血液透析导管材料选择及感染的防治

背景：能够抑制生物被膜形成的高分子血液透析导管材料对预防高分子导管相关感染具有重要意义。目的：综述血液透析导管材料的选择及其引发感染的相关因素及防治。方法：应用计算机检索CNKI、PubMed数据库2005/2011与血液透析导管材料及其引发感染的防治相关的文献。结果与结论：良好的血管通路是保证血液透析顺利进行和透析充分的首要条件,由导管引发的感染也十分常见,其中导管材料选择、操作是否无菌、感染原因、部位、感染后处理是关键因素,直接影响到是否可以深静脉留置导管成功且能否稳定可靠。目前倾向首选硅胶类或聚氨基甲酸乙酯导管,高分子材料透析导管中带涤纶套永久性双腔血液透析导管长期留置具有不影响血流动力学、不需要反复进行皮肤穿刺、良好的抗感染性能、留置取出简单等优点,是老年透析、严重心血管疾患及肾移植过渡期患者的最佳选择。     

血液透析中长期留置导管并发感染的原因及护理

血液净化是现代肾脏替代治疗的主要手段之一。建立和维持有足够功能的永久性血管通路是保证透析程序“生命线”。但随着世界人口的老龄化,高血压以及糖尿病病人的持续增加,已经存在的血管病变给长期血管通路的建立带来了挑战。长期涤纶套导管的临床使用近几年不断增加,但导管使用的维护仍然需要特别强调,若对导管感染的认识以及处理不规范,将导致导管失用。现将血液透析中长期留置导管并发感染的原因及护理介绍如下。     

血液透析中长期留置导管并发感染的原因及护理

血液净化是现代肾脏替代治疗的主要手段之一.建立和维持有足够功能的永久性血管通路是保证透析程序"生命线"[1].但随着世界人口的老龄化,高血压以及糖尿病病人的持续增加,已经存在的血管病变给长期血管通路的建立带来了挑战.     

临时性血液透析中心静脉留置导管的感染并发症分析

目的探讨临时性血液透析中心静脉留置导管感染并发症的发生率、危险因素以及防治措施.方法回顾性研究95例患者103例次中心静脉留置导管的特征,感染并发症情况,用多因素分析方法分析感染并发症的危险因素.结果11例留置导管者发生导管相关性感染（出口感染3例,导管相关性血流感染8例）,占10.7%,导管相关性感染的发生率为4.5次/1 000导管日.病原菌以葡萄球菌属为主.随着导管留置时间的增加,发生导管感染的危险性呈线性增加趋势.未发现年龄、性别、糖尿病、置管部位、白蛋白水平、免疫抑制剂使用与感染相关.结论临时性血液透析导管感染的发生率高.发生导管感染的危险性随导管留置时间呈线性增加趋势.需早期发现感染并积极正规治疗.     

维持性血液透析感染的防治

维持性血液透析(血透)感染的发生率可达30％～40％,死于感染者亦达15％～20％。近年来,由于不少较有效的新的抗生素问世,透析技术也有改进,病人死亡率比过去已有明显的下降。 一、血透病人易发感染的原因 1.免疫功能:尿毒症病人免疫功能的降低已为大     

血液透析患者长期留置导管感染并发症的分析

对尿毒症患者而言，稳定、可靠的血管通路是进行血液透析的保证，临时血管通路插管方便，但保留时间短，并发症多。我们科从1998年开始，行永久性带涤纶套导管留置术，现报告近5年使用长期留置导管的感染并发症情况，并与临时性双腔导管作一比较，对感染并发症作回顾性分析，对防治措施进行探讨。     

血液透析患者导管感染原因分析与对策

目的分析血液透析患者留置导管感染的相关因素、常见致病菌,并探讨预防措施。方法对238例血液透析患者进行回顾性分析,观察置管方式、常见致病菌与导管相关性感染的关系。结果长期留置导管患者的感染率3.35例次/1 000导管日,明显低于临时留置导管患者的感染率9.22例次/1 000导管日,差异具有统计学意义(P0.05)。常见致病菌为金黄色葡萄球菌、表皮葡萄球菌、大肠杆菌。结论血液透析护士严格无菌操作,并加强透析室环境及物品清洁消毒,可以减少导管相关性感染的发生。     

力健新封管预防血液透析导管相关性感染的效果分析

目的探讨力健新封管在血液透析深静脉导管相关性感染的应用价值。方法将46例随机分为试验组和对照组，每次血液透析结束后，对照组单纯采用肝素封管，试验组给予肝素与力健新混合进行封管。结果对照组出现导管感染4例，试验组中出现导管感染1例，肝素加力健新封管组的感染率明显低于对照组（P〈0．05）。结论力健新封管可预防血透患者中心静脉导管相关性感染。     

血液透析用深静脉留置导管相关感染因素及治疗方法探讨

【目的】系统观察血液透析常用的血管通路之一深静脉留置导管相关感染的发生原因、临床特征及有效的治疗方法。【方法】对234例建立深静脉留置导管的血透患者进行系统的观察,了解导管相关感染的临床特征及不同治疗方法的疗效。【结果]234例中共发生与深静脉留置导管相关的感染23例（9．8％）,致病菌主要为葡萄球菌属,伯克霍尔德菌属和假单孢菌属等,深静脉留置导管相关感染的临床表现多呈现与血透相关的畏寒和发热,拔管或尿激酶并庆大霉素封管是有效的治疗方法。【结论】血透患者深静脉留置导管感染的临床表现具有特异性,应采取相应的治疗措施。     

