康惠尔水胶体敷料在胸腔置管引流护理中的应用

目的探讨康惠尔水胶体敷料在留置中心静脉导管胸腔引流穿刺部位皮肤护理中的应用效果。方法将64例留置中心静脉导管胸腔引流的患者按随机数字表法分成观察组与对照组各32例。观察组采用康惠尔水胶体敷料透明贴保护引流穿刺部位皮肤,对照组采用3M灭菌透明膜保护穿刺部位。观察两组皮肤受损及导管相关性发热的发生情况。结果观察组穿刺部位皮肤受损发生率显著低于对照组(P0.01),无导管相关性发热病例。结论康惠尔水胶体敷料透明贴可保护胸腔置管引流患者穿刺部位皮肤,预防皮肤受损及导管相关性感染。     

胫骨缺损并软组织缺损行重建单边外固定架治疗的围术期护理

目的探讨康惠尔水胶体敷料在留置中心静脉导管胸腔引流穿刺部位皮肤护理中的应用效果。方法将64例留置中心静脉导管胸腔引流的患者按随机数字表法分成观察组与对照组各32例。观察组采用康惠尔水胶体敷料透明贴保护引流穿刺部位皮肤,对照组采用3M灭菌透明膜保护穿刺部位。观察两组皮肤受损及导管相关性发热的发生情况。结果观察组穿刺部位皮肤受损发生率显著低于对照组（P〈0．01）,无导管相关性发热病例。结论康惠尔水胶体敷料透明贴可保护胸腔置管引流患者穿刺部位皮肤,预防皮肤受损及导管相关性感染。     

应用碘伏敷料预防中心静脉导管感染

目的探讨应用碘伏敷料行中心静脉导管穿刺点护理预防中心静脉导管感染的效果。方法将138例留置中心静脉导管的患者，应用分层随机化法分为两组各69例。透明敷料组于常规消毒后采用无茵透明薄膜敷盖穿刺点；碘伏敷料组则采用10％碘伏棉质敷料覆盖后再加用无茵透明薄膜覆盖。结果两组导管保留时间比较。差异无显著性意义（P〉0.05）；透明敷料组感染发生率及局部皮肤阳性反应率显著高于碘伏敷料组（均P〈0.05）。结论应用碘伏敷料行中心静脉导管穿刺点护理可降低导管感染率。     

应用银离子喷剂预防经外周置入中心静脉导管感染

目的:探讨银离子敷料对经外周置人中心静脉导管穿刺点护理预防中心静脉导管感染的效果.方法:特84例行中心静脉置管的患者随机分为透明敷料组和银离子敷料组各42例.透明敷料组用3M透明敷贴联合银离子喷剂敷料贴于PICC固定处皮肤,银离子敷料组单用3M透明敷贴.结果:透明敷料组感染发生率及局部皮肤阳性反应率显著高于银离子敷料组(均P＜0.05).结论:应用银离子喷剂行中心静脉导管穿刺点护理可降低导管感染率.     

应用碘伏敷料预防中心静脉导管感染

目的 探讨应用碘伏敷料行中心静脉导管穿刺点护理预防中心静脉导管感染的效果.方法 将138例留置中心静脉导管的患者,应用分层随机化法分为两组各69例.透明敷料组于常规消毒后采用无菌透明薄膜敷盖穿刺点;碘伏敷料组则采用10%碘伏棉质敷料覆盖后再加用无菌透明薄膜覆盖.结果 两组导管保留时间比较,差异无显著性意义(P＞0.05),透明敷料组感染发生率及局部皮肤阳性反应率显著高于碘伏敷料组(均P＜0.05).结论 应用碘伏敷料行中心静脉导管穿刺点护理可降低导管感染率.     

三种透明敷料固定中心静脉导管的效果比较

目的探讨3种3M透明敷料固定中心静脉导管的效果。方法将行单腔中心静脉导管置管的141例患者分为对照组、观察1组和观察2组各47例,置管后对照组、观察1组、观察2组分别采用1630TegadermTM、9546HPTegadermTM、1635TegadermTM透明敷料固定导管。敷料一般每周更换2次,出汗多、热疗后、被污染、潮湿、脱落时立即更换。结果三组导管脱出率比较,差异有统计学意义(P0.05),其中对照组发生率最高,观察1组次之,观察2组最低。三组敷料更换频率比较,差异有统计学意义(P0.01),其中对照组敷料更换频率最高,观察2组次之,观察1组最少。结论 1635 TegadermTM透明敷料牢固性最好但透气性较9546HP TegadermTM敷料差。建议常规选用1635 TegadermTM透明敷料,易出汗者选用9546HP TegadermTM敷料。     

