乳腺癌静脉化疗患者经外周静脉穿刺中心静脉置管的循证护理

目的观察循证护理干预对乳腺癌化疗患者经外周静脉穿刺中心静脉置管(PICC)的效果。方法选取本院收治的行PICC置管的乳腺癌患者50例,随机分为观察组和对照组,每组25例。对照组实施普通护理,观察组在普通护理方法的基础上实施循证护理干预,比较2组行PICC置管后的效果和并发症的发生情况。结果观察组行首次PICC置管穿刺的成功率为92.00%,高于对照组的88.00%,差异无统计学意义(P 0.05);观察组PICC留置时间为(108.92±2.35) d,优于对照组的(82.65±3.79) d,差异无统计学意义(P 0.05); 2组均在术后30 d内并发症情况发生比较,差异无统计学意义(P0.05),观察组30～60 d内并发症发生率为8.00%,低于对照组的32.00%,差异无统计学意义(P 0.05)。结论对乳腺癌静脉化疗患者采用循证护理干预方法可降低PICC置管后的并发症发生率,延长PICC置管的留置时间。     

中心静脉置管的临床应用及护理进展

为了进一步了解中心静脉留置导管临床应用的相关知识,减少并发症,通过查阅文献、综合论点,得出中心静脉置管途径已由深静脉向外周静脉发展,封管方法及封管液的选择和减少并发症仍是导管护理的重要内容。     

中心静脉穿刺置管的护理

随着中心静脉穿刺置管在临床上应用的日益广泛。其引起的并发症也逐渐增多,良好的护理是减少并发症的关键,其护理要点主要包括：保持导管通畅,预防感染,导管的固定,空气栓塞的预防等。     

乳腺癌化疗采用经外周静脉穿刺中心静脉置管30例临床护理

2005年8月～2008年8月,我院对30例乳腺癌化疗患者采用经外周静脉穿刺中心静脉置管(PlCC),以减少大剂量化疗药物对静脉的损伤,降低化疗毒副反应发生率.现报告如下.     

肿瘤患者中心静脉置管化疗22例临床护理

目的:探讨肿瘤患者中心静脉置管化疗的护理方法.方法:对22例肿瘤患者采用中心静脉置管进行化疗药物输入,并给予置管前护理、导管护理及出院指导.结果:本组除2例因置管而发生感染外,其余20例患者无发生皮肤局部血肿及静脉栓塞,全部完成了化疗周期,拔管后伤口愈合好.结论:中心静脉置管适用于晚期肿瘤患者的化疗,可减少化疗致静脉炎及渗透性损伤的发生,减轻惠者的痛苦,提高护理质量;同时也减轻了护士的工作量.     

中心静脉置管在乳腺癌化疗病人中应用及护理研究

化疗是乳腺癌治疗的重要方法之一,常用的化疗方案是大剂量的静脉化疗.由于化疗药物的毒副反应会引起静脉炎或渗漏性损伤,而中心静脉置管化疗可以保证病人按疗程化疗,同时可以减少化疗致静脉炎及渗漏性损伤的出现,既可以减轻病人的痛苦,又提高了护理质量.     

中心静脉置管在乳腺癌化疗病人中应用及护理研究

化疗是乳腺癌治疗的重要方法之一，常用的化疗方案是大剂量的静脉化疗。由于化疗药物的毒副反应会引起静脉炎或渗漏性损伤，而中心静脉置管化疗可以保证病人按疗程化疗，同时可以减少化疗致静脉炎及渗漏性损伤的出现，既可以减轻病人的痛苦，又提高了护理质量。中心静脉置管术用于乳腺癌化疗病人化疗，安全、方便，保留时间长，更有利于保护血管，解决了乳腺癌化疗病人多疗程的化疗。现就近年来中心静脉置管在乳腺癌化疗病人中应用的护理研究综述如下。     

