化疗药物静脉外渗的循证管理

全球范围内每天都进行着数以百万计的化疗药物静脉输注,经静脉输注化疗药物会导致血管壁不同程度的损伤,甚至出现化疗药物静脉外渗。有研究报道,发疱剂外渗发生率在儿童中为11%,成人中为22%[1-2]。发疱剂外渗经外周静脉输注的发生率为0.1%～6.0%,经输液港输注的发生率为0.3%～4.7%[3]。如果不进行及时处理,化疗药物外渗可能导致组织坏死、功能受损和永久的形态     

1例静脉输液港导管断裂患者的护理及原因分析

正植入式静脉输液港又称植入式中央静脉导管系统,简称输液港,是一种可以完全植入体内的闭合静脉输液系统,主要由供穿刺的注射座及静脉导管两部分组成[1]。可用于长期高浓度输注化疗药物、完全肠外营养液、血制品以及血标本的采集等。输液港操作步骤少、维护少,增加了患者活动的自由[2]。随着输液港的广泛使用,导管相关并发症也随之出现。本科室于5月4日发生1例静脉输液港导管断裂病例,断裂的输液港港座     

中西医结合治疗霍奇金淋巴瘤非穿刺性损伤1例临床护理

<正>静脉输注化疗药物治疗霍奇金淋巴瘤(HL)在临床上被广泛应用。然而在治疗过程中,常发生化疗药物外渗的现象,尤其输注高渗性、刺激性药物等,对局部组织有刺激作用。药物一旦外渗,轻则局部皮肤肿胀疼痛,重则发生局部组织溃烂、坏死等。外周静脉给药导致化疗药物渗漏性损伤发生率0.5%~6.0%~[1]。尽管采用了保护性穿刺方法,但也有文献报道,药物渗漏与置管部位、输液时间以及药物种类有关~[2]。     

数字减影血管造影引导下植入式静脉输液港在癌症化疗患者中的应用

目的 探讨数字减影血管造影引导下植入式静脉输液港在癌症化疗患者中的应用效果。 方法 选取2014年2月-2016年2月肿瘤科收治的癌症化疗患者117例作为研究对象,采用随机数字表法将其分为2组,对照组60例在超声实时引导下植入静脉输液港,观察组57例在数字减影血管造影引导下植入静脉输液港,比较2组一次性穿刺成功率、患者对导管的耐受性及并发症的发生情况。 结果 观察组一次性穿刺成功率低于对照组(χ²=5.498;P=0.019);观察组患者对导管的耐受性好于对照组(χ²=4.009,P=0.045);2组输液港相关并发症的发生例数比较,差异无统计学意义(χ²=1.229,P=0.268)。 结论 经数字减影血管造影引导下植入静脉输液港,能够精准追踪输液港导管末端植入位置,提升患者对导管的耐受性,值得推广。     

1例植入式静脉输液港化疗药物外渗原因分析及护理

正植入式静脉输液港,又称植入式中心静脉导管系统(CVPAS),是一种埋植于皮下组织中,可以长期留置的中心静脉输液装置[1]。主要由供穿刺的注射座和静脉导管系统组成,可用于输注各种药物、补液、营养支持治疗、输血、血样采集等[2,3]。在输注过程中,化疗药物由于各种原因渗漏到皮下组织中,使注射部位出现疼痛、肿胀、红斑,此时检查静脉通路应无回血。如果化疗药物渗漏后处理不当,可引起局部皮肤变化,表     

思维导图联合小丑照护在儿童留置针静脉输液中的应用

<正>留置针静脉输液为需要长期输液的患者提供了便利,减轻患者的疼痛感^[1,2]。但对于儿童而言,由于其血管较成年人细,加之自控力弱,配合度低,易发生输液外渗、输液堵管、静脉炎等不良事件^[3,4]。因此对儿童留置针静脉注射的护理显得尤为重要。思维导图最先应用于教育领域,应用于临床中时,     

一例PICC导管体内破损发生化学药物迟发性损伤的护理

正经外周置入中心静脉导管(Peripherally inserted central catheter,PICC)是目前临床使用较多的输液工具,已成为化疗输液的安全通道[1]。PICC优点是极大减少了频繁静脉穿刺给患者带来的痛苦,导管不易滑出、避免化疗药物外渗、保留时间长等[2]。但有报道[3-4]指出,导管在长期使用过程中有0.67%~3.5%的患者会发生体外或体内不同部位的断裂,从     

植入式静脉输液港的临床应用及护理

植入式静脉输液港是一种可植入皮下,长期留置在体内的静脉输液装置,为需要长期输液治疗及化疗的病人提供了可靠的静脉通路。能将各种药物直接输送到中心静脉处,避免了高浓度、刺激性强的药物对一般静脉输液造成的外周血管硬化、栓塞及静脉炎,也有效防止了化疗时药物对血管壁的损伤、药物外渗等原因造成的局部组织坏死。我科于2004年10月以来引进了植入式静脉输液港,通过对患者精心护理及健康指导,并做好输液港的维护,确保了各项治疗顺利完成,并提高了患者的生活质量,临床效果满意。1临床资料我科2004年10月～2006年10月为5例肿瘤术后者植入…     