三种透明敷料固定中心静脉导管的效果比较

目的探讨3种3M透明敷料固定中心静脉导管的效果。方法将行单腔中心静脉导管置管的141例患者分为对照组、观察1组和观察2组各47例,置管后对照组、观察1组、观察2组分别采用1630TegadermTM、9546HPTegadermTM、1635TegadermTM透明敷料固定导管。敷料一般每周更换2次,出汗多、热疗后、被污染、潮湿、脱落时立即更换。结果三组导管脱出率比较,差异有统计学意义（P〈0.05）,其中对照组发生率最高,观察1组次之,观察2组最低。三组敷料更换频率比较,差异有统计学意义（P〈0.01）,其中对照组敷料更换频率最高,观察2组次之,观察1组最少。结论 1635 TegadermTM透明敷料牢固性最好但透气性较9546HP TegadermTM敷料差。建议常规选用1635 TegadermTM透明敷料,易出汗者选用9546HP TegadermTM敷料。     

中心静脉置管应用不同敷贴局部细菌定植研究

目的 探讨不同敷贴对儿科患者中心静脉置管局部皮肤细菌定植的影响,以寻求一种更有利于降低中心静脉导管相关性感染的敷贴.方法 将61例留置中心静脉置管患儿随机分为透明敷贴组(22例)、含碘敷贴组(20例)和高通透敷贴组(19例),分别采用透明敷贴、含碘敷贴和高通透敷贴覆盖在穿刺点及周围皮肤,在观察期(7 d)内使用同一种敷贴用于中心静脉维护.结果 含碘敷贴组穿刺点细菌培养阳性率显著低于透明敷贴组和高通透敷贴组(均P＜0.017);敷贴内面的细菌培养阳性率显著低于透明敷贴组(P＜0.017);三组患儿未发生全身感染,观察期内各组局部感染率比较,差异无统计学意义(均P＞0.05).结论 含碘敷贴在抑制中心静脉穿刺局部皮肤菌落生长方面的效果优于高通透敷贴及透明敷贴.     

中心静脉导管敷贴更换频率对敷贴下皮肤细菌定植的影响

目的 探讨中心静脉导管敷贴更换频率是否对敷贴下皮肤细菌定植率产生影响。 方法 对PICU和CICU留置中心静脉导管的试验组（29例）在首次留置中心静脉导管24 h后不更换敷贴,在留置导管的第7天更换敷贴;对照组（28例）在首次留置中心静脉导管24 h后更换敷贴,在留置导管的第8天再次更换敷贴。试验组在第7天、对照组在第8天更换敷贴时对敷贴下皮肤进行采样,比较两组皮肤细菌定植的差异性。 结果 两组皮肤细菌定植率比较,差异无统计学意义（P＞0.05）。两组共培养了228个采样点,其中61个采样点（26.75%）出现阳性结果;两组间各采样部位细菌培养阳性率比较无统计学差异（均P＞0.05）。两组均未发生中心静脉导管相关性血流感染及医用粘胶相关性皮肤损伤。 结论 在严格无菌屏障下留置中心静脉导管,置管24 h后不更换敷贴不会增加敷贴下皮肤细菌定植。     

3M HP型透明敷料应用于PICC置管后的效果观察

目的:调查分析3M加强型(HP型)透明敷料对PICC固定处皮肤的保护作用.方法:选择2011年5月～2012年5月98例PICC置管患者,随机分为实验组50例和对照组48例,固定敷料实验组选用3M加强型透明敷料(HP型).对照组选用选用3M普通透明敷料,敷料实验组患者更换频率一般均为每周1次,对照组每周更换2次,观察两组患者穿刺点周围的皮肤反应情况,并调查患者自感舒适情况以及有无导管脱出现象.结果:实验组皮肤反应和导管脱出明显低于对照组,自我舒适感明显高于对照组.结论:PICC置管后应用3M加强型透明敷料固定,能够有效避免或减少患者不同程度的皮肤反应和预防导管脱落,较大提高患者的自觉舒适度.     

Treatment of catheter-related bacteraemia with an antibiotic lock protocol: effect of bacterial pathogen.

