老年患者外周静脉状况及静脉输液通道使用情况调查分析

目的:了解老年患者外周静脉状况及静脉输液通道使用情况,为老年患者静脉输液的血管选择及保护提供依据。方法:研究者自行设计调查表,对222例老年患者进行调查,评估患者的外周静脉状况,了解患者静脉输液治疗的药物种类和静脉输液通道使用情况,对不同静脉输液通道进行比较分析。结果:老年患者随着年龄的增长,外周静脉充盈程度逐渐下降,尤其是手背静脉和前臂静脉的充盈程度下降明显。老年患者住院期间静脉输液治疗率高达94.59%,其中有64.89%的患者静脉输注过BCEG(即TPN、化疗药、脱水剂、血管活性药)中至少一类药物。老年患者静脉输液时,43.69%的患者使用静脉留置针,49.10%的患者使用头皮针,36.48%患者使用中心静脉输液途径。结论:老年患者外周静脉充盈程度低,应根据患者的血管情况和治疗方案,合理选择静脉输液途径,减少输液对血管造成的损害,减轻患者的痛苦,有效提高临床静脉输液护理质量。     

A new reliable tool (PVC assess) for assessment of peripheral venous catheters

Rationale and aims To evaluate the extensive use of peripheral venous catheters (PVCs), including catheter‐related complications, a reliable tool for PVC assessment is needed. The aim of this study was to develop such a tool to evaluate PVCs in relation to management, documentation and signs and symptoms of thrombophlebitis (TH), as well as to determine its inter‐rater and test‐retest reliability. Method The tool development included confirmation of content and face validity. Two groups of registered nurses used the new tool (PVC assess ) to assess PVC management and signs of TH independently. Group A (n = 3) assessed 26 items in 67 PVCs bedside (inter‐rater reliability). Group B (n = 3) assessed photographs (67 PVCs, 21 items) of the same PVCs as those in Group A with a 4‐week interval (test‐retest reliability). Proportion of agreement P(A) and Cohen's kappa were calculated to evaluate inter‐rater and test‐retest reliability. Results Among nurses assessing PVCs at bedside, the P(A) was good to excellent (0.80–1) in 96% of the items in PVC assess . In 80% of the items kappa was substantial to almost perfect (0.61–1). TH sign erythema fell into the fair range (kappa = 0.40). In test‐retest reliability analysis the P(A) was within the good and excellent range (0.80–1.0) and kappa varied from moderate to almost perfect (0.41–1.0) in 95% of the items. One item ‘outer dressing is clean’ was in fair range (0.21–0.40). Conclusions The PVC assess instrument shows satisfactory inter‐rater and test‐retest reliability. Reliability tests on reviewing documentation remain to be performed.     

外周静脉短导管选择与置入的最佳证据分析

目的遴选并获取外周静脉短导管选择与置入的相关证据,并对最佳证据进行总结。方法检索Best Practice(BMJ)、Joanna Briggs Institute循证卫生保健中心数据库、Cochrane Library、加拿大安大略注册护士协会、美国静脉输液护理学会、美国指南网、英国国家临床医学研究所指南库及医脉通临床指南网等关于外周静脉短导管选择与置入的所有证据,包括临床实践指南(近5年)、证据总结、系统评价等。由2名研究者对纳入的文献质量进行独立评价,并对符合质量标准的文献进行证据提取。结果结合专业人员的判断,总结出18条外周静脉短导管选择与转入方面的最佳证据。包括输液适应症、导管及穿刺部位的选择、患者教育、止血带及穿刺部位准备、麻醉剂的应用、置管困难或穿刺失败的措施、导管更换及敷料固定8个方面。结论临床护理人员应把握输注适应症、谨慎选择目标血管,保证患者安全;同时,在置入环节对置管困难患者积极尝试可视化、加热及无痛技术,提高置管成功率,减少患者不适。     

Effect of rapid cycle deliberate practice in peripheral intravenous catheters insertion training: A simulation experimental study

