结论 迷你中线导管置管后皮下瘀斑的形成与穿刺技术（穿刺次数、操作时长）、止血带使用时长（时间＞36秒）及患者配合度密切相关。临床规范穿刺流程，实施“一针化”护理模式，首次穿刺失败后立即按压2至3分钟，规范止血带使用时间（≤36秒），加强患者宣教及个体化护理干预，可有效降低皮下瘀斑发生率并提升患者满意度。
关键词： 迷你中线导管；皮下瘀斑；危险因素
Abstract
Objective To explore the risk factors for subcutaneous ecchymosis formation after mini midline catheterization and provide a basis for optimizing clinical operations. Methods A single-center retrospective study design was adopted. Data of 304 patients who successfully received mini midline catheterization in the Department of Urology of the First Affiliated Hospital of Xi'an Medical University from November 2023 to April 2024 were collected, among which 110 patients met the inclusion criteria. Clinical data (gender, age, BMI, etc.) and catheterization-related data (number of punctures, tourniquet time, patient cooperation, etc.) were obtained through the electronic medical record system. Univariate χ2 test and multivariate logistic regression model were used to analyze and screen the independent risk factors for subcutaneous ecchymosis. Results The incidence of subcutaneous ecchymosis was 42.73% (47/110), including 22 cases (20.00%) of mild, 14 cases (12.73%) of moderate, and 11 cases (10.00%) of severe. The multivariate analysis results showed that more than one puncture (OR = 9.281, 95% CI: 3.624 - 23.770), no compression after the first puncture failure (OR = 0.108, 95% CI: 0.042 - 0.276), puncture time > 10 minutes (OR = 2.348, 95% CI: 1.084 - 5.086), tourniquet time > 36 seconds (OR = 3.611, 95% CI: 1.630 - 7.997), VAS pain score > 3 points (OR = 18.406, 95% CI: 6.537 - 51.826), and patient non-cooperation (OR = 15.500, 95% CI: 5.756 - 41.741) were independent risk factors for subcutaneous ecchymosis (p < 0.05). Conclusion The formation of subcutaneous ecchymosis after mini midline catheterization is closely related to puncture technique (number of punctures, operation time), tourniquet application time (time > 36 seconds), and patient cooperation. Standardizing the puncture process, implementing a "one-needle" nursing model, immediately applying pressure for 2 to 3 minutes after the first puncture failure, standardizing the tourniquet application time (≤ 36 seconds), and strengthening patient education and individualized nursing intervention can effectively reduce the incidence of subcutaneous ecchymosis and improve patient satisfaction.
Key words： Mini midline catheter; Subcutaneous ecchymosis; Risk factors
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