Chlorhexidine and silver-sulfadiazine coated central venous catheters in haematological patients—a double-blind,randomised, prospective,controlled trial

Background Central venous catheters (CVCs) are essential for the intensive care of patients with haematological illness. Catheter-related infections (CRI) are an important problem in modern medicine, which may lead to life-threatening situations, to prolonged hospitalisation and increased cost. In immunocompromised patients suffering from haemato-oncological diseases, CRI is a significant factor for adverse outcome. Several clinical studies have shown that CVCs coated with antiseptics such as chlorhexidine and silver-sulfadiazine (CHSS) reduce the risk of catheter-related bacteraemia. Most studies, however, were performed on intensive care patients not suffering from chemotherapy-induced immunosuppression.Patients and methods A prospective double-blind, randomised, controlled trial was performed to investigate the effectiveness of CHSS-coated catheters in haemato-oncological patients. A total number of 184 catheters (median duration of placement, 11 days) were inserted into 184 patients (male 115, female 69), of which 90 were antiseptically coated. After removal, all catheters were investigated for bacterial growth.Main results Catheters coated with CHSS were effective in reducing the rate of significant bacterial growth on either the tip or subcutaneous segment (26%) compared to control catheters (49%). The incidence of catheter colonisation was also significantly reduced (12% coated vs 33% uncoated). Data obtained show a significant reduction of catheter colonisation in CHSS catheters. There was no significant difference in the incidence of catheter-related bacteraemia (3% coated vs 7% uncoated). However, due to the overall low rate of CRI, we could not observe a significant reduction in the incidence of catheter-related bacteraemia.Conclusion Our data show that the use of CHSS catheters in patients with haematological malignancy reduces the overall risk of catheter colonisation and CRI, although the incidence of catheter-related bacteremia was similar in both groups.     

肝移植患者留置漂浮导管并发症的观察及护理

笔者报道了肝移植患者留置漂浮导管并发症的观察及护理。通过临床观察,并发症有:心律失常,气囊破裂,气栓,血栓形成和栓塞,导管脱出、打结、折断,感染等。采用相应的护理措施:心电监测、病情观察、保护隔离、严格无菌操作等,减轻了病人痛苦,提高了手术成功率。     

CCU患者留置导尿管相关感染的预见性护理

目的对CCU留置导尿管者采取预见性护理预防以降低相关感染的发生。方法对本院CCU病房78例留置导尿管患者,采取插管前预防感染,插管过程中防止损伤,留置过程中和更换尿管时采取相应护理措施,预防和治疗导尿管相关尿路感染。结果本组插管前尿路感染3例(留管时细菌培养阳性),第3天、第7天和第14天CAUTI发生率分别是11.84%、14.63%和19.23%。脱落细胞、结晶尿和尿沉渣等导致的尿管堵塞5例,通过调整尿p H值和/或膀胱冲洗转清。脓尿6例,采用复方黄柏液灌注冲洗全部治愈。结论采取预见性护理,可有效防止和尽快治疗留管并发症。     

Can noncontact mapping distinguish between endo- and epicardial foci?

Objectives  Noncontact mapping has been demonstrated to facilitate RF ablation of ventricular arrhythmias, but the reproducibility in the localization of endocardial exit sites during focal ventricular tachycardia (“VT”) originating from defined myocardial layers has not been systematically studied. Furthermore, it remains unclear whether noncontact mapping can distinguish between endo- and epicardial foci. Methods  In six dogs, constant pacing was applied through octopolar needle electrodes in the left ventricle to mimic VT of subendocardial, midmyocardial (mid1; mid2) or subepicardial origin. Using noncontact mapping, the site of origin was determined for each of 50 consecutive beats of all “VTs” and the variation between respective exit sites was measured. Exit sites were reconstructed for 50 consecutive beats of each “VT” and the time span between site of origin and exit site was measured as a parameter of intramural conduction. Results  While subendocardial and midmyocardial (mid1, mid2) foci were pinpointed with a variation of ≤2 mm, a variation of 4 mm was encountered for subepicardial foci. A gradual increase in intramural conduction was evident from endocardial towards epicardial foci, with significant differences between subendocardial (4.8 ± 0.9 ms), midmyocardial (mid1 = 11.1 ± 4.6 ms; mid2 = 11.8 ± 3.5 ms) and subepicardial (16.8 ± 3.6 ms) foci (P < 0.005). Systematic differences in the morphology of virtual waveforms depending on the site of origin could not be detected. Conclusions  Except for subepicardial foci, noncontact mapping localized focal activity in the LV with high reproducibility. In contrast to morphological parameters, the determination of intramural conduction provides a fair estimate of the depth of foci and is proposed as a novel parameter to identify a subepicardial origin. Dr. Frederik Voss and Dr. Alexander Bauer contributed equally to this work.     

