两种敷料固定颈内静脉穿刺导管的效果观察

[目的]观察两种敷料固定颈内静脉导管的效果。[方法]将169例全身麻醉术后颈内深静脉置管病人随机分为对照组83例和观察组86例,观察采用3MTegadermTM1685透明敷料,对照组采用3M4008透明敷料。比较两组导管敷料维持时间、发生卷边和松脱情况。[结果]观察组敷料更换后维持时间长于对照组,发生卷边或松脱少于对照组(P0.05)。[结论]全身麻醉术后颈内深静脉置管病人采用3MTegadermTM1685透明敷料进行固定的效果优于4008透明敷料固定。     

3M透明敷料在深静脉置管中的应用

目的 减少深静脉置管并发症,延长置管时间.方法 使用3M透明敷料或无菌方纱,分别对38例和42例患者进行深静脉置管穿刺点的固定保护,观察两组患者静脉炎发生情况.结果 两组患者静脉炎发生情况差异有统计学意义(P<0.05).结论 采取3M透明敷料固定保护深静脉置管穿刺点,可降低静脉炎的发生率,延长深静脉置管的时间.     

中心静脉置管局部换药敷料的比较研究

目的探讨中心静脉置管患者局部不同季节换药的最佳敷料,减少局部感染并发症,使患者舒适,降低医疗费用。方法将中心静脉置管的患者随机分为2组,每组各100例,透明敷料组以一次性透明敷料覆盖固定。无菌纱布组以传统的无菌纱布覆盖固定。对两组局部感染情况、与冬春季与夏秋季感染的关系及敷料留置的时间进行分析、比较。结果透明敷料组局部感染9例,无菌纱布组局部感染2例,两组均无严重感染病例,差异有显著意义(P<0.05),透明敷料组夏秋季局部感染率明显高于春冬季;两组敷料在使用时间上无菌纱布组明显长于透明敷料组(P<0.05);两组敷料在消耗费用上,透明敷料的换药费用明显高于无菌纱布的换药费用,尤其在夏秋季。结论两组方法对比表明,中心静脉置管局部换药应根据患者的具体情况和季节的不同选择敷料,作者推荐春冬季可选择透明膜敷料,夏秋季使用无菌纱布(棉质)敷料。     

自黏弹性绷带用于预防PICC置管术后出血的效果观察

[目的]观察自黏弹性绷带用于预防经外周静脉穿刺中心静脉置管(PICC)术后出血的效果.[方法]42例行PICC置管肿瘤病人随机分成对照组和观察组,每组21例,PICC管置管成功后对照组采用常规3M透明敷料加纱布固定,观察组在3M透明敷料加纱布固定的基础上,加用自黏弹性绷带固定.观察并比较两组病人PICC穿刺成功后12 h和24 h出血情况.[结果]观察组12 h和24 h出血5例(23.8%)和8例(38.1%),对照组12 h和24 h出血19例(90.5%)和21例(100.0%). [结论]3M透明敷料加纱布再加自黏弹性绷带预防PICC置管术后24 h内出血效果明显.     

康惠尔敷帖在中心静脉置管中的应用

[目的]探讨两种敷料换药对中心静脉置管穿刺点局部的影响。[方法]对60例锁骨下静脉穿刺病人用3M公司生产的无菌透明敷帖换药,列为对照组;同期对60例锁骨下静脉穿刺病人用康惠尔敷帖换药,列为实验组。比较两组穿刺点局部皮肤过敏及感染率。[结果]实验组穿刺点局部皮肤过敏及感染率显著低于对照组(P<0.05)。[结论]使用康惠尔敷帖换药可降低中心静脉穿刺点局部皮肤过敏及局部感染率。     

