Infrastructure Requirements for an Urgent-Start Peritoneal Dialysis Program

Patients with advanced chronic kidney disease nearing dialysis but without pre-established access almost uniformly initiate dialysis with a temporary central venous catheter. These catheters are associated with high rates of infection and flow disturbances, requiring removal and subsequent replacement. Many of these patients might be candidates for peritoneal dialysis (PD), but because of the absence of prior catheter placement, the default initial modality is hemodialysis. Recent reports, however, have demonstrated the feasibility of initiating PD urgently despite the late referral for access placement. Urgent-start PD clinical pathways require a unique infrastructure and treatment approach. This article reviews the salient features required to establish an urgent-start PD program.     

急诊介入手术的护理31例

目的　正确掌握危重病人急诊介入手术的护理方法 ,是提高急诊介入手术抢救成功率的重要因素。方法　对 31例鼻腔大出血、支气管大咯血、肝癌自发性破裂出血、脑动脉瘤伴蛛网膜下腔出血、下肢动脉栓塞的急诊病人介入手术期护理作回顾性分析。结果　 31例急诊介入手术病人 ,抢救成功。结论　应该开展急救护理 ,密切配合手术医生 ,把握病情变化 ,从而有效地提高介入手术抢救成功率 ,减少并发症和死亡率。     

Feasibility of electromagnetically guided transjugular intrahepatic portosystemic shunt procedure

Objectives: To develop an electromagnetic navigation technology for transjugular intrahepatic portosystemic shunt (TIPS) creation and translate it from phantom to an in-vivo large animal setting.

Material and methods: A custom-designed device for TIPS creation consisting of a stylet within a 5 French catheter as well as a software prototype were developed that allow real-time tip tracking of both stylet and catheter using an electromagnetic tracking system. Feasibility of navigated TIPSS creation was tested in a phantom by two interventional radiologists (A/B) followed by in-vivo testing evaluation in eight domestic pigs. Procedure duration and number of attempts needed for puncture of the portal vein were recorded.

Results: In the phantom setting, intervention time to gain access to the portal vein (PV) was 144?±?67?s (A) and 122?±?51?s (B), respectively. In the in-vivo trials, TIPS could be successfully completed in five out of eight animals. Mean time for the complete TIPS was 245?±?205?minutes with a notable learning curve towards the last animal.

Conclusions: TIPS creation with the use of electromagnetic tracking technology proved to be feasible in-vitro as well as in-vivo. The system may be useful to facilitate challenging TIPSS procedures.     

吸入镇静在重症医学科的应用

重症医学科（ICU）镇静治疗已成为一项基本的治疗措施。最近文献报道ICU应用吸入镇静在唤醒时间、简单遵医嘱动作时间上要短于持续静脉注射镇静,而且有心脏、大脑等器官功能保护作用。目前国内ICU尚未见吸入镇静报道,本文将对吸入镇静在ICU中的应用做一综述。     

Ultrasound-guided peripheral intravenous access in the intensive care unit

Purpose

Central venous catheters continue to be a popular means of maintaining vascular access in surgical intensive care units despite well-described complications. With edema, obesity, and difficult to visualize veins potentially affecting the surgically ill, inability to obtain peripheral intravenous (PIV) access may hinder the clinician's ability to avoid the use of central lines. With ultrasound gaining increased popularity for obtaining vascular access, we evaluated its utility in ultrasonagraphically placing PIV catheters for the purposes of either avoiding central venous access or removing central venous catheters.

Materials and Methods

We performed a retrospective cohort review of our requests for ultrasound-guided PIV access in the intensive care unit between September 2007 and February 2008.

Results

Over a 6-month period, 77 requests for ultrasound-guided PIV access were made for 59 surgical, trauma, and cardiothoracic intensive care unit patients. Reasons for inability to obtain PIVs through standard means included edema (95%), obesity (42%), IV drug abuse history (8%), and emergency access (4%). Of the 148 PIV lines that were requested, 147 PIV catheters were successfully placed (99%). Of these, 105 PIV catheters were placed on the first attempt (71%). Complications of PIVs included IV infiltration (3.4%), inadvertent removal (2.7%), and phlebitis/cellulitis (0.7%). As a result of placing these PIV catheters, 40 central lines were discontinued and 34 central lines were avoided. The average number of line days at the time of central venous catheter removal was 11 ± 11 days.

Conclusion(s)

In intensive care unit patients who do not require central venous lines, ultrasound-guided PIV access can have a high placement success rate and can result in fewer central line days and/or less reliance on central venous catheters for access-only purposes.     