植入式输液港与PICC管在恶性肿瘤治疗中的应用比较

浙江大学医学院附属邵逸夫医院1998年6月在浙江省率先开展经外周中心静脉置管（peripherallyinsertedcentralcatheter,PICC）,自2002年起逐步使用植入式输液港。这两种方法均可提供中长期的静脉输液治疗,为中晚期肿瘤患者开辟了一条方便、安全有效的静脉通路,避免了化疗药物及高渗营养液外渗引起的静脉炎及组织坏死,但发现存在不少远期并发症[1]。     

1例输液港植入后纤维蛋白鞘形成致拔管病人的护理

植入式静脉输液港简称输液港,是一种可植入皮下长期留置在体内的静脉输液装置,适用于需要长期反复静脉化疗、输血、胃肠外营养及支持治疗的血液肿瘤病人。它与其他中心静脉导管相比具有护理维护简单、病人日常活动和自我形象不受影响等优点,既攻克了普通中心静脉导管无法长期留置的难题,又较好地解决了传统的外周静脉输液对病人较大活动时造成渗透和对血管的损伤[1]。但也存在着血栓形成、抽回血困难、注射座处并发症、导管断裂、药液外渗、相关性感染等问题[2,3]。我科遇到1例输液港植入22d即发现纤维蛋白鞘形成,而拔除输     

Reduction in plasma transfusion after enforcement of transfusion guidelines

BACKGROUND: The majority of fresh‐frozen plasma (FFP) is transfused in the United States in the management of acquired bleeding disorders. The prothrombin time (PT), and its derivative the international normalized ratio (INR), is the most common test used to detect the presence and gauge the severity of these disorders. Observation studies have shown that the PT correlates poorly with clinical bleeding and that transfusion of plasma often achieves no measurable change in the INR nor is of any known clinical benefit. STUDY DESIGN AND METHODS: Data on FFP and red blood cell transfusions and measures of hospital activity and mortality were collected over a 12‐year period. The first 3 years were baseline years, the next 3 years were physician education years, and in the last 6 years all requests for FFP were screened. Orders were discouraged if the INR was less than 2.0 in the absence of active bleeding and the use of vitamin K was encouraged if the patient was taking warfarin. RESULTS: This program ultimately resulted in an approximate 80% reduction in transfused FFP using the average of the baseline years compared to the average of the last 3 years (157 ± 19 units FFP/1000 discharges vs. 30 ± 15, p < 0.01, respectively). Overall, hospital activity remained largely unchanged or increased. No unexpected bleeding was reported, which was attributed to a failure to transfuse FFP, and inpatient mortality rate decreased during these 12 years. CONCLUSIONS: A program of engagement and interdiction using evidence‐based guidelines can successfully decrease the use of FFP without any observable increase in unexpected bleeding.     

输血病历质量分析与医疗安全

目的 :加强医院病历质量规范管理,分析输血病历存在的问题,改进和完善输血病历的质量,以提高临床输血的安全性。方法:根据《病历书写基本规范》、《临床输血技术规范》等相关制度要求,制定输血病历质量检查标准,对3年中所有归档的1 856份输血病历进行质量分析,从中总结输血病历中存在的不足,并提出防范的相关对策。结果:输血病历质量符合检查标准的占83.1%(1 543/1 856),不符合检查标准占16.9%(313/1 856),不达标的输血病历在逐年下降;非手术科室输血病历达标率明显高于手术科室,两者比较有统计学差异(P     

Risks of transfusion

Each year, more than 4 million patients receive a blood transfusion in the United States to control symptoms associated with anemia, coagulopathy, thrombocytopenia, or some combination thereof. In each of these cases, the physician and the patient must weigh the potential benefits of the transfusion along with the associated risks. To assess accurately the risk:benefit ratio and to discuss this with the patient, the physician must be familiar with the range of adverse transfusion outcomes and the current estimates of their frequency. Most important, during the past decade the risk profile of transfusion has changed significantly. Transfusion-transmitted disease, although still a rare outcome of transfusion, is no longer an overriding concern in transfusion safety considerations; however, risks such as hemolysis, transfusion-related lung injury, and anaphylaxis continue to represent significant concerns and are relatively more common than the transmission of infectious diseases after transfusion. Against this background, the development of a national hemovigilance system, designed to evaluate more accurately transfusion adverse outcomes in the United States, will require greater precision and reliability in the assessment of adverse transfusion outcomes by clinicians if the proposed benefits of this system are to be realized.     

Blood transfusion

Patients in hospitals receive 10,000 transfusions every day due to blood disorders, trauma and disease. Nurses play a significant role in the safe administration of blood and its products. This guide describes the nursing care of the patient before, during and after a blood transfusion.     

Blood transfusion

This Clinical Update considers issues relating to transfusion of blood components--erythrocytes, platelets and plasma products--obtained from human donors.