肝癌合并乙型肝炎患者经外周静脉穿刺的中心静脉导管维护时护士体验的质性研究

肝癌电子杂志 ›› 2025, Vol. 12 ›› Issue (3): 45-50.

肝癌合并乙型肝炎患者经外周静脉穿刺的中心静脉导管维护时护士体验的质性研究

李彩云¹, 王鑫¹, 郭环飞¹, 张继文², 刘扬³, 张伟^2,*

1.国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肝胆外科,北京 100021;
2.国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院护理部,北京 100021;
3.国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肿瘤内科,北京 100021

收稿日期:2025-06-24 出版日期:2025-09-30 发布日期:2025-11-03
通讯作者: ^*张伟,E-mail: 18611112804@163.com
基金资助:
2023年中国医学科学院临床与转化医学研究专项项目(2023-I2M-C&T-B-099)

Nurses' experiences in maintaining peripherally inserted central venous catheter in patients with with hepatocellular carcinoma complicated by hepatitis B: a qualitative study

Li Caiyun¹, Wang Xin¹, Guo Huanfei¹, Zhang Jiwen², Liu Yang³, Zhang Wei^2,*

1. Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
2. Department of Nursing, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
3. Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Received:2025-06-24 Online:2025-09-30 Published:2025-11-03
Contact: ^* Zhang Wei, E-mail: 18611112804@163.com.

摘要/Abstract

摘要： 目的: 深入了解护士为肝癌合并乙型肝炎患者进行经外周静脉穿刺的中心静脉导管（PICC）维护时的体验,挖掘其在PICC维护过程中的感受与需求,以便为改善临床实践工作提供参考。
方法: 采用目的抽样法,选取中国医学科学院北京协和医学院肿瘤医院肝胆外科15名护士进行深入访谈,采用Colaizzi 7 步分析法分析访谈资料。
结果: 护士为肝癌合并乙型肝炎患者维护PICC时的体验共提炼出3个大主题：职业暴露与维护的双层压力（有职业暴露的风险、复杂病情下的维护难点）、护患互动困境（护士情感耗竭强、患者维护行为不足）、培训效能局限。
结论: 护士在为肝癌合并乙型肝炎患者维护PICC的过程中面临着多重挑战,建议管理者采取针对性的干预措施改善护士的职业困境（如优化资源配置保障,加强心理支持体系、建立规范化管理制度,提高护士的PICC护理能力、创新教育模式,回应患者的疾病需求、构建区域性电子平台,提高患者依从性）,提高复杂病症下PICC维护的护理质量。

关键词: 肝癌合并乙型肝炎, 经外周静脉穿刺的中心静脉导管, 护士体验, 质性研究

Abstract: Objective: To explore nurses'experiences in maintaining peripherally inserted central venous catheter (PICC) for patients with hepatocellular carcinoma (HCC) complicated by hepatitis B, and to identify their perceptions and needs in the care process in order to inform improvements in clinical practice.
Methods: Using purposive sampling, in-depth interviews were conducted with 15 nurses from the Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences. Data were analyzed using Colaizzi's seven-step phenomenological method.
Result: Three main themes were extracted from nurses' experiences in maintaining PICC for patients with liver cancer complicated by hepatitis B: dual pressure from occupational exposure and maintenance (including the risk of occupational exposure and maintenance difficulties in the context of complex conditions), difficulties in nurse-patient interaction (including strong emotional exhaustion of nurses and insufficient maintenance behaviors of patients), and limitations of training effectiveness.
Conclusion: Nurses face multiple challenges in the process of maintaining PICC for patients with liver cancer complicated by hepatitis B. It is suggested that managers take targeted intervention measures to alleviate nurses' occupational dilemmas (such as optimizing resource allocation and guarantee, strengthening the psychological support system; establishing standardized management systems to improve nurses' PICC nursing competence; innovating educational models to meet patients' disease-related needs; and building regional electronic platforms to enhance patient compliance), and improve the quality of PICC maintenance nursing in the context of complex diseases.

Key words: Hepatocellular carcinoma with hepatitis B, Peripherally inserted central venous catheter, Nurse experience, Qualitative study

李彩云, 王鑫, 郭环飞, 张继文, 刘扬, 张伟. 肝癌合并乙型肝炎患者经外周静脉穿刺的中心静脉导管维护时护士体验的质性研究[J]. 肝癌电子杂志, 2025, 12(3): 45-50.

Li Caiyun, Wang Xin, Guo Huanfei, Zhang Jiwen, Liu Yang, Zhang Wei. Nurses' experiences in maintaining peripherally inserted central venous catheter in patients with with hepatocellular carcinoma complicated by hepatitis B: a qualitative study[J]. Electronic Journal of Liver Tumor, 2025, 12(3): 45-50.

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