静脉麻醉镇痛法在患者胃镜检查中的应用效果观察及护理

目的观察静脉麻醉镇痛法在患者胃镜检查中的应用效果,以便提高患者胃镜检查的依从性。方法对845例需胃镜检查的患者实施静脉镇痛麻醉,观察胃镜检查过程中患者镇静程度、遗忘程度及对麻醉镇痛效果的满意程度。结果845例患者顺利完成胃镜检查,均未出现并发症,且在检查完毕后10min内恢复清醒。镇静程度2级718例,占85.0%（为最理想镇痛效果）;术后722例（85.4%）完全遗忘;794例（94.0%）患者表示对镇痛效果满意。结论静脉麻醉镇痛实施胃镜检查可减轻患者的痛苦,提高其检查依从性,从而确保了检查顺利进行,提高了诊断检查的成功率。     

Collaborative Practice

Collaborative Practice provides a forum for healthcare professionals to share expertise and enhance communication.     

Transitioning to the Electronic Medical Record: Its Impact on Nursing Care in Interventional Radiology

Electronic medical records (EMRs) are being integrated into the health care industry. It is widely believed that EMRs will improve the overall quality of patient care through the promotion of both patient safety and satisfaction. The introduction of EMRs at Boston Children's Hospital created a multitude of challenges for the nurses in the hospital's interventional radiology (IR) department. Despite the difficulties the new EMR presented, the IR nurses were able to safely transition their documentation to the electronic format.     

Variability in management of implantable ports in oncology outpatients

Purpose of the researchTo describe the variability in practice regarding the management of vascular access ports in adult oncology patients at Spanish outpatient clinics and to evaluate its compliance with the recommended procedural guidelines.Methods and sampleThree e-mailings or three postal mail-outs were sent to all Spanish outpatient clinics, in accordance with the hospital's preference. An additional fourth postal mail-out was made to all units. In total 185 units at Spanish outpatient clinics out of a total 256 completed the survey questionnaire.Key resultsA number of variations exist in the techniques used for insertion, withdrawal of needle from vascular access ports, blood sampling and unblocking procedure. There is considerable agreement in relation to the use of a special beveled needle, the use of gloves in the access and withdrawal procedures and checking of reservoir permeability by aspirating blood. In most cases, sterile gloves are used but there is a lesser occurrence of both scrubbed hands and correct antiseptic use.ConclusionsThere are considerable differences in the management of the vascular access ports in terms of the recommendations published in the main international guidelines, though these are based on low level evidence. The results highlight the need for further quality studies in ports use and manipulation to lessen the variability between published recommendations and clinical practice.     

护理团队文化建设与管理实践

优秀的护理团队文化对护理团队的成长与发展具有至关重要的作用,在协和护理传统文化的基础上,通过不断创新与发展,我院在新时期形成了符合时代特点、富有自身特色的护理团队文化建设模式与管理方法。     

我院护理人才梯队建设实践

目的探求护理人才梯队建设的方向与措施。方法对护理人员按照成长型,骨干型和专家型方向进行培养。结果经过10余年的努力,我院护理人员结构趋于合理:博士1名,硕士13名,本科144名,大专608名,大专以上学历占全院护士总数的50.49%。近3年,发表论文497篇,开设我院第一个护理专家门诊。结论人才的培养与专业学科的发展紧密结合,人才梯队建设可极大地促进护理学科的发展。     

Prehospital use of heparin locks: A cost-effective method for intravenous access

Intravenous (IV) infusions were ordered in nearly 95% of paramedic runs called into a busy base station hospital. Most of the patients received IV lines for either prophylactic access or administration of single or multiple bolus medications. In this group of patients, the application of a heparin lock injection port directly to the IV catheter, followed by the injection of 10 units of heparin, was evaluated. Of 102 consecutive patients treated in the field, 98 (97%) were treated with heparin locks only. The total number of patients requiring an IV infusion drip (either by paramedics or in the emergency department of the receiving hospital) was 20 (20%). If all 102 patients had received conventional IV drip infusions, the total patient equipment charges would have been $4,610.40. The actual charges for all patients in this series, either with heparin locks or IV infusion sets, was $1,846.14--a 60% savings. The results of the study indicate that the heparin lock is a safe, convenient, and cost-effective method for maintaining IV access in the prehospital environment.     

Acute Gastrointestinal Bleeding: The Role of Diagnostic and Interventional Radiology

The goal of this review article is to provide an overview to the initial management, classification, diagnosis, and treatment of acute gastrointestinal bleeding with emphasis on the use of radiology modalities and intervention. Special attention was placed on highlighting the nursing staff's imperative role during all phases of care in these cases.