“⌒”形管芯植入法为导尿困难患者成功插管的方法探讨

目的探讨“⌒”形（外科泌尿系金属导尿仪的形状）管芯植入法为导尿困难患者成功插管的方法。方法管芯植入法是将无茵钢丝植入导尿管内，折成金属导尿仪的形状，再用导尿管经尿道插入膀胱引出尿液的方法。结果利用“⌒”形管芯导尿管为前列腺肥大、骨盆骨折并尿道损伤等56例导尿困难的患者成功插管。结论此法操作简单，成功率高，并发症少，最大限度地减轻了患者的痛苦。     

两种不同留置导尿管方法对男性导尿困难患者的效果分析

目的观察两种不同留置导尿管方法对男性导尿困难患者的效果。方法将80例男性导尿困难患者分为观察组和对照组,各40例。观察组采用自制不锈钢导尿管支架插入导尿管腔内进行导尿。对照组采用普通尿道探子先扩张尿道再进行导尿。观察两组一次性插管成功率。结果两组一次性插管成功率比较有显著性差异（P〈0．01）。结论采用自制不锈钢导尿管支架插入导尿管腔内进行导尿,能提高一次性插管成功率,减轻患者痛苦,可应用于临床。     

改良金属导尿管治疗球部尿道损伤22例

目的:探讨用改良金属导尿管治疗球部尿道损伤的价值.方法:将普通金属导尿管改良,经尿道插入膀胱,导入导丝,引导插入Foley导尿管.结果:22例球部尿道损伤患者经常规导尿失败后改用本法,16例成功插入导尿管,随访无一例尿道狭窄.结论:改良金属导尿管治疗球部尿道损伤方法简单、有效.     

前列腺肥大患者简易导尿术

临床工作中,特别是在前列腺增生肥大尿潴留的病人中,使用普通橡胶导尿管经常遇到导尿插管失败的病例。作者在实践中摸索出一种简易方法,即用普通橡胶导尿管插管失败后,取无菌注射器抽取地塞米松５ｍｇ沿导尿管缓缓推入,待１～２ｍｉｎ后继续置管,一般可顺利插入成功。作者２年来对１５例年龄５３～７９岁,前列腺肥大,其中１２例合并尿潴留,常规插管失败的患者,用此法全部导尿成功,无任何并发症。 前列腺增生肥大伴有尿潴留患者,由于尿道梗阻,普通橡胶导尿管较难插入;金属导尿管太硬,易损伤尿道且不能久置,并发症多;膀胱穿…     

125例尿路感染患儿行气囊导尿管导尿的问题分析及对策

总结125例尿路感染患儿使用气囊导尿管导尿操作中出现的临床问题及护理对策.125例首次导尿成功104例；21例患儿导尿管插入不畅,经相应处理后17例再次导尿成功,4例导尿失败；尿道外口暴露不明显58例；插管时导尿管内未见尿液排出,不能准确判断导尿管气囊部位是否已完全进入膀胱39例;尿道出血5例；拔管困难4例；误入阴道3例；导尿管自行脱出1例.临床护士掌握患儿尿道解剖生理特点和气囊导尿管结构、使用注意事项,选择合适导尿管,规范气囊导尿管临床应用技术,掌握患儿导尿技巧,能有效提高患儿导尿成功率,减少惠儿气囊导尿管导尿过程中各种临床问题的发生.     

康利特导尿管内芯引导男性导尿困难患者的护理

导尿术是一项基本的护理操作技术,一般情况下导尿易成功,但对于老年男性前列腺增生患者,因尿道伸长、受压及变形,尿道阻力增加,同时阴茎萎缩、柔软,缺乏支撑,导致插管困难甚至失败,给患者带来痛苦[1].有时反复插管,引起尿道黏膜水肿、出血及假道形成[2],无法完成导尿,出现急性尿潴留,而不得不行膀胱造瘘,给患者造成很大的痛苦和伤害[3].我科2008年1月至2010年1月在导尿操作过程中发生导尿困难的老年男性患者108例,借助康利特导尿管内芯引导成功完成导尿,成功率为100％,具有操作简便,创伤小,避免了常规导尿时的盲目反复插管操作,患者疼痛感减轻,心理压力小,避免了膀胱造瘘,取得了良好的效果,现报道如下.     

硬膜外麻导管用于婴儿导尿的临床观察

随机选择1990年1月~1997年9月男性婴儿尿潴留导尿术患者50例,其中25例选用普通导尿管导尿为对照组,25例选用硬膜外麻导管导尿为观察组,进行效果比较,经统计学处理,结果显示:观察组导尿成功率明显优于对照组,2组比较有显著差异性,P<0.05.作者认为男性婴儿尿潴留选用硬膜外麻导管导尿克服了因尿道狭窄小儿普通导尿管插管困难和损伤尿道的缺点,具有一定的临床应用价值.     

