指（趾）端回压静脉穿刺法在老年患者中的应用

目的探讨老年患者指（趾）间静脉输液的有效穿刺方法，减轻患者痛苦。方法2005年9月-2006年9月，将56例手背、足背静脉穿刺困难的患者，采用指（趾）端回压静脉穿刺法，按输液单双日分对照组和观察组进行自身比较。对照组采用传统方法如握拳、拍打局部使静脉充盈；观察组采用指（趾）端回压静脉3-6次后穿刺。比较2组浅静脉充盈程度及穿刺成功率。结果观察组和对照组的浅静脉充盈优秀率分别为78．57％和51．79％，穿刺成功率2组分别为96．43％和73．21％，差异均有统计学意义（P〈0．01）。结论回压指（趾）端静脉穿刺法血管充盈优秀率、穿刺成功率明显高于传统法，指（趾）端回压静脉穿刺法有临床应用价值。     

静脉输液逆向穿刺的临床观察

目的 研究手背远端指掌关节附近静脉输液逆向穿刺的临床效果。方法 采用自身前后对照的方法，对200例患者指掌关节附近血管先后采用逆向、顺向静脉穿刺方法，观察2种方法1次穿刺成功率、穿刺疼痛率、固定后返修率及重新穿刺率。结果 2组患者1次穿刺成功率有差异（P〈0．05）；穿刺疼痛率、固定后返修率、重新穿刺率有显著差异（P〈0．01）。结论 逆向静脉穿刺穿刺成功率高；穿刺疼痛程度轻；返修率和重新穿刺率低，值得临床推广采用。     

老年静脉穿刺逆行方法探讨

目的探索不同的穿刺方法以提高老年病人静脉穿刺成功率。方法将100例静脉穿刺的老年病人随机分为两组，实验组采取逆行静脉穿刺方法；对照组按常规静脉穿刺方法，穿刺次数300次，穿刺部位为整个手足背静脉。结果实验组穿刺成功率明显高于对照组，差异有统计学意义（P〈0．01）。结论老年病人输液采用逆行进针方法值得推广。     

双止血带结扎法在浅静脉穿刺输液并抽血中的应用

[目的]探讨浅静脉穿刺双止血带结扎法对静脉血管充盈度、静脉穿刺成功率及静脉抽血成功率的影响。[方法]将600例同时接受静脉输液及抽血化验的静脉血管充盈度差的住院病人随机分为实验组和对照组,实验组采用双止血带结扎法,对照组采用传统的单止血带结扎法,观察两组静脉血管充盈度、一次穿刺成功率、一次抽血成功率。[结果]实验组静脉血管充盈度及一次静脉穿刺成功率、一次抽血成功率明显高于对照组（P〈0．05或P〈0．01）。[结论]对浅静脉充盈度差的病人采用双止血带结扎法,能明显改善静脉血管的充盈度,从而提高静脉穿刺及抽血的成功率。     

外周静脉套管针行浅静脉逆行穿刺法在老年患者中的应用

目的 评价外周静脉套管针浅静脉逆行穿刺法在老年患者中应用的效果.方法 将125例老年患者随机分成两组,实验组施行浅静脉逆行穿刺留置针输液,对照组采用传统顺行穿刺留置针输液.观察比较两组穿刺效果.结果 实验组与对照组的穿刺成功率分别为96.0%,86.0%,两组比较差异有统计学意义（x2=28.306,P＜0.01）;穿刺疼痛率分别为13.3%,30.0%,两组比较差异有统计学意义（Х^2=5.208,P＜0.05）;静脉炎的发生率分别为1.33%,12.0%,两组比较差异有统计学意义（Х^2=4.597,P＜0.05）.结论 对需长时间输液的老年患者采用浅静脉逆行穿刺留置针,可以提升静脉输液效果,避免静脉输液并发症.     