BACKGROUND: The standard therapy of dialysis catheter-related bacteraemia involves both systemic antibiotics and catheter replacement. We reported recently that instillation of an antibiotic lock (highly concentrated antibiotic solution) into the catheter lumen after dialysis sessions, in conjunction with systemic antibiotics, can successfully treat many episodes of catheter-related bacteraemia without requiring catheter removal. The present study evaluated whether the likelihood of achieving a cure with this protocol depends on the type of pathogen. METHODS: This was a historically controlled interventional study of an antibiotic lock protocol for the treatment of catheter-related bacteraemia. We analysed prospectively the likelihood of clinical cure (fever resolution and negative surveillance cultures) with an antibiotic lock protocol among patients with dialysis catheter-related bacteraemia. In addition, infection-free catheter survival was evaluated for up to 150 days, and compared with that observed among patients managed with routine catheter replacement. RESULTS: Overall, the antibiotic lock protocol was successful in 33 of 47 infected patients (70%) with catheter-related bacteraemia. The likelihood of a clinical cure was 87% for Gram-negative infections, 75% for Staphylococcus epidermidis infections, and only 40% for Staphylococcus aureus infections (P = 0.04). The median infection-free catheter survival with the antibiotic lock protocol was longer than that observed among patients with routine catheter replacement (154 vs 71 days, P = 0.02). CONCLUSIONS: The clinical success of an antibiotic lock protocol in eradicating catheter-related bacteraemia while salvaging the catheter is highly dependent on the bacterial pathogen. Thus, the overall success rate in an individual dialysis programme will depend on the relative frequencies of different bacterial pathogens.     

肿瘤患者PICC体外导管不同留置长度效果比较

目的 评价肿瘤患者PICC体外导管不同留置长度的应用效果。方法 将340例肿瘤患者随机分为对照组（168例)和观察组（172例)。对照组PICC置管体外导管长度为7 cm,观察组体外导管长度为5 cm,比较两组留置导管期间导管相关不良事件发生率。结果 观察组敷料未全覆盖、敷料7 d内卷边、导管滑脱和非计划维护的发生率显著低于对照组（均P＜0.05）。结论 肿瘤患者PICC体外导管长度5 cm时,导管固定较好,可减少导管相关不良事件的发生。     

The Clinical Utility of Maceration Dressings in the Treatment of Inpatient Hand Infections: An Evaluation of Treatment Outcomes Compared to Standard Care

Background: In cases of oral antibiotic-resistant infection of the hand, we propose utilizing a heated, moist maceration dressing to help shorten and simplify the in-hospital clinical course by increasing the efficacy of antibiotic deliverance to infection sites, increasing the success of nonoperative management, and decreasing eradication time of infection of the hand. Methods: Fifty-six patients older than 18 years of age who presented with hand infections requiring inpatient intravenous antibiotics at our suburban academic hospital over a 30-month period were included and randomly assigned to either the maceration dressing group or the standard treatment group. Maceration dressings included warm and moist gauze, kerlix, webril, Orthoglass, Aqua K Pad, and sling. Results: Fifty-two patients who were mostly male and younger than 60 years of age were included. Patients who used the maceration dressing had significantly shorter hospital lengths of stay (P = .02) and intravenous antibiotics duration before transition to oral antibiotics (P = .04), and decreased need for formal operating room irrigation and debridement to obtain source control (P = .02) compared to patients treated with the standard dressing. Post-hoc analysis yielded improved outcomes when using the maceration dressing regardless of whether initial bedside incision and drainage was needed to decompress a superficial abscess or not. Conclusion: The maceration dressing can be used along with proper intravenous antibiotic treatment to improve the treatment course of patients with hand infections regardless of whether the patient needs an initial bedside incision and drainage or not. Level of Evidence: Therapeutic Level II.     

Pediatric clean surgical wounds: is dressing necessary?

Background/Purpose

The covering of the sutured surgical wound with a sterile dressing is usually considered a routine conclusion to an aseptic operation. The wound is usually left dressed for a minimum of 3 to 5 days. The main purpose of dressing is protection of the wound against bacterial contamination that remains a significant source of postoperative morbidity. The aim of this study was to compare the infectious local risk when the clean pediatric surgical wounds were dressed or left exposed without dressing after the completion of wound closure.

Methods

Four hundred fifty-one patients with clean surgical wounds were randomized prospectively to receive dressing (n = 216) or have their wounds left exposed without any dressing (n = 235) after the completion of wound closure.

Results

In the group that received wound dressing, wound infection developed in 3 patients (1.4%), whereas in the group that had wounds exposed without any dressing, 4 patients (1.7%) developed wound infection.