循证护理模式降低血液透析患者导管感染的应用

目的探讨循证护理模式对血液透析患者导管感染的影响。方法选取血液透析患者180例,随机分为2组,对照组患者实施常规护理,观察组患者实施循证护理模式,比较2组患者导管相关感染发生率,评价相关知识掌握情况、卫生习惯、生活质量。结果观察组导管感染发生率明显低于对照组,差异有统计学意义(P0.05);干预前2组患者导管相关知识掌握、卫生习惯保持以及生活质量等因素差异无统计学意义(P0.05);观察组患者知识掌握优秀和卫生习惯保持良好者明显多于对照组,生理状况、心理状况、社会功能、环境状况4个方面得分均明显高于对照组,差异有统计学意义(P0.05)。结论对血液透析患者以循证模式进行护理,有利于降低导管感染的发生率、加强患者对相关知识的掌握,促使患者自觉保持良好卫生习惯,提高患者的生活质量。     

The choice of a peripheral access catheter

The administration of liquids, electrolytes and pharmaceutical products by intravenous means is considered to be the most rapid, effective therapy which provides the best effects in patients who require hospital care which justifies this method being a method frequently chosen for the majority of patients checked into hospital care. The choice of peripheral catheter makes it possible to achieve, in an easy and relatively bloodless manner, venous access for short or medium duration treatment with a low risk of serious complications. Due to the nurse's responsibility when a catheter is installed, and the treatment when applying and the follow up necessary for endovenous therapy, we deduce the importance to correctly evaluate the necessities, advantages and inconveniences of each type of these devices and systems at the time nurses decide which catheter should be used on a patient. The criteria used to select a peripheral catheter are basically determined by a patient's age, the quality and calibre of the access veins, the objective of their use, the foreseen time for their use, the aggressiveness of the solutions which will be passed through the catheter, and the characteristics of the catheter itself.     

The catheter and urinary tract infection

Catheter-associated bacteriuria is the most common infection acquired in hospitals and nursing homes. This infection would be even more common but for the use of the closed catheter system. Most modifications have not improved upon the closed catheter itself. However, even with meticulous care, this system will not prevent bacteriuria forever. After bacteriuria develops, our ability to limit its complications is minimal. Additionally, the catheterized urinary tract becomes a reservoir of bacteria that can be transferred to other patients. Once a catheter is put in place, one must keep two important concepts in mind: (1) keep the catheter system closed in order to postpone the onset of bacteriuria; and (2) remove the catheter as soon as possible. If the catheter can be removed before bacteriuria develops, postponement becomes prevention. However, the best prevention is not to use a urethral catheter at all. Non-device alternatives to urethral catheterization should be used whenever possible. If these are not useful or successful, then other devices might be considered. For incontinent men, a condom catheter is a useful alternative. For patients with urinary retention, intermittent or suprapubic catheterization may be options for both short-term and long-term needs. The roles of these alternatives to urethral catheters must be defined by controlled trials.     

Offering patients a choice of urinary catheter drainage system

The aim of this article is to promote understanding of the benefits, assessment process and suitability of catheter valves, as a form of urinary drainage for patients. A literature review on the benefits of catheter valves provides the opportunity for an in-depth discussion that compares and contrasts different urinary drainage systems. On the evidence of the literature review, all patients require a holistic assessment which considers a number of factors, and provides the nurse with the essential objective data to ascertain the suitability of the catheter valve. These data can be transferred into an easy step-by-step algorithm to help guide the nurse in making the decision, with the patient, on the most appropriate urinary catheter drainage system.     

中心静脉置管术后导管相关性感染的预防及护理

[目的]预防中心静脉导管感染。[方法]选择重症监护病房中心静脉置管病人201例,分为两组,实验组100例,在中心静脉置管处放置一个纱球,上面覆盖3M无菌透明敷料固定;对照组101例,置管处用3M无菌透明敷料固定。比较两组置管时间及感染情况。[结果]两组置管时间、感染率比较差异有统计学意义(P<0.05)。[结论]采用3M无菌透明薄膜覆盖消毒小纱球及置管处的护理方法,可延长置管时间,降低感染率。     

Driving down catheter associated infection rates

Caring for patients with an indwelling urinary catheter is common in nursing practice. While catheters are essential for some patients, evidence suggests that in many cases catheterisation may be unjustified. This exposes patients to significant and unnecessary risks of acquiring urinary tract infections, extending their length of stay and imposing an extra burden of care and cost on healthcare providers. Improving care for patients with catheters depends on good education, robust research and audit pathways, evidenced best practice, adequate resources, and effective devices and treatment. This article discusses national and local initiatives that have been developed to enable health professionals to drive down catheter-associated urinary tract infections rates.     

两种皮肤消毒剂对中心静脉导管相关感染防控效果的Meta分析

摘要 目的 评价氯已定和聚维酮碘皮肤消毒剂对中心静脉导管相关感染的防控效果。方法 通过检索国内外文献数据库收集相关研究文献,采用Meta分析法对氯已定和聚维酮碘皮肤消毒剂对中心静脉导管相关感染防控效果进行评价。结果 共纳入研究文献14篇,其中随机对照试验文献6篇,队列研究文献8篇,样本总量20 202例患者。与聚维酮碘相比,氯已定皮肤消毒剂应用于中心静脉导管相关感染防控,可有效降低中心静脉导管相关感染、,降低导管细菌定植发生率,但会增加导管局部皮肤反应的风险。结论 临床操作人员应针对不同人群选择最佳消毒方案进行中心静脉导管相关感染的防控。