导尿术的临床应用进展

近 5年来 ,国内同行通过临床实践 ,对导尿管插入技术进行了大量的研究与改进 ,在置管方式、插入长度、置管时机、留置时间、消毒方法、并发症的预防、尿管材料的筛选及改进、尿管的改进等方面进行了深入的探讨与研究 ,现综述如下。1　置管方法的选择1.1　男性婴儿导尿法为解决男性婴儿导尿插管困难的问题 ,蒋小剑等[1] 用硬膜外麻导管对发生尿潴留男性婴儿进行导尿 ,此法克服了因小儿尿道狭窄导致普通导尿管损伤尿道的缺点 ,具有一定的临床应用价值。1.2　男性留置导尿加压导尿法男性尿潴留导尿术加压导尿法[2 ] 插管方法为 ,通过尿管在尿道…     

改进导尿法在老年男性病人导尿中的应用

[目的]探讨提高老年男性病人一次插管成功率和减少尿道损伤、疼痛程度的导尿方法。[方法]30例采用改进导尿法,在插入导尿管前从尿道口注入3mL~5mL无菌液状石蜡,充分润滑尿道后再插入导尿管;30例采用传统导尿法,用无菌液状石蜡棉球润滑导尿管前端后插入导尿管,观察两组效果。[结果]改进组病人尿道损伤率和严重疼痛发生率明显低于传统组,一次插管成功率明显高于传统组。[结论]改进导尿法可明显提高一次导尿成功率,减少尿道损伤,减轻疼痛程度。     

自制金属支架导尿管在男性导尿困难时的应用

[目的]探讨男性患者在导尿困难时应用金属支架导尿管导尿的操作要点及临床价值.[方法]回顾性分析总结53例导尿困难患者应用金属支架导尿管治疗的经验.[结果]53例均导尿成功,平均操作时间8(5～15)min.其中28例前列腺增生患者完善术前准备后行经尿道前列腺切除.余25例1周后拔除导尿管,排尿通畅,随访6～12个月,无排尿困难,平均最大尿流率16(14～20)mL/s.[结论]男性患者导尿困难时应用金属支架导尿管,操作简单,安全有效.     

尿管测压与拔管时机探讨

目的探讨潴留型神经源性膀胱功能障碍留置尿管患者的拔尿管时机。方法用输液管从导尿管旁测量患者逼尿时产生的逼尿压力,观察患者拔除尿管后能自主排尿前测到的压力。结果和结论测压管液面上升达28cm以上者,拔除尿管后能自主排尿。     

三腔气囊导尿管在前列腺摘除术中的应用

传统的耻骨上经膀胱前列腺摘除术,放置气囊导尿管及膀胱蕈状造瘘管各一条,病人痛苦大,腹部切口易并发感染,造成切口愈合延迟,引发腹壁切口疝,且病人住院时间长,花费大。我院2003年4月～2005年4月共行耻骨上经膀胱前列腺摘除术31例,术中应用三腔气囊导尿管进行膀胱持续冲洗,不需另置蕈状膀胱造瘘管,取得良好手术效果,且无1例发生切口感染。现将体会介绍如下。     

使用气囊导尿管致男性尿道损伤分析

目的 探讨因留置导尿管所致的男性尿道损伤的原因和治疗方法。方法 对13例尿道损伤的临床资料进行分析。结果 全部为住院患，年龄23岁-79岁，其中内科5例，外科8例，因导尿而损伤10例，拔尿管损伤3例，尿道 部分裂伤10例，尿道粘膜损伤3例，其中前尿道6例，后尿道4例，全尿道3例，除1例未置尿管外其余12例均重新置导尿管且全部成功，拔管后排尿正常，无并发症。结论 气囊导尿管致尿道损伤多由于操作不当引起，多为尿道部分裂伤和粘膜损伤，一旦发现应及时处理，重新插导尿管困难，先用尿道扩张器探入膀胱，再用自制的钢丝芯引导尿管入膀胱，保留10-14d，疗效满意。     