Aimto compare the effect of rapid cycle deliberate practice simulation training with skill-training simulation on peripheral intravenous catheter insertion for Licensed Practical Nurses.BackgroundThe use of peripheral intravenous catheters is associated with high rates of complications, although it is widely used in clinical practice. Training strategies to ensure good performance can minimize the risks inherent to this procedure.DesignA randomized simulation experimental pre-post interventional study.MethodsSixty participants were allocated to intervention (n = 30) or control (n = 30) groups. Participants allocated to the intervention group were trained through the Rapid cycle deliberate practice simulation strategy, while participants in the control group were trained through the skill-training simulation strategy. A pre-test was applied before any intervention and a post-test after intervention. The primary outcome was the performance in the peripheral intravenous catheter insertion skill. The comparison of correct performance in the tests was analyzed intergroup and intragroup. The effect size of the interventions was also analyzed. The t-Student and Mann-Whitney tests compared the difference between the groups. The training effect was calculated by Cohen's dm and Glass's Δ measures.ResultsPerformance between the pre-post-test increased from 59.4% to 96% (p < 0.001) in the intervention group and from 57.8% to 93.5% in the control group (p < 0001). There was no statistical difference between the groups after intervention (p = 0225). Cohen's dm measurement was 2.95 and 3.59 in the control and intervention groups, respectively.ConclusionsThe rapid cycle deliberate practice simulation strategy resulted in Licensed Practical Nurses’ performance improvements in peripheral intravenous catheter insertion, evidenced by the increase of correct performance actions in the post-test compared to the pre-test. However, with no statistical difference compared to the skill-training simulation strategy.     

Predisposing factors to phlebitis in patients with peripheral intravenous catheters: a descriptive study

PURPOSE: The purpose of this study was to investigate the predisposing factors in the development of phlebitis in peripheral intravenous (IV) catheterization sites in patients treated with a variety of IV infusion solutions and drugs. DATA SOURCES: Systematic observation of 568 IV sites inserted for fluid infusion and drug administration in 355 patients in the Department of General Surgery of a University Hospital in Turkey. A data collection tool was based on standards established by the Infusion Nurses Society. Patients' infusion sites were monitored every 24 h during treatment and for 48 h after discontinuation of the IV. CONCLUSIONS: In contrast to the usual findings in the literature, the authors found that infusion through an infusion pump and insertion of catheters in the veins around the elbow increased the risk of phlebitis. Also, the number of times infusions were started led to an increased rate of phlebitis. However, conflicting results were obtained about the relation between phlebitis, gender, and catheter size. IMPLICATIONS FOR PRACTICE: Phlebitis causes sepsis, pain, additional diagnostic investigations, and treatments, and may lead to increased duration of hospitalization, patient's stress level, and financial burden, as well as increasing staff workload. Advanced practice nurses need to be aware of the factors that increase the likelihood of phlebitis and take appropriate measures to prevent it.     

中线导管在老年患者经导管主动脉瓣置换术围术期中的应用效果

目的探讨中线导管在老年患者经导管主动脉瓣置换术(TAVR)围术期中的应用效果。方法将2017年7月至2019年2月我院心血管外科收治的60例实施TAVR手术治疗的老年心脏瓣膜疾病患者随机分为外周静脉留置针(PIV)组与中线导管(MC)组,各30例。比较两组的并发症发生情况、留置时间及总穿刺次数。结果PIV组的静脉炎、静脉渗漏、导管堵塞发生率均高于MC组(P<0.05)。PIV组的留置时间短于MC组,总穿刺次数多于MC组(P<0.05)。结论MC在老年患者TAVR围术期中的应用效果显著,可减少患者穿刺痛苦,降低静脉输液并发症发生率。     

Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins

Introduction

Current European Resuscitation Council (ERC) guidelines recommend intraosseous (IO) vascular access, if intravenous (IV) access is not readily available. Because central venous catheterisation (CVC) is an established alternative for in-hospital resuscitation, we compared IO access versus landmark-based CVC in adults with difficult peripheral veins.

Methods

In this prospective observational study we investigated success rates on first attempt and procedure times of IO access versus central venous catheterisation (CVC) in adults (≥18 years of age) with inaccessible peripheral veins under trauma or medical resuscitation in a level I trauma centre emergency department.