完全胃肠外营养静脉导管的护理进展

完全胃肠外营养治疗已广泛应用于临床，其静脉导管的护理是重要环节，作通过查阅国内外相关献，总结完全胃肠外营养时导管的材质、种类；置管的部位、方法及护理的新进展。     

Variability in interventions with pulmonary artery catheter data

Objectives To determine if intensivists given PAC data from critically ill patients make uniform management choices.Design Cross-sectional survey of board-certified intensivists.Setting Medical intensive care unit.Participants Board-certified intensivists who are members of the American College of Chest Physicians and Society of Critical Care Medicine.Interventions A survey questionnaire containing three medical intensive care clinical vignettes was mailed to critical care physicians. Each vignette contained PAC data and one-half of the surveys contained echocardiographic (Echo) information. Every respondent was asked to select one of six interventions for each vignette.Measurements There were 126 evaluable surveys returned. In vignette 1 an intervention (none of the above) was selected by more than 50% of respondents. In vignettes 2 and 3, the most frequent selection was chosen only 44 and 37% of the times, respectively. There was a significant difference in the distribution of management choices between the Echo and the non-Echo subgroups.Conclusions There is significant heterogeneity in selecting an intervention based on PAC data among intensivists. The presence of Echo information may change the intervention selected but does not reduce heterogeneity. Any randomized trial evaluating efficacy of PACs will have to have strict treatment protocols.Electronic Supplementary Material Supplementary material is available in the online version of this article at An editorial regarding this article can be found in the same issue ()     

In Vivo Ventricular Lesion Growth in Radiofrequency Catheter Ablation

While radiofrequency catheter ablation has proved highly effective in the treafment of various supravenfricular tQchyarrhythmias, resulls in the trentment of ventricular tachycardia invite improvement. Knowledge of lesion growth in vivo might improve understanding of this discrepancy. So far only information from in vitro and in vivo studies using a small 2 mm tip eiectrode is available. Growlh of ventricular radiofrequency lesions created with a 4 mm ahlalion electrode was studied in 11 closed-chest dogs. Endocardia] ablations were performed at 31 left and 35 right ventricuiar sites at a power setting of 25 Watts and 5, 10, 20, 30 or 60 seconds pulse duration. Macroscopic and histopathologic lesion examination were performed after one week survival. Mean lesion volume increased from 52 mm³ after 5 seconds pulse duration to a maximum 388 mm³ and approximately 7 mm depth after 30 seconds. Lesions were prolate spheroid in form, with a sparing of subendocardial myocardium and maximum lesion diameter at some millimeters depth. Results indicate that catheter positioning at no more tlian 7 mm from the target is required for successful ablation. Due to lesion geometry, subendocardial targets demand even more exact catheter positioning, while subepicardial substrates may not be ammenable to ablation if ventricular wall thickness exceeds 7 mm at the ablation site. Repeated pulses at adjacent sites may be required for ablation of extended arrhytbmogenic areas. Volume at 5 seconds was only approximately 15% of mature lesions. Therefore, the use of a short'test pulse after careful mapping may be useful to pinpoint the most appropriate site for ablation in discrete pathways.     

超声引导经穿刺针内腔门脉留置导管化疗——动物实验及临床初步应用

门脉留置导管化疗是肝癌治疗的一条较好途径，具有一定疗效。以往超声引导穿刺置管技术较复杂。本文对门脉穿刺技术进行了新的研究。穿刺针选用１８ＧＰＴＣ针，内径１．０ｍｍ，导管外径０．９ｍｍ。导管直接从１８Ｇ穿刺针针腔内送入门脉留置。导管可从门脉右前或左枝矢状部进入门脉主干。穿刺顺利，患者易耐受，经肝素处理的导管留置三天仍保持通畅，无明显并发症。我们认为：超声引导下的门脉穿刺留置导管化疗可望成为肝癌非手术治疗的常用方法之一     

医用橡皮膏牵引固定前列腺摘除术后气囊导尿管的效果观察

[目的]观察医用橡皮膏牵引固定前列腺摘除术后气囊导尿管的效果。[方法]将124例前列腺摘除术后病人随机分成实验组和对照组各62例,分别采用医用橡皮膏和纱布牵引固定气囊导尿管。观察术后气囊导尿管固定的稳定性及病人体温变化、出血情况、膀胱持续冲洗的时间、冲洗液的量、疼痛不适感等。[结果]采用医用橡皮膏牵引固定明显优于纱布牵引固定法。医用橡皮膏牵引固定法病人术后出血量少,体温变化多为中等热,持续时间短,膀胱持续冲洗时间短,冲洗量少,疼痛不适感减轻,两组比较有统计学意义(P<0.05)。[结论]医用橡皮膏牵引固定气囊导尿管是一种较好的方法。     

Incidence and Prevention of Cardiac Tamponade Complicating Ablation for Atrial Fibrillation

Cardiac tamponade complicating catheter ablation of atrial fibrillation (AF) occurs in approximately 1% of pulmonary vein isolation (PVI), and up to 6% of linear ablation procedures. We reviewed 348 consecutive AF ablation (including repeat) procedures over 1 year, which all included PVI, with additional linear lesions at the mitral isthmus in 73%, and cavotricuspid isthmus (CTI) in 76%. An irrigated-tip ablation catheter was used, with power limited to 25–35 W for PVI and 45–60 W for linear lesions. Tamponade occurred in seven men and three women (2.9% of the population) during the creation of linear ablation lesions. Mechanical perforations occurred in two patients, and "popping" during radiofrequency (RF) energy delivery at the mitral isthmus in six, and at the CTI in two patients. Peak RF power was significantly higher in patients with than without tamponade (53 ± 4 W vs 48 ± 7 W; P = 0.02), and was greater than 48 W in all cases of "popping." In the following year, RF power for linear ablation was limited to ≤42 W. Among 398 procedures, tamponade occurred in four patients (1.0%; P = 0.047 vs first year), three from "popping" and one from mechanical trauma. Procedural success rate remained the same despite reduction of power. Risk of tamponade was highest during linear ablation, mainly associated with high energy delivery and "popping." Reducing the energy limited, though did not eliminate this complication.