Incidence,severity and outcome of central line related complications in pediatric oncology patients; A single center study

BackgroundCentral venous access device (CVAD)-related complications are associated with high morbidity rates. This study was performed to underline the importance of CVAD-complication prevention and treatment.MethodsAn audit of practice of CVAD-related complications in pediatric oncology patients receiving a CVAD between January 2015 and June 2017 was performed. CVADs included were totally implantable venous access ports (TIVAPs), Hickman–Broviac® (HB), nontunneled, and peripherally inserted CVADs.ResultsA total of 201 children, with 307 CVADs, were analyzed. The incidence rates per 1000 CVAD-days for the most common complications were 1.66 for malfunctions, and 1.51 for central line-associated bloodstream infections (CLABSIs). Of all CVADs inserted, 37.1% were removed owing to complications, of which 45.6% were owing to CLABSIs. In 42% of the CLABSIs, the CLABSI could be successfully cured with systemic antibiotic treatment only. Of all included patients, 5.0% were admitted to the intensive care unit owing to CLABSI. The HB-CVAD compared to the TIVAP was a risk factor for CVAD-related complications, CLABSIs and dislocations in particular.ConclusionsThe incidence of CVAD-related complications is high. Research on the prevention and treatment of CVAD-related complications in pediatric oncology patients should be a high priority for all health care professionals.Type of studyPrognosis study (retrospective).Level of evidenceLevel II.     

PICC延续性照护服务现状及制约因素分析

目的从患者和社区医疗机构层面了解PICC延续性照护服务现状并分析制约因素,为PICC维护技术在社区医疗机构的推广提供参考。方法对在株洲市3所三级医院进行PICC置管维护的196例患者采用自行设计的问卷进行调查,对10家社区医疗机构负责人进行半结构式深入访谈。结果 88.8%的PICC带管者平时的维护地点为三级医院,31.1%的患者愿意到社区医院进行导管维护,61.2%的患者因社区诊疗技术不足而不到社区医疗机构进行导管维护。访谈共提取6个主题:人力资源不足,相关知识及技术缺乏,担心风险,收费标准缺乏文件依据,缺乏国家政策支持,建议提高医疗风险的保额。结论社区医院PICC维护情况不容乐观,推进PICC维护进社区存在较多的制约因素,政府、三级医院及社区医疗机构应积极采取对策加以改进,以发挥社区医疗机构初级医疗保健作用。     

蒲地蓝消炎口服液联合氢定乳膏治疗PICC局部湿疹临床观察

目的观察蒲地蓝消炎口服液联合应用氢定乳膏治疗PICC局部湿疹的疗效。方法采用病例对照研究的方法,选择PICC门诊2014年1月-2018年12月PICC局部湿疹患者80例,随机分为实验组39例和对照组41例,观察组用蒲地蓝消炎口服液联合氢定乳膏加局部敷料开窗法进行护理。对照组用氢定乳膏加局部敷料开窗法,比较2组的临床疗效。结果观察组39例,总有效34例(87.18%);对照组41例,总有效23例(56.10%)。2组比较差异具有统计学意义(P<0.01)。结论蒲地蓝消炎口服液联合氢定乳膏治疗PICC局部湿疹的效果优于对照组。     

风险管理在预防PICC相关性静脉血栓中的临床观察

目的：探讨风险管理对降低PICC相关性血栓的应用效果。方法：选取2012年1月-2014年12月PICC置管患者291例作为对照组。2015年1月-2017年12月PICC置管患者568例作为干预组。对照组给予常规护理措施,干预组在此基础上给予风险管理,比较2组在深静脉血栓发生情况。结果：干预组PICC相关性静脉血栓的发生率为0.53 %,对照组血栓发生率为2.06%,差异有显著性( P=0.037),对照组中有1位肺癌患者因血栓而耽误治疗,最终死亡。干预组中3例血栓经积极治疗血栓完全溶解,无相关其他并发症的发生。结论：护理风险管理能够有效预防或降低PICC导管相关性静脉血栓的发生 ,值得临床推广应用。     

PICC 置管患者健康教育护理的研究进展

介绍PICC置管期间不同的健康教育模式，如PDCA循环模式、护理路径模式、三日知晓法模式、系统化模式、个性化模式、家庭模式、Orem自护模式、五位一体模式等，以及相关的健康教育方法，如卡片，画册，电话等。为提高临床PICC置管成功率以及患者身心舒适度提供参考。     

PICC management led by technicians: Establishment of a cooperation program with radiologists and evaluation of complications

