静脉留置针与普通静脉输液在儿科的对比观察

目的:比较儿科静脉留置针输液与普通静脉输液的防液体渗漏、穿刺次数、导管脱落及静脉炎发生总例数等项指标.方法:将我科2010年5月至10月开展的静脉留置针静脉输液100例中随机抽取52例,与同期进行的普通头皮针输液118例中随机抽取的58例的防液体渗漏、穿刺次数、导管脱落及静脉炎发生总例数等指标进行比较性研究.结果:静脉留置针输液与普通静脉输液比较,在防液体渗漏、穿刺次数、导管脱落及静脉炎发生等方面存在显著差异.结论:静脉留置针输液较普通静脉输液能更好防液体渗漏,减少血管穿刺,防导管脱落,使用方便,减轻了患儿的痛苦,值得普遍推广.     

新生儿头皮静脉留置针送导管方法的改进

目的 提高新生儿头皮静脉留置针穿刺成功率.方法 将77例罹患不同疾病的新生儿随机分为观察组(40例)和对照组(37例),对照组在静脉留置针操作中采用"见回血后将针芯退出0.5 cm,再将导管并针芯送入静脉内"的常规方法;观察组采用"见回血后固定针芯、推送导管再抽出针芯"的改进方法.结果 观察组静脉导管穿刺成功率显著高于对照组(P＜0.01).结论 改进方法可提高留置针穿刺成功率.     

深静脉穿刺置管方法介绍

材料应用上海医用诊察仪器厂生产的15cm长穿刺输液导管针(以下简称导管针)。导管针由外导管和内管组成,外导管为塑料,内管为金属穿刺针,构造见示意图。使用前外导管和穿刺针分别用生理盐水内外冲     

新生儿头皮静脉留置针送导管方法的改进

目的提高新生儿头皮静脉留置针穿刺成功率。方法将77例罹患不同疾病的新生儿随机分为观察组（40例）和对照组（37例），对照组在静脉留置针操作中采用“见回血后将针芯退出0．5cm，再将导管并针芯送入静脉内”的常规方法；观察组采用“见回血后固定针芯、推送导管再抽出针芯”的改进方法。结果观察组静脉导管穿剌成功率显著高于对照组（P〈0．01）。结论改进方法可提高留置针穿刺成功率。     

静脉留置针相关静脉炎的危险因素研究进展

综述应用留置针静脉输液致机械性、化学性、感染性、血栓性静脉炎的危险因素。机械性静脉炎与导管型号、输液量、导管穿刺与固定技术有关;化学性静脉炎与药物性质、输液速度、液体温度、封管技术有关;感染性静脉炎与操作者手卫生、无菌操作、导管拔除或替换时间、输液装置及敷贴更换时间有关;血栓性静脉炎与导管材质、穿刺部位有关。此外,高龄、女性、血液高凝状态及免疫力低下患者是静脉炎的高危人群。提出应提高临床护士对各类静脉炎危险因素的识别与控制能力,有利于降低留置针相关静脉炎发生率,提高留置针使用效能。     

负压气囊在椎管内联合麻醉穿刺中的应用

蛛网膜下腔－硬膜外联合麻醉（ＣＳＥＡ）是将腰麻和硬膜外麻醉结合在一起的新方法,目前此种联合麻醉多采用Ｇ２５－２７针内针型腰穿针,由于该针细长脑脊液回流缓慢不易观察,因而我们采用自制负压气囊,以助观察脑脊液回流,判断腰穿是否成功,效果满意,现报告如下：负压气囊制作与应用方法将Ｍａｌｌｉｎｃｋｏｒｄｔ气管导管上充气套囊连接气管导管端剪去２ｍｍ再接上内径２．５ｍｍ、长１６ｍｍ的玻璃管,其充气囊另一端带有充气阀,见图１。我们采用的是ＣＳＥＡ针内针型２５Ｇ腰穿针,于Ｌ３－４行硬膜外穿刺成功后拔出针芯,自硬…     

PICC穿刺延迟1分钟拔出针芯观察

PICC即经外周静脉置入中心静脉导管时可因操作者的原因及患者的凝血功能、血管状况等因素导致穿刺术中有出血的发生.笔者通过对穿刺成功后常规松止血带后即拔出针芯送导管这一细节的改进,在临床穿刺100例中,通过延迟1 min拔出针芯使穿刺术中出血量明显减少,报告如下.     

