克利夫兰临床研究：画外音互动幻灯片用于家庭肠外营养导管护理教育

　　背景：在家通过隧式导管/外周置入中心导管（TC/PICC）输液，导管相关性血流感染（CRBSI）的风险和并发症导致患者再住院和费用增加。如果通过数字视频光盘用画外音互动幻灯片（VOIPP）进行培训教育能否改善临床结局尚未可知。

　　资料与方法：在四级医疗中心采用随机、对照、两组设计研究，TC/PICC住院患者接受常规护理教育或常规护理（UC）加出院前VOIPP教育。在接受教育前、完成教育后即刻、出院后7～10天分别填写一份多项选择的6题知识问卷。90天后，评估患者每1000导管日CRBSI发病率、再住院率、CRBSI相关住院率、非CRBSI并发症、患者电话联系家庭肠外营养（HPN）临床医生的情况。用方差分析、χ2、Kruskal-Wallis检验比较两组结果。

　　结果：51例患者，其中UC组27例、UC＋VOIPP组24例，平均年龄46.3±14.3岁，68.6%为女性，HPN持续时间2.2±1.01个月，出院后检查完成的时间为11.5±5.2天。两组基线资料无差异。两组患者在接受教育前、教育后和出院后的认知及认知变化相似（P值分别为0.88、0.30、0.37）。两组间CRBSI发生率、再住院率、CRBSI相关再住院率、非CRBSI并发症无差异。UC＋VOIPP组比UC组有更多患者呼叫（每1000导管日21.8比7.7次呼叫，P＜0.001）。

　　结论：录制教育导致更多患者呼叫HPN临床医生；但两组间其他结局无差异。

Nutr Clin Pract. 2015;30(5):714-9.

Voiceover Interactive PowerPoint Catheter Care Education for Home Parenteral Nutrition.

Emery D, Pearson A, Lopez R, Hamilton C, Albert NM.

Cleveland Clinic, Cleveland, Ohio.

BACKGROUND: In home infusions via tunneled catheter/peripherally inserted central catheter (TC/PICC) the risk of catheter-related bloodstream infection (CRBSI) and complications contribute to rehospitalization and costs. It is unknown if voiceover interactive PowerPoint (VOIPP) via digital video disc education improves clinical outcomes.

MATERIALS AND METHODS: In a quaternary care medical center and using a randomized, controlled, 2-group design, hospitalized patients with TC/PICC received usual care education or usual care (UC) plus VOIPP education prehospital discharge. A multiple-choice 6-item knowledge questionnaire was administered preeducation, immediately posteducation, and 7-10 days postdischarge. At 90 days, patients were assessed for CRBSI incidence rates per 1000 catheter-days, rehospitalization, CRBSI-related hospitalization, non-CRBSI complications and patient calls to the home parenteral nutrition (HPN) clinicians. Analysis of variance, Pearson χ(2), and Kruskal-Wallis test were used to compare results between groups.

RESULTS: Of 51 patients (UC, n = 27; UC+VOIPP, n = 24), mean ± SD age was 46.3 ± 14.3 years, 68.6% were female, HPN duration was 2.2 ± 1.01 months, and time to postdischarge test completion was 11.5 ± 5.2 days. There were no baseline differences between groups. Between-group knowledge and changes in knowledge were similar at preeducation, immediate posteducation, and postdischarge (P = .88, 0.30, and 0.37, respectively). There were no differences in CRBSI incidence, rehospitalization, CRBSI-related rehospitalization rates, and non-CRBSI complications between groups. The UC+VOIPP group had more patient calls than did the UC group (21.8 vs 7.7 calls/1000 catheter-days, P < .001).

CONCLUSION: Recorded education led to more patient calls to the HPN clinicians; however, there were no differences between groups in other outcomes.

KEYWORDS: central venous catheters; home infusion therapy; home parenteral nutrition; infection; nutritional support; patient education

PMID: 25998123

DOI: 10.1177/0884533615584391