PurposeThe purpose of this study was to evaluate a cooperation program in order to compare incidence of complications after peripherally inserted central catheter (PICC) placement between radiologists and technicians.Materials and methodsPICC placement technique was standardized with ultrasound-guided puncture and fluoroscopic guidance. Numbers of PICC delegated to technicians, and PICC placement difficulties, were prospectively recorded for the whole study population whereas complications such as PICC infection, deep venous thrombosis and catheter occlusion were prospectively recorded until PICC removal for a subgroup of patients included during one month.ResultsA total of 722 patients had PICC placement. There were 382 men and 340 women with a mean age of 66.8 ± 15.8 (SD) years (range: 18–94 years); of these, 442/722 patients (61.22%) were included in the cooperation program with 433/722 patients (59.97%) who effectively had PICC placement by technicians and 289/722 (40.03%) by radiologists. Technicians needed radiologists’ help for 23/442 patients (5.20%) including 6 failed PICC placement subsequently performed by radiologists. Twenty complications (20/77; 26%) were recorded in the subgroup of 77 patients studied for complications. No differences in complications rate were found between the 33 patients who underwent PICC placement by radiologists (6/33; 18%) and the 44 patients who underwent PICC placement by technicians (14/44; 32%) (P = 0.296). Complications included 8 PICC-related infections (8/77; 10.4%), 3 deep venous thromboses (3/77; 3.9%) and 9 catheter occlusions (9/77; 11.7%).ConclusionPICC placement led by technicians is feasible and safe without statistical difference in terms of complications compared to PICC placement made by radiologists.     

心电采集盒联合智能手机应用于PICC导管头端定位的效果评价

目的将心电采集盒联合智能手机应用于PICC导管头端定位,以期提高PICC导管头端的1次到位率。方法将180例行PICC置管的患者随机分为对照组和观察组,对照组采用超声引导结合MST下的PICC置管后拍X片确定导管头端位置,观察组在超声引导结合MST下的PICC置管时采用心电采集盒联合智能手机观察P波形态变化引导置管然后再拍X片确定导管头端位置。结果观察组PICC导管头端1次到位率为97.8%,显著高于对照组的90.0%(P0.05);2周内2组静脉炎发生率差异无统计学意义;观察组患者满意度为98.9%,显著高于对照组的91.1%(P0.05)。结论采用心电采集盒联合智能手机应用于PICC导管头端定位,不仅可提高PICC导管头端一次性到位率,减少医疗花费,而且可提高患者满意度,值得在临床推广。     

胃肠道恶性肿瘤患者行FOLFOX6方案化疗的护理

目的 探讨外周穿刺中心静脉导管(PICC)与便携式化疗泵在胃肠道恶性肿瘤FOLFOX6化疗方案中的应用.方法 58例胃肠道恶性肿瘤行FOLFOX6方案化疗患者,采用经外周静脉中心静脉置管结合便携式化疗泵给药,对患者进行相关护理及指导.结果 58例胃肠道恶性肿瘤患者应用PICC置管完成580次FOLFOX6化疗,一次插管成功率为91.3%,留置时间5～180 d,平均置管时间为62 d;其中10.3%出现静脉炎,3.4%出现导管堵塞,5.2%出现导管移位,未出现严重相关并发症.结论 胃肠道恶性肿瘤患者采用经PICC管结合化疗泵FOLFOX6方案化疗治疗,不仅提高化疗效果,降低毒副反应.同时减轻了护理工作量,值得临床推广.     

压迫法阻断颈内静脉预防PICC置管术中导管异位效果的Meta分析

目的对已发表的文献采用Meta分析方法系统评估压迫法阻断颈内静脉预防PICC置管时导管异位的效果。方法计算机检索中国学术期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、万方数据库、重庆维普数据库、PubMed等中英文数据库,检索关于压迫法阻断颈内静脉预防PICC患者置管时导管异位颈内静脉的临床随机对照试验,按照纳入与排除标准筛选文献、提取资料并评价纳入研究的质量后采用RevMan 5.3软件进行Meta分析,计算合并OR值及其95%CI,并进行发表偏倚评估及敏感性分析。结果 Meta分析共有10项符合条件的研究纳入,共有1 263例通过B超引导下压迫法阻断颈内静脉配合PICC导管置入手术和1 261例通过传统的"偏头法"阻断颈内静脉配合PICC导管置入手术。Meta分析结果表明:压迫法阻断颈内静脉配合PICC导管置入比常规"偏头法"阻断颈内静脉配合PICC导管置入显著降低了PICC置管术中导管异位颈内静脉发生率[OR=0.24,95%CI(0.14,0.42),P0.01]。结论通过B超引导采用压迫法阻断颈内静脉配合PICC导管置入,可降低PICC导管置入手术中导管尖端异位发生率,尤其是颈内静脉导管尖端异位发生率,在当前的证据下可推荐临床使用。     

改良直置式套管针替代导入鞘法在新生儿PICC置入中的应用

目的评价改良直置式套管针替代安全型撕裂式导入鞘法置入新生儿PICC的可行性和安全性。方法对135例新生儿应用20G直置式套管针置入PICC(观察组),与应用导入鞘置入PICC的128例新生儿(对照组)进行对比,比较两组穿刺时间、第1次换药时间、穿刺成功率及留置时间。结果两组穿刺时间、穿剌成功率及导管留置时间比较,差异无统计学意义(均P>0.05);观察组较对照组第1次换药时间延长(P<0.01)。结论在新生儿PICC置管中,经济简便的直置式套管针可以替代安全型撕裂式导入鞘使用。