透明敷料维护经外周静脉中心静脉置管的效果

目的探讨透明敷料(型号为Ⅳ3000)在经外周静脉中心静脉置管(peripherally inserted central catheter,PICC)维护中的应用效果。方法将100例PICC置管后的患者按随机数字表法分为观察组和对照组各50例,观察组患者采用透明敷料(标准型10cm×12cm)固定穿刺部位,对照组患者采用普通透明敷料固定穿刺部位,观察并比较两组患者在皮肤过敏、置管处局部感染、敷料保留时间及患者主观舒适度方面的差异。结果观察组患者的敷料保留时间及主观舒适度均优于对照组(P<0.05),皮肤过敏及局部感染的患者例数明显少于对照组,差异有统计学意义(P<0.05)。结论 透明敷料在PICC置管后的维护中,具有保留时间长、有效防止感染、明显改善患者的舒适度及生活质量等优点,值得在临床推广应用。     

中心静脉置管无缝线固定方法的效果研究

目的 研究分析无缝线固定方法在肿瘤患者锁骨下静脉置管化疗中的应用效果.方法 随机选取我科2012年6月至2013年6月行锁骨下静脉置管术肿瘤化疗患者240例,随机分为对照组114例和实验组126例,两组患者的年龄、性别、诊断、病程、置管时间比较,差异无统计学意义(P>0.05).对照组置管时穿刺部位予4#(2-0 USP 3 Metric)蚕丝线缝合加3M无菌透明敷料(9546HP)固定,实验组置管时穿刺部位不缝合,只用3M无菌透明敷料(9546HP)加无纺布敷料﹝优韧宁粘贴型敷料10 cm×10 cm(法国优格)﹞固定.比较两组患者的疼痛与不适感、导管感染、导管阻塞、导管脱出、皮肤破损、敷料松脱等并发症发生率和更换敷料次数及费用的差异,并进行统计学分析.结果 实验组比较对照组在疼痛与不适感、导管感染、皮肤破损等并发症发生率和更换敷料的次数及费用方面明显降低(P<0.05).结论 肿瘤患者中心静脉置管化疗时予无缝线固定方法可避免穿刺时缝合、置管后缝线牵拉与拔管时拆线的痛苦,减轻了不适感,减少了皮肤破损和导管感染的发生率,降低了更换敷料次数和费用.两组患者的导管脱出发生率、导管堵塞率比较,差异无统计学意义(P>0.05).因此,无缝线固定方法是一种简便、安全、经济、并发症少的锁骨下中心静脉置管固定方法.     

水胶体透明敷料在锁骨下静脉置管导管固定中的应用研究

目的观察应用水胶体透明敷料护理锁骨下静脉置管的效果。方法将153例锁骨下静脉置管的患者按随机数字表分为对照组79例和观察组74例,对照组应用3M HP Tegaderm TM敷料固定导管,观察组用水胶体透明敷料固定导管,比较两组患者置管并发症发生率、非计划性拔管情况和换药总费用及换药工作量。结果观察组置管并发症发生率和非计划性拔管发生率均显著低于对照组;观察组换药频率和换药总时间低于对照组,差异有统计学意义,单次换药时间、换药总费用两组比较无统计学意义。结论水胶体透明敷料能更好地维护锁骨下静脉置管,减少护理工作量。     

3MCHG敷贴预防PICC穿刺点感染的研究

[目的]探讨3MTMTegadermTMCHG敷料预防经外周静脉置入中心静脉导管(PICC)穿刺点感染的效果。[方法]选择2014年1月—2015年3月在本科行PICC置管病人160例,随机分为对照组和观察组,对照组采用3MTMTegaderm透明敷料固定,观察组采用3MTMTegadermTMCHG抗菌透明敷料固定。比较两组病人PICC穿刺点的感染率。[结果]观察组PICC穿刺点感染率为2.50%,明显低于对照组(15.00%),两组比较,差异有统计学意义(P0.05)。[结论]对于极易出汗、渗血和化疗后的病人,PICC穿刺点选择3MTMTegadermTMCHG抗菌透明敷料换药,可以降低穿刺点感染率,提高导管留置的安全性。     