Results

Forty consecutive adults under resuscitation were analysed, each receiving IO access and CVC simultaneously. Success rates on first attempt were significantly higher for IO cannulation than CVC (85% versus 60%, p = 0.024) and procedure times were significantly lower for IO access compared to CVC (2.0 versus 8.0 min, p < 0.001). As for complications, failure of IO access was observed in 6 patients, while 2 or more attempts of CVC were necessary in 16 patients. No other relevant complications like infection, bleeding or pneumothorax were observed.

Conclusions

IO vascular access is a reliable bridging method to gain vascular access for in-hospital adult patients under resuscitation with difficult peripheral veins. Moreover, IO access is more efficacious with a higher success rate on first attempt and a lower procedure time compared to landmark-based CVC.     

老年结直肠癌化疗患者2种中心静脉置管真实体验的质性研究

目的探讨老年结直肠癌化疗患者先后置入经外周静脉中心静脉置管(Peripherally Inserted Central Catheter,PICC)和植入式中心静脉输液港(Totally Implantable Venous Access Ports,TIVAP)2种导管的真实体验。方法采用现象学研究方法,对12例先后置入TIVAP和PICC 2种中心静脉导管的老年结直肠癌化疗患者进行半结构访谈,应用Colaizzi现象学资料七步分析法分析资料。结果通过访谈归纳出3个主题,分别为:老年结直肠癌化疗患者置入PICC和TIVAP后的体验,导致老年结直肠癌化疗患者二次置管的原因,老年结直肠癌化疗患者对PICC和TIVAP的评价。结论医护人员置管前应实施充分的评估及规划,协助患者选择合适的输液工具,通过积极干预降低导管相关并发症,减少非计划拔管。关注患者不同阶段的心理变化,给予针对性的心理支持。各级部门应加强培训力度,优化导管使用过程;同时应注重对患者健康教育,提供多渠道、多形式、正规、适时、适度的宣教,以提升患者带管过程中的真实体验。     

Selection of appropriate venous access for the collection of peripheral blood progenitor cells by experienced apheresis nurses

Peripheral blood progenitor cells (PBPC) have been extensively used to restore hematopoiesis after myeloablative chemotherapy. While collection regimens designed for optimal mobilization of PBPC are becoming standardized, the ideal venous access option for collection remains unresolved. The purpose of this study was to determine if the venous access of patients could be accurately assessed and appropriate intervention, if necessary, electively undertaken prior to PBPC collection. In this prospective study, 95 consecutive patients about to undergo PBPC collection were evaluated at time of referral to determine the type of venous access necessary for adequate PBPC collection. There were three possible interventions: 1. No access device for patients determined to have an adequate antecubital vein for apheresis access. 2. Insertion of a double lumen Quinton PermCath for those patients with poor antecubital veins. 3. Insertion of a double lumen Hickman catheter for patients with adequate antecubital veins for apheresis but poor peripheral veins for chemotherapy administration. The blood and marrow transplant nurse coordinator evaluated the patients' veins. Of the 95 patients having 192 PBPC collections, 65 were collected using antecubital veins, 21 were collected from PermCaths, and 9 from Hickman catheters. All patients predicted to collect peripherally did so and achieved flow rates equivalent to the PermCath. No patient required urgent line placement at time of PBPC collection. There was no difference in the number of cells collected between the three groups. The result of this study strongly supports a policy of appropriate venous access based on patient vein assessment by experienced nurses. J. Clin. Apheresis 14:51–56, 1999. © 1999 Wiley-Liss, Inc.     

对乳腺癌中心静脉置管患者实施风险管理的实践与效果

目的探讨对乳腺癌中心静脉置管患者实施护理风险管理的效果。方法对乳腺癌中心静脉置管患者实施护理风险管理，并对比实施风险管理前后患者的临床资料。结果实施风险管理后，护理缺陷和投诉下降、患者满意度提高、置管期间护理风险发生率降低（P〈0．05）。结论对乳腺癌中心静脉置管患者实施风险管理可提高护理人员对置管风险的认识，减少护理缺陷和投诉，降低护理风险，提高患者满意度。