超声引导下乳腺病变空芯针穿刺活检临床价值研究

目的 评价超声引导空芯针穿刺活检（US-CNB）在乳腺病变术前诊断中的应用价值。方法 宁夏医科大学附属医院肿瘤外科2007年8月至2009年5月行超声引导空芯针穿刺活检病人115例,结合手术后病理切片,对空芯针穿刺活检标本和切除活检（EP）标本的病理组织学诊断进行比较和分析。结果 115例乳腺疾病病人经空芯针穿刺活检组织学诊断浸润性导管癌81例,浸润性小叶癌3例,导管内癌2例,交界性肿瘤1例,导管上皮不典型增生2例,其他良性病变26例。US-CNB与切除活检的病理诊断符合率为93.9%,kappa=0.891（P＜0.01）。US-CNB 病理诊断的敏感性为95.6%,特异性为100%,假阴性4.39%,无假阳性。结论 超声引导下空芯针穿刺活检是一种敏感性高、特异性强的乳腺病变诊断方法,对少数特殊类型乳腺病变的诊断存在一定的局限性,对于任何可疑病变或不典型增生改变均应做切除活检。     

新型纳米芯片能检测罕见循环肿瘤细胞

西班牙GregorioMaranon大学的研究人员对长期留置血管穿刺导管周围皮肤（如固定针座、套管等）进行细菌培养，判断与导管相关血行感染（catheter—relatedbloodstreaminfection，C-RBSIS）的关系。该项目研究进行了两年,     

三种下肢静脉穿刺置管方法效果比较

目的 寻找下肢静脉最佳的穿刺置管方法.方法 将经下肢化疗的85例肿瘤患者分为三组.外周深静脉组23例,选择内踝大隐静脉起始处或小腿内侧,以15°～30°角进针行静脉穿刺,置入16 G PICC导管至大隐静脉末段或股静脉,经X线拍片证实导管尖端位置正确后接通输液装置输液;股静脉组41例,选择股动脉搏动最明显部位的内侧0.5 cm处,针头指向患者头部、与皮肤呈30°～45°角穿刺,王入16 G单腔中心静脉导管输液;外周留置针组21例,采用18～22 G贝朗留置针,选择下肢浅静脉行静脉穿刺王管输液.结果 三组一次置管成功率及操作平均耗时、化疗性静脉炎发生率总体比较差异有统计学意义(P<0.05,P<0.01),股静脉组成功率最低且耗时最多,外周留置针组化疗性静脉炎发生率最高;外周深静脉组导管平均留置时间显著短于股静脉组(P<0.05),两组并发症发生率比较差异无统计学意义(P>0.05),但股静脉组发生严重感染1例.结论 为预防化疗性静脉炎,应避免使用外周静脉而选择深静脉给药.外周深静脉置管与股静脉穿刺王管比较,操作简单、一次操作成功率高、耗时少,无严重并发症,是下肢深静脉置管较理想的方式.     

Syringe suction drain.

A mini suction drain made up of a 20 cc glass syringe, a stainless steel spring and a scalp vein cannula (whose needle end has been cut off and multiple holes made in the distal 2.5-5 cm) is described. It is very useful in preventing postoperative haematoma formation, in nasogastric tube suction, in easy drawing up of fluids from vials, and in exploration of deep seated abscesses and collections. It is inexpensive, as syringe and spring can be re-used after sterilisation by autoclaving.     