改进头皮静脉留置针留置方法的效果观察

[目的]观察改进头皮静脉留置针留置方法的效果。[方法]将105例应用头皮静脉留置针的患儿随机分为两组,对照组50例使用肝素帽、盐水封管方法,将3M透明敷贴盖住留置针进行固定,观察组55例使用无菌输液接头封管,先用输液贴盖住留置针针眼,后覆盖3M透明敷贴,留置期间使用弹力帽作头部固定。比较两组患儿头皮静脉留置针留置时间及回血堵管、静脉炎发生情况。[结果]观察组病人患儿头皮静脉留置针留置时间长于对照组,回血堵管、静脉炎发生率低于对照组。[结论]应用无菌输液接头封管可降低回血堵管率;改进的头皮静脉留置针留置方法可有效避免留置针脱出,降低静脉炎发生,延长留置针的使用时间。     

Remote magnetic navigation-assisted catheter ablation enhances catheter stability and ablation success with lower catheter temperatures

Background: It has been suggested that remote magnetic navigation (RMN) may provide enhanced catheter stability and substrate contact to aid in ablation. To date, no study has examined this claim. Accordingly, we compared the characteristics of the successful ablation of atrioventricular reentry tachycardia (AVNRT) using RMN with a matched population ablated using a conventional (CON) manual approach.
Methods: Sixteen patients who underwent RMN-assisted ablation of typical AVNRT were matched with 16 patients who had a CON-AVNRT ablation.
Results: All patients had successful slow pathway modification without complication. The mean catheter temperature achieved with the successful ablation was significantly lower with RMN than with CON (42 ± 7°C vs 47 ± 3°C, P ≤ 0.05). Time to junctional tachycardia (JT) was significantly earlier (5.7 ± 4.1 s vs 11.2 ± 8.9 s, P ≤ 0.05) and variation in catheter temperature with the successful ablation (0.89 ± 0.45 vs 1.45 ± 0.49, P < 0.01) was significantly reduced in the RMN group than in the CON group. There was no significant difference between RMN and CON in terms of the total number of lesions and the mean power achieved during the successful lesion.
Conclusions: Although the construction of the ablation catheters is similar, ablations with RMN catheters resulted in a lower mean temperature, earlier time to JT, and less variability of temperature during ablation, suggesting greater catheter stability. This study indicates that ablation with RMN can achieve success with lower catheter temperatures.     

Urethral catheter audit

An audit was undertaken in one children's hospital to evaluate practice relating to indwelling urethral catheterisation of children. The records of 47 patients admitted over an eight-month period were reviewed to obtain information regarding catheter use. A questionnaire was sent to 384 qualified nursing staff and 174 medical staff to identify what training they had received and their level of knowledge about catheterisation practice. In the absence of national guidelines for urethral catheter care, locally developed standards were used for comparison in the audit. Timing and location of catheter insertion were noted. Duration of catheterisation ranged from one to 38 days but in 13 per cent of cases it was not possible to identify duration because of lack of documentation. Both nursing and medical staff reported low levels of training and areas of limited understanding of practice. A majority of nursing staff had never catheterised a child or did so less than once a year. Novel approaches to education are required to maintain knowledge and skills in this area of practice. Documentation needs to improve and include the use of computerised care plans and catheter care pathways.     

Urethral catheter selection

Many patients undergo urethral catheterisation. Selecting the most appropriate catheter for an individual patient requires knowledge and a practical understanding of the types of catheter available. A number of factors should be considered in catheter selection, including patient needs, indications for catheterisation, the type of material, the balloon size and the length and diameter of the catheter. The aim of this article is to provide information that will clarify some of the concerns nurses might have regarding urethral catheterisation.     

Urinary catheter management

The use of urinary catheters should be avoided whenever possible. Clean intermittent catheterization, when practical, is preferable to long-term catheterization. Suprapubic catheters offer some advantages, and condom catheters may be appropriate for some men. While clean handling of catheters is important, routine perineal cleaning and catheter irrigation or changing are ineffective in eliminating bacteriuria. Bacteriuria is inevitable in patients requiring long-term catheterization, but only symptomatic infections should be treated. Infections are usually polymicrobial, and seriously ill patients require therapy with two antibiotics. Patients with spinal cord injuries and those using catheters for more than 10 years are at greater risk of bladder cancer and renal complications; periodic renal scans, urine cytology and cystoscopy may be indicated in these patients.