| Objective:1.To construct the risk assessment scale of medical adhesive related skin injury at PICC site of tumor patients,test the reliability and validity of the assessment scale and determine the risk level.2.To construct a risk grading prevention plan based on the risk assessment scale of medical adhesive related skin injury at the PICC site of tumor patients.3.To apply and evaluate the prevention effect of the risk grading scheme based on the risk assessment scale,and provide the basis for clinical prevention of medical adhesive related skin injury.Methods:1.Construction and reliability and validity test of the assessment scale: the first draft of the risk assessment scale was prepared through literature review.Select nursing experts in the field of intravenous therapy and wound care to consult by letter,and revise the entries of the risk assessment scale in combination with expert opinions.The judgment matrix was constructed according to the analytic hierarchy process,the weights of each item were determined and assigned,and the final risk assessment scale was formed.Using the convenient sampling method,195 tumor patients who underwent PICC maintenance in the venous access center of a Grade A tertiary hospital in Shanxi Province from October 2021 to March 2022 were selected as the survey objects,the reliability and validity of the evaluation scale were tested,and the risk level was determined according to the percentile method.2.Construction of risk grading prevention plan: based on the evidence system to search the domestic and foreign literature,and combined with the risk assessment scale entries,the first draft of risk grading prevention plan for medical adhesive related skin injury at the PICC site of tumor patients was prepared.The Delphi method was used to conduct two rounds of correspondence with 20 experts,and the risk classification prevention plan was constructed according to the experts’ opinions.3.Application and evaluation of the scheme: 305 tumor patients with PICC in the Hematology Department,Gynecology Department,Radiotherapy Department,Gastroenterology Department and Respiratory Department of a Grade A tertiary hospital from July 2022 to February 2023 were selected and randomly divided according to the ward.The patients in the first ward served as the control group,with a total of 150 patients,and routine nursing measures of tube placement and maintenance were adopted.The patients in the second ward were the experimental group,155 in total.And on the basis of routine nursing,the risk level of the patients was assessed using the risk assessment scale built in the early stage,and the corresponding risk grading prevention measures were implemented according to the risk level.The total incidence,incidence of different types of medical adhesive related skin injury at PICC site and incidence of different degrees of contact dermatitis were compared between the two groups;the time of the first occurrence of medical adhesive related skin injury and the skin comfort of the patient’s intubation site.Results:1.Risk assessment scale of medical adhesive related skin injury at PICC site of tumor patients: 21 articles were selected from literature review,summarize risk factors and build the first draft.31 experts conducted two rounds of correspondence,with expert authority coefficients of 0.90.Based on expert opinions,a final risk assessment scale was formed,including five first-level items,13 second-level items and 36 third-level items.The inter-rater reliability was 0.968,the item content validity index was 0.83～1.00,the unanimous content validity of the evaluation scale was 0.83,and the average content validity was 0.97.The area under the working characteristic curve of the subjects which predicted the risk of medical adhesive related skin injury was 0.757,and the sensitivity and specificity of the scale was 80.0% and 65.6% at a best cut-off score of 15.5.According to the percentile method,the risk level of the assessment scale is determined,13～15 points was classified as low risk,16～22 points was classified as medium risk,and≥23 points was classified as high risk.2.The risk classification prevention scheme of medical adhesive related skin injury at PICC site of cancer patients: 13 articles were included in the literature review,including two guidelines,three expert consensus,two evidence summaries,four experimental studies,one case report,and one prospective cohort study,and form the first draft including 5 primary indicators and 31 secondary indicators.The positive coefficient of experts in two rounds of expert correspondence were 100%,the authoritative coefficients of experts were 0.94,and Kendall cofficient of concordance were 0.12 and 0.16 respectively(P<.001).Combined with expert opinions and group discussions,the final risk grading prevention plan was formed,covering 6 parts,including assessment,maintenance personnel,skin preparation,dressing use,comfort improvement and health education.Among them,there were 21 low risk measures,five medium risk measures and five high risk measures.3.Application effect evaluation of the risk grading prevention scheme: The results showed that there was no statistically significant difference between the two groups in the risk assessment level of medical adhesive related skin injury before intubation(X~2=0.403,P>.05).The incidence of medical adhesive related skin injury in the test group was 8.39%,lower than 20.00% in the control group,the incidence of different types of medical adhesive related skin injury in the test group was lower than that in the control group,and the difference was statistically significant(P<.05).However,there was no statistically significant difference between the two groups in the incidence of mechanical injury of different types and different severity of contact dermatitis(P>.05).The time of the first occurrence of medical adhesive related skin injury were(120.77 ± 54.72)and(79.60 ± 53.62)days respectively in the test group and the control group,and the skin comfort score of the PICC site were(8.01 ± 1.04)and(6.42 ± 1.06)points respectively.The difference between the two groups was statistically significant(P<.05).Conclusion:1.The risk assessment scale of medical adhesive related skin injury at PICC site of tumor patients,which was constructed through literature review and expert consultation,is scientific and reliable,with good reliability and validity,and strong clinical operability,and can dynamically assess the risk of medical adhesive related skin injury in patients at an early stage.2.On the basis of the risk assessment scale,based on evidence-based and expert consultation,this study has constructed a risk grading prevention scheme for medical adhesive related skin injury at PICC site of tumor patients,which has certain scientific,reliable and clinical guiding significance.3.The preliminary application of the risk classification prevention scheme of medical adhesive related skin injury at PICC site of tumor patients can reduce the incidence of medical adhesive related skin injury,delay its occurrence time,improve the skin comfort of the patient’s PICC site,and alleviate the patient’s pain. |
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