两种静脉穿刺方法对患者的影响

目的改进静脉穿刺方法,提高成功率,减少患者痛苦。方法将60例需要静脉输液的患者随机分为对照组和实验组各30例,对照组采用传统“三段式”进针法,实验组采用进针角度35—45°直接刺入血管法。观察两种不同穿刺方法所用时间、患者对疼痛的感觉及穿刺成功率。结果直接刺入血管法患者疼痛感觉轻于“三段式”进针法（P〈0．01）,穿刺所用时间短于“三段式”进针法（P〈0．01）,穿刺成功率（95．0％）高于“三段式”进针法（87．7％）（P〈0．05）。结论直接刺入血管法可减轻患者疼痛,缩短穿刺时间,提高穿刺成功率,值得在临床推广应用。     

弯曲静脉应用留置针输液穿刺方法的改进

目的探讨弯曲静脉及难穿刺血管应用留置针输液的穿刺方法,以找出更好的穿刺方法。方法采用成组病例对照研究方法,将120例静脉难穿刺手术患者随机分成两组,观察组和对照组各60例,对照组采用常规留置针穿刺方法,对观察组患者穿刺方法进行改进,比较两组穿刺效果。结果观察组58例患者一次穿刺成功,1例患者感觉不适,57例患者输液滴速符合要求,两组患者一次穿刺成功率及不适率比较差异有统计学意义（P〈0．05）;输液速度比较差异无统计学意义（P〉0．05）。结论弯曲静脉及其难穿刺血管通过改进穿刺方法,提高了穿刺成功率,是一种保护血管的有效方法。     

4岁以下小儿浅静脉穿刺失败因素分析与对策

目的总结4岁以下小儿浅静脉穿刺失败的相关因素,并寻找对策。方法每天对4岁以下小儿浅静脉穿刺失败例数进行统计,根据失败原因分类登记。结果全年4岁以下小儿浅静脉穿刺共21920例,其中未一次性成功穿刺者2850例（13．0％）。穿刺失败的原因有难穿刺到血管（30．0％）、回血不及时（39．5％）、针头固定失败（20．0％）、以及输液过程中护理不当（10．5％）等。结论小儿浅静脉穿刺失败的原因明确,采用积极的护理对策,4岁以下小儿浅静脉穿刺成功率可逐渐提高。     

改良上肢浅静脉穿刺方法的效果观察

目的：探讨上肢浅静脉不同穿刺方法对患者疼痛的影响。方法：用自身对照法对58例静脉输液患者采取两种不同的静脉穿刺方法各穿刺1次。结果：“改良法”对患者造成的疼痛程度明显低于“传统法”（P〈0．005）。结论：用“改良法”对上肢浅静脉进行穿刺可明显减轻患者的疼痛。     

肥胖患者2种静脉穿刺方法效果比较

目的 探讨对肥胖患者采用2种方法进行静脉穿刺，以提高一次性穿刺成功率。方法 对124例次肥胖患者采取自身对比法，进行常规静脉穿刺和探索式渐进法静脉穿刺各62例次，观察患者的一次性穿刺成功率及疼痛反应。结果 2组一次穿刺成功率比较有统计学意义（P〈0．01），疼痛无显著差异（P〉0．05）。结论 肥胖患者采用探索式渐进法进行静脉穿刺，明显提高静脉一次性穿刺成功率，并且不增加患者疼痛。     

静脉留置套管针采血对葡萄糖耐量试验的影响

目的：观察静脉留置套管针采血对葡萄糖耐量试验（OGTT）结果的影响。方法：采用自身对照法,对6名志愿同时用常规静脉穿刺采血法和静脉留置套管针采血,分别抽取空腹及口服葡萄糖后30,16,120,180min时静脉血各30份,用葡萄糖氧化酶法检测血糖植。结果：两种静脉采血法检测OGTT无差异（P＞0.05)。结论：静脉留置套管针采血做OGTT可以取代常规的5次静脉穿刺采血法,以减轻患的痛苦。     

静脉留置套管针采血对葡萄糖耐量试验的影响

目的探讨静脉留置套管针采血对葡萄糖耐量试验(OGTT)的影响。方法采用自身对照法,对6名志愿者同时用常规静脉穿刺采血法和静脉留置套管针采血,分别抽取空腹及口服葡萄糖后30、60、120、180min的静脉血各30份,用葡萄糖氧化酶法检测血糖浓度。结果2种静脉采血法检测OGTT无差异(P>0.05)。结论静脉留置套管针采血做OGTT可以取代常规的5次静脉穿刺采血法,以减轻病人的痛苦。     