Conclusions

In children, there was no significant difference in terms of wound infection after applying dressing or leaving the clean surgical wounds exposed without any dressing after completion of wound closure. Dressing clean surgical wounds may be unnecessary.     

A surfactant‐based wound dressing can reduce bacterial biofilms in a porcine skin explant model

Bacterial biofilms have been found in many, if not all, chronic wounds. Their excessive extracellular matrix secretion and the metabolic changes that they undergo render them highly tolerant of many antibiotic and antimicrobial treatments. Physical removal and/or disruption are a common approach to treating wounds suspected of having bacterial biofilms. While many of these techniques use mechanical energy as the primary means of removal, we have begun to investigate if surfactants could facilitate the removal of bacterial biofilms, or if they might sensitise the biofilms to antimicrobial interventions. We tested a new surfactant‐based wound gel on an ex vivo porcine skin explant model infected with a functionally tolerant 3‐day biofilm. The wounds were dressed with a surfactant‐based gel directly on the wound or with moistened gauze. The wounds were then wiped daily with moistened gauze, and the gel or gauze was re‐applied. Each day, an explant from each group was harvested and tested for total viable bacteria counts and viable biofilm‐protected bacteria counts. The results show that daily wiping with moistened gauze led to an initial decrease of bacteria, but by day 3, the biofilm had been fully re‐established to the same level prior to the beginning of treatment. For the surfactant‐based treatment, there was no detectable functional biofilm after the first treatment. The gauze control, which was also subjected to daily wiping, still contained functional biofilms, indicating that this result was not due to wiping alone. The total bacteria in the surfactant‐treated explants steadily decreased through day 3, when there were no detectable bacteria, while the wiping‐only control bacteria counts remained steady. The use of a moist gauze to wipe the visually apparent slime off of a wound appears to be insufficient to reduce biofilm over a 3‐day period. Daily application of the surfactant gel dressing and wiping reduced the biofilm to undetectable levels within 3 days in a skin explant model. A 3‐day regimen of dressing the wound model with a surfactant gel followed by gentle removal of the gel by wiping with a moistened gauze appears to be a simple and adequate approach to removing a bacterial biofilm infection in an ex vivo model. Additional clinical evidence is needed to determine if this promising approach can perform the same in clinically infected chronic wounds.     

术后硬膜外镇痛导管细菌培养情况的临床研究

目的 探讨用于术后硬膜外镇痛导管尖端细菌培养的阳性率.方法 收集208例术后硬膜外镇痛患者镇痛结束拔除的导管,选取其不同部化行细菌培养,并记录留置导管期间与导管有关的症状、体征.结果 导管皮下及尖端部分细菌培养阳性率分别为10.4%和11.4%;最常见的培养细菌为凝固酶阴性的葡萄球菌和痤疮丙酸杆菌.导管尖端部位的细菌与皮下细菌培养结果 呈显著的直线相关(P<0.01).结论 细菌沿硬膜外导管的移位是硬膜外导管沾染细菌的主要途径.     

Persistent Sciatic Artery Aneurysm: a Case Report

Central venous catheterization is one of the important sepsis reasons in surgical patients. In this randomized controlled study, the effect of the frequency and type of catheter site care, as well as age, coexisting malignancy or diabetes mellitus, total parenteral nutrition administration and antibiotics use, on central venous catheter infection was investigated.

Seventy-two single-lumen polyurethane catheters were included. In group I (n: 33), a transparent occlusive dressing was applied to the insertion site and not removed for 7 days unless there were signs of local infection. In group II (n: 39), daily site care was done with povidone-iodine 10% solution and a new sterile gauze was applied. Chi-square, linear correlation and multiple regression tests were used for statistical analysis.

Mean duration of catheters was 8 ±4 days. There was no catheter-related sepsis. Ten (13.9%) patients had positive catheter tip cultures of whom three had site infection as well. The incidence of site and tip infections were not significantly different in group I and II (p > 0.05). Site infection and age younger than 60 years significantly increased the rate of tip infection (p: 0.004 and p: 0.02 respectively). Total parenteral nutrition administration was associated with higher rate of tip infection (p: 0.06). Coexisting malignancy or diabetes mellitus, duration of catheter and antibiotics use did not have any significant effect on the rate of central venous catheter infections (p > 0.05).

In conclusion, we observed that the frequency of insertion site care and the type of dressing applied to the site had no significant effect on the rate of CVC infection. Insertion site infection was the most significant factor increasing the incidence of catheter tip infection. The use of the CVC for total parenteral nutrition facilitated tip infection as well.