老老年患者留置尿管细菌生物被膜感染的研究

目的探讨老老年患者留置尿管内壁细菌生物被膜形成情况及其对导管相关感染（CRI）的影响。方法分析2007年2月-2009年10月住院的175例留置尿管患者,均为男性,年龄75-96岁,平均86岁。不同留置时间（7-15d53例、16-30d49例、31-45d44例、〉45d29例）的尿管,于拔出尿管后运用超声震荡使尿管内表面生物被膜完全脱落,梯度稀释后进行生物被膜活菌计数,细菌的培养分类及构成比分析;采用扫描电镜观察尿管内壁细菌生物被膜形成的情况;观察尿管留置时间与生物被膜CRI的关系。结果随着尿管留置时间的延长,尿管内表面生物被膜活菌计数呈指数趋势增长,CRI发生率有升高趋势,各置管时段组间尿管内表面生物被膜活菌计数及CRI发生率比较差异均有统计学意义（P〈0．05）。扫描电镜见生物被膜的形成随时间的延长而明显增多。结论细菌生物被膜形成是老老年患者留置尿管相关性尿路感染的重要致病因素,尿管留置时间越长,尿管生物被膜感染的危险性及几率越高。更换尿管或缩短留置时间仍是防止尿管生物被膜感染的主要方法。     

Ultrasound Guidance Versus Electrical Stimulation for Femoral Perineural Catheter Insertion

Objective. Continuous femoral nerve blocks provide potent analgesia and other benefits after knee surgery. Perineural catheter placement techniques using ultrasound guidance and electrical stimulation (ES) have been described, but the optimal method remains undetermined. We tested the hypothesis that ultrasound guidance alone requires less time for femoral perineural catheter insertion and produces equivalent results compared with ES alone. Methods. Preoperatively, patients receiving a femoral perineural catheter for knee surgery were randomly assigned to either ultrasound guidance with a nonstimulating catheter or ES with a stimulating catheter. The primary outcome was the catheter placement procedure time (minutes) starting when the ultrasound transducer (ultrasound group) or catheter insertion needle (ES group) first touched the patient and ending when the catheter insertion needle was removed after catheter insertion. Results. Perineural catheters placed with ultrasound guidance (n = 20) took a median (10th–90th percentiles) of 5.0 (3.9–10.0) minutes compared with 8.5 (4.8–30.0) minutes for ES (n = 20; P = .012). All ultrasound‐guided catheters were placed according to the protocol (n = 20) versus 85% of ES‐guided catheters (n = 20; P = .086). Patients in the ultrasound group had a median procedure‐related discomfort score of 0.5 (0.0–3.1) compared with 2.5 (0.0–7.6) for the ES group (P = .015). There were no vascular punctures with ultrasound guidance versus 4 in the ES group (P = .039). Conclusions. Placement of femoral perineural catheters takes less time with ultrasound guidance compared with ES. In addition, ultrasound guidance produces less procedure‐related pain and prevents inadvertent vascular puncture.     

Structured Outpatient Peritoneal Dialysis Catheter Insertion Is Safe and Cost-Saving

♦ Background: Data about outcomes and costs for peritoneal catheter insertion on an outpatient basis are scarce.♦ Methods: Using patient files, all peritoneal dialysis (PD) catheter insertions performed between 2004 and 2009 in a single-center tertiary care institution for adult patients were located. Patient demographics, complications, hospitalizations, survival, and treatment modality changes were recorded. Procedure-related expenses were valued as actual production costs.♦ Results: During the study period, 106 PD catheters were inserted. In 46 cases, the patients were admitted electively for catheter insertion; 19 catheters were placed during admission for other medical reasons; and 41 catheters were placed on an outpatient basis. Among the study patients (54.7 ± 16.0 years of age), 45% were diabetic. Early (<30 days) catheter-related complications occurred in 22% of patients. The incidences of technique failure and any complication within 90 days were 10% and 38% respectively. The occurrence of complications was not statistically significantly different for outpatients and electively admitted patients. Average costs for catheter insertion were higher in electively hospitalized patients than in outpatients (€2320 ± €960 vs €1346 ± €208, p < 0.000).♦ Conclusions: Compared with an inpatient procedure, outpatient insertion of a PD catheter results in similar outcomes at a lower cost.     

Urethral Pressure Profilometry: A Low Compliant Recording System With Perfused Catheter

Summary. A new catheter for recording the urethral closure pressure profile (UCPP) in men and women is introduced. The measuring system utilizes perfusion and saline as a transmission medium. The dynamic response of the whole catheter system as a unit was studied in vitro, and profile studies of the female urethra were performed in vivo using a solid catheter equipped with micro-transducers as a reference. The small transmission volume and a low-compliant perfusion gave a sufficient bandwidth for recordings of the UCPP. No significant difference was found in closing pressure and functional length in the UCPP of women between the new cather and the solid cather.