手背掌指关节处采用离心性静脉穿刺的效果

目的比较手背远端掌指关节附近离心性静脉穿刺与临床常规向心性静脉穿刺的应用效果。方法对200例老年患者采用自身前后对照,选用患者掌指关节附近的静脉,单日向心性静脉穿刺,双日离心性静脉穿刺。结果离心性静脉穿刺一次穿刺成功率、回血率和输注成功率均高于向心性静脉穿刺（P〈0．01）。结论对血管条件差、静脉穿刺困难而掌指关节处有静脉显露的患者,行离心性穿刺输液是较好的选择。     

反方向静脉穿刺法在长期静脉输液患者中的应用效果

目的 探讨反方向静脉穿刺法临床应用可行性及效果.方法 90例患者单日用顺向穿刺法,穿刺130例次;双日用反方向穿刺法,穿刺124例次,比较一次性穿刺成功率和输液外渗率.结果 反方向静脉穿刺法的一次性穿刺成功率提高(P<0.05).结论 对输液造成的血管受损、变硬、阻塞的患者,应用反方向静脉穿刺法,效果好,值得推广.     

手背皮神经分布与静脉穿刺疼痛程度的相关性研究

背景静脉穿刺是临床治疗最常用的方法之一.手背静脉又是最常选用的静脉穿刺部位.但这种治疗方法是一种有创伤性的操作,它给患者带来一定的痛苦.目前还较少有人从手背静脉与手背皮神经分布、走向规律与穿刺部位疼痛性关系进行研究.目的探讨手背静脉穿刺疼痛程度最低的最佳部位,减轻患者疼痛.设计随机对照的前瞻性研究.地点和对象资料收集于广州医学院荔湾医院,所选取的对象有12例24侧成人防腐标本和在本院住院及门诊静脉穿刺的3 011例次患者.方法首先对24侧成人手背标本进行解剖、观察,找出手背静脉与皮神经分布规律,进行分区.以随机方式对本院2000-08/2001-02就诊留医患者2 980例按不同分区部位进行静脉穿刺.采用双盲法对穿刺患者进行疼痛评分(简化Megill疼痛评分法).分组进行相互对照,方差分析法对数据进行分析.主要观察指标解剖观测结果及静脉穿刺疼痛评分结果.结果手背解剖研究发现桡骨茎突、尺骨茎突及第三掌骨头所形成的三角形区域内神经与静脉呈交叉关系,神经分布稀疏(可称为乏神经区),此区域内静脉穿刺疼痛分值明显低于其他区域(P＜0.01).结论乏神经区内神经分布稀疏,是减少手背静脉穿刺疼痛的最佳部位.     

利多卡因凝胶在术前静脉穿刺置管术中的应用效果观察

[目的]探讨利多卡因凝胶涂抹对术前静脉穿刺置管术的影响及效果。[方法]选择手术前静脉留置针穿刺保留且意识清楚病人160例,分为观察组和对照组各80例,观察组在静脉留置针穿刺前以2%盐酸利多卡因凝胶涂抹皮肤,2min后再行穿刺置管术;对照组常规静脉留置针穿刺。观察两组病人一次穿刺成功率、病人的疼痛度、满意度。[结果]两组病人一次穿刺成功率比较差异无统计学意义(P0.05),穿刺时疼痛度和满意度比较,差异有统计学意义(P0.05)。[结论]术前静脉穿刺置管时应用2%盐酸利多卡因凝胶涂抹皮肤能缓解穿刺时疼痛,提高病人满意度,无药物不良反应发生。     