A simple technique for placement of a portacaval shunt tube in rats

We devised a new technique for the placement of portacaval shunts in rats. Using a Teflon tube with a commercially available puncture needle, we placed the tube between the infrarenal inferior vena cava (IVC) and the main portal branch. An upper laparotomy was performed, after which the tube attached to the needle was used to puncture the IVC from the right dorsal wall through toward the left side. Subsequently, the needle was advanced further to puncture the main portal vein. After each end of the tube had been successfully placed in the lumina of the IVC and portal vein, the needle was gently pulled out. Bleeding was controlled by compressing the puncture site gently for approximately 30s. Seven shunts out of ten were found to be patent at second laparotomies carried out 1 week after the primary tubing operation. The remaining three were occluded with white and red thrombi. No dislodging of the tube was noted, and radiography confirmed the patency of the shunt. This method is fast and simple, and yields a high patency rate, even in the hands of relatively inexperienced surgeons. It can be recommended as an experimental model for additional studies.     

Method of proximal anastomosis with a new assist device

Various devices have been invented for proximal anastomosis performed during coronary bypass surgery. Enclose II allows a handling of the needle to be similar to a single cross clamp proximal anastomosis with almost no blood loss. However, when creating the anastomotic hole, it is difficult to determine whether an incision into the aortic wall will extend to the intima, and in some instances there is a risk that the hemostatic membrane may be injured. With Enclose II's hemostatic confirmation tube, the hemostatic membrane is opened and the tube is inserted into the aortic wall. The vent plug of the extension tube is opened, blood fills between the aortic wall and the instrument, and air is removed. An isotonic saline solution is injected and the pressure checked to insure that no air enters. An incision into the aortic wall is then made with a scalpel. When the intima is pierced, isotonic saline solution will gush out. In this way, one can prevent injury to the hemostatic membrane and ensure a correctly pierced anastomotic hole in the intima--even with just 1 punch.     

不同浓度肝素封管液在小儿静脉留置针封管中的应用

目的观察3种不同浓度肝素钠封管液用于小儿静脉留置针封管的效果。方法选择需静脉留置针输液的患儿120例,随机分成3组,每组40例,A、B、C3组分别采用生理盐水100、250、500mL＋肝素12500U作为封管液,比较3组留置针的留置时间、堵管发生率、并发症的发生情况。结果 B组平均留置时间比A组长,而A组平均留置时间比C组长,而堵管发生率A组略低于B组,而C组则明显高于B组,差异有统计学意义（P〈0.05）。而3组的并发症无明显差异（P〉0.05）。结论生理盐水250mL＋肝素12500U作封管液用于小儿静脉留置针封管的疗效最佳,值得临床推广。     

A splint for nonsurgical correction of cryptotia

A method for making an apparatus for nonsurgical correction of cryptotia from a paper clip and the tube of a scalp vein puncture needle is described. These materials can be found in any clinic or hospital and are easy to process without complex tools.     

A Splint for Nonsurgical Correction of Cryptotia

Summary A method for making an apparatus for nonsurgical correction of cryptotia from a paper clip and the tube of a scalp vein puncture needle is described. These materials can be found in any clinic or hospital and are easy to process without complex tools.     

An improved design for vacuum tube drains

Mini vacuum drains can be helpful in reconstructive surgery. The drains may be assembled using a scalp needle and a vacuum tube. The addition of the adapter that is used with the vacuum tubes for blood sampling improves the ease of use and practicality of these drains and increases their safety.     

Simplfied technique of lumbar subarachnoid-peritoneal shunt (author's transl)

The authors have developed a simplified technique of lumbar subarachnoid peritoneal shunt in which the spinal tube is easily introduced through a puncture needle without doing a laminectomy. Seventeen cases of communicating hydrocephalus of various orgin have been treated by this procedure. In this paper, we reported our shunting system and the technique of precedures, and discussed the clinical results and some advantages of this method. The spinal tube is a custom made Silastic tube with small side holes 2 mm apart from each other at slanting tip located within the first 1.0 cm of the end. French No. 5 tube is available for older children and for adults, and French No. 3.6 tube for infants. Total length of the tube measures 30 cm with 4 black markers at 5 cm intervals from the tip for assisting in positioning. The puncture needle is a modified Touhey needle. Two needles different in size are prepared according to the size of the tube. Outer diameter of these needles is 2.1 mn & 1.8 mn. Our operative procedures are divided into following three steps. 1) Puncture of the lumbar subarachnoid space and insertion of the spinal tube through the needle. 2) Introduction and placement of the peritoneal tube into some point of the peritoneal cavity. Concerning to this point, we have the three candidates, namely into the Douglas pouch, the suprahepatic space, and the bursa omental cavity. 3) Connection of the spinal tube and the peritoneal catheter end. We used a kind of flushing device only in some exceptional cases, and recently, we feel that it is not so necessary for this shunting. We have employed this technique in a total of 17 cases. Eleven cases of them are adults and the other 6 cases are children less than 2 years of age. Postoperative follow up period varied from 13 months to 1 month, and all the cases except two had good result, suggesting the shunt system is working well with no evidence of complications such as low pressure syndrome or radicular irritation. Some troubles occurred in two children. One was a disconnection between the spinal and the peritoneal tube, and the other was an obstruction at the peritoneal tube end. The authors believe that our L-P shunt has several advantages as listed below, 1)Procedure is very simple, in other words, there is no need of laminectomy. 2) The entire system is short. 3) No need to pass the catheter into the brain tissue. 4) Obstruction of the spinal catheter end is very unusual. 5) Alteration of communicating hydrocepalus into non communicating one by secondary obstruction of aqueduct of Sylvius is less likely with this shunting system. 6) Siphon effect might be minimal, if present. 7) As compared to V-A shunt, severe complication like septicemia will not occur in the L-P shunt. With this simple method and good material, we hope that this L-P shunt is employed more widely for the patients with communicating hydrocephalus.     

A newly designed puncture needle for suction decompression of giant aneurysms. Technical note.

A newly designed puncture needle for aspirating large or giant aneurysms is described. This puncture needle represents a modification of an intravenous catheter with an internal needle. It is designed to prevent blood from leaking when the internal needle is removed and has a lateral tube for aspiration. Following aneurysm puncture with the parent artery temporarily trapped, the catheter is positioned on the head frame with a brain spatula and a self-retaining retractor. Blood is suctioned through the lateral tube with a syringe or the suction system normally used in the operating room.     

Safe Intestinal Decompression in Fresh Postoperative Gastric Bypass

Background: Dilatation of the Roux-limb is sometimes found following Roux-en-Y gastric bypass (RYGBP) procedures. This could be the result of a transient episode due to ileus, or a partial or complete obstruction. The risk of this complication is an increase in intraluminal pressure with the potential for leak. Blind insertion of a nasogastric tube for decompression could be risky due to possible perforation at the stapled or sutured edges. Methods and Results: The diagnosis was made with routine extended upper gastrointestinal x-rays 24 hours after surgery. To determine the relationship of the intestinal dilatation, increase in intraluminal pressures and leaks, measurements were taken in porcine models duplicating a RYGBP. Pressures obtained at the anastomoses were higher than pressures in the jejunum between the anastomoses, and related directly to the production of leaks. Elevations of intraluminal intestinal pressures have also been observed in patients who required decompression. The angles of a freshly constructed pouch and the recent stapled or sutured edges may be easily perforated with a nasogastric tube, especially a hard one. We use a soft flexible tube. An angled-end 0.035" wire is introduced into the intestines with fluoroscopic assistance. The tube tip is perforated with a needle, and through this opening, the wire is passed into the tube. The tube is then fed over the wire for safe decompression. Conclusion: Decreasing the intestinal pressure by safe decompression may avoid one of the causes of leaks.