手指、足趾静脉离心性穿刺输液的探讨

目的 探索在手指、足趾静脉进行离心性静脉穿刺输液的可行性。 方法 2008年8月-2011年3月406例患者根据入院日期单双日分为试验组和对照组。试验组采用手指足趾离心性静脉穿刺法,对照组采用手背向心性静脉穿刺。比较2组一次穿刺成功率和输液成功率。 结果 2种一次穿刺成功率和输液成功率比较,差异无统计学意义。 结论 手指、足趾离心性静脉穿刺输液的方法可解决长期静脉输液患者静脉穿刺困难的问题。     

Patient Opinions and Attitudes toward Medical Student Procedures in the Emergency Department

OBJECTIVES: To determine emergency department (ED) patients' preferences about having medical students perform procedures as part of medical student clinical training. METHODS: A questionnaire was administered to a sequential sample of 150 patients of 196 approached (76.5% participation rate) in a teaching hospital ED. Patients were asked how many procedures a medical student should have performed on other patients before the participant would allow the student to perform the procedure on them. The procedures included venipuncture, starting an IV, suturing the face, suturing the arm, performing a lumbar puncture, starting a central line, inserting a nasogastric tube, intubation, and cardioversion. RESULTS: If they had their preference, only a minority of patients would allow medical students to perform their first procedure on them for any of the procedures (a high of 42% for venipuncture, with a low of 7% for a lumbar puncture). Many patients prefer that medical students never perform a procedure on them (a high of 56% for a central line and a low of 21% for venipuncture). Patient beliefs were independent of age, gender, or insurance status. CONCLUSIONS: Patients are reluctant to be a medical student's first patient when it comes to procedures in the ED. This has implications for medical training and informed consent.     

Venipuncture-induced causalgia: anatomic relations of upper extremity superficial veins and nerves, and clinical considerations

BACKGROUND: In 1994, 11 patients with injury to upper extremity cutaneous nerves after routine venipuncture were reported. All developed causalgia (Complex Regional Pain Syndrome, Type 2). Nerve injury appeared secondary to direct trauma via "inappropriate" needle or bolused material entry into the plane of the nerves beneath the veins, or nerves overlying the veins. However, in 3 of 13 additional patients, the venipunctures were properly performed and atraumatic. STUDY DESIGN AND METHODS: To explore the anatomic relationships of superficial veins and cutaneous nerves with regard to the role of direct nerve trauma during venipuncture in the development of causalgia, the 14 upper extremities of seven randomly chosen cadavers were dissected at three common venipuncture sites. In addition, the clinical features of all 24 patients are presented. RESULTS: Major branches of cutaneous nerves were superficial to and overlay veins in six extremities. In multiple instances, nerves and veins were intertwined, requiring detailed dissection to separate them. In the classic situation, nerves were immediately as deep as veins, often with no fascial separation. CONCLUSIONS: Anatomical relationships between upper extremity superficial veins and cutaneous nerves are so intimate that needle-nerve contact during venipuncture is common. Because venipuncture-induced nerve injuries are rare, factors other than direct nerve contact appear necessary for the chronic pain syndrome to occur.     

Evaluation of venous distension device: phase II: cannulation of nonemergent patients

A device designed to augment venous filling by applying a vacuum to the arm during tourniquet application was evaluated in adult patients considered to have difficult peripheral venous access and in need of nonemergent venipuncture or intravenous cannulation. Patients taking medications that affected platelet activity or who had venipuncture attempts within 1 week in the same extremity were excluded. A total of 21 patients (age, 38.8 +/- 15 years; weight, 77.3 +/- 22.5 kg) were studied. The majority were obese (62%) and/or did not have prominent veins even when a standard tourniquet cuff was placed (71%). Use of the device was successful in 19 patients (90%), with a mean time to venipuncture after vacuum removal of 38 +/- 30 seconds. In the 2 patients in whom the device was unsuccessful, both patients were intravenous drug users and subsequently required either external jugular or central venous line placement. Seven patients had unsuccessful attempts at venipuncture or intravenous cannulation on the opposite extremity immediately before use of the device. In these 7 patients, subsequent use of the device was 100% successful (p = 0.0003, Fisher's exact test, assuming all attempts using standard techniques would have been unsuccessful). When conventional tourniquets are unsuccessful for venipuncture, the use of the venous distension device may obviate the need for more invasive forms of venous access.