乳腺癌患者经外周静脉置入中心静脉导管置管化疗的并发症及预见性护理

目的探讨乳腺癌患者经外周静脉置入中心静脉导管(PICC)置管化疗的并发症及预见性护理措施。方法选取140例乳腺癌患者作为研究对象,患者均接受PICC置管化疗,每周跟踪随访1次,持续6个月,分析不同化疗周期PICC常见并发症和预见性护理措施。结果 PICC置管患者的并发症有静脉炎、接触性皮炎、导管感染、堵塞和脱落,总发生率为23. 57%;患者住院期的并发症发生率低于化疗间歇期,差异有统计学意义(P 0. 05);患者第1、6个化疗周期的并发症发生率相对较低,第4个化疗周期的并发症发生率相对较高。结论乳腺癌患者PICC置管化疗的并发症有穿刺点出血和渗液、感染、导管移位(或脱出),对患者采取预见性护理措施能够降低并发症发生率。     

肿瘤病人中心静脉置管化疗的护理

目的为了预防和减少化疗药物致静脉炎及渗漏性损伤的发生。中心静脉置管需长期或反复给药,是一种可以减轻病人痛苦、方便治疗的常用技术。方法对16例肿瘤患者采用中心静脉置管进行化疗药物输入。结果经临床观察,静脉炎和渗漏性损伤的发生率降为0,除1例因置管而发生感染外。其余15例患者无发生皮肤局部血肿及静脉栓塞,全部完成了化疗周期,拔管后伤口愈合好。结论掌握好局部解剖位置和操作要领是置管成功的关键,严格无菌操作是预防导管感染和堵管的关键。该方法操作简便、安全、有效,且可长期留置,间断给药既保证病人按时化疗又减少化疗致静脉炎及渗漏性损伤的发生,是减轻病人的痛苦,提高护理质量的好方法,值得临床应用。     

预见性护理对胸心外科患者中心静脉置管并发症的影响

目的:探讨预见性护理对胸心外科患者中心静脉置管并发症的影响。方法:选择我科2013年1~8月182例深静脉置管患者为研究对象,随机分为观察组86例和对照组96例。对照组给予中心静脉置管常规护理,观察组在对照组基础上实施预见性护理。结果:观察组患者并发症发生少于对照组,两组比较差异有统计学意义(P0.05)。结论:对中心静脉置管患者进行预见性护理,能有效降低中心静脉置管并发症的发生。     

乳腺癌临床护理路径的制定与应用研究进展

近几十年来,我国对乳腺癌临床护理路径的研究主要是探索将其应用于行手术、化疗、放疗等治疗的乳腺癌患者中的护理效益,然而我国尚无官方发布的乳腺癌临床护理路径,现有研究中路径的制定方法和规范性参差不齐。基于我国在临床护理路径制定方面的研究相对缺少。本文主要从乳腺癌临床护理路径的制定和临床应用对国内外文献进行综述,以期为后续开展乳腺癌临床护理路径的相关研究提供参考。     

Successful treatment of fungal right atrial thrombosis complicating central venous catheterization in a critically ill child

A 9-year-old boy was admitted to our pediatric intensive care unit after multiple trauma. On the 17^th day post trauma, he developed catheter-related sepsis with candidemia. After removal of the catheter and 6 days of unsuccessful intravenous antifungal therapy, conventional and transesophageal two-dimensional echocardiography was performed revealing a large right atrial thrombus. Surgical thrombectomy under cardiopulmonary bypass was performed and the patient recovered within a few days. Fungal right atrial thrombus is a rare, lifethreatening complication of central venous catheterization. Two-dimensional echocardiography is a simple and effective diagnostic technique that should be performed when candidemia is detected. The proper therapeutic response depends on the findings of this examination. For a symptomatic patient with a large, mobile thrombus, we strongly recommend thrombectomy. Surgery not only allows removal of the mass and thus elimination of the mechanical complication but is also a key to management of infection.     

下肢深静脉血栓导管溶栓临床护理路径的应用研究

目的评价下肢深静脉血栓导管溶栓临床护理路径的应用效果。方法将下肢深静脉血栓导管溶栓患者80例分为路径组和对照组各40例。两组临床治疗方法一致,对照组接受常规护理,路径组接受临床护理路径模式护理。结果路径组住院天数缩短,住院费用降低,患者对护理工作满意度、健康教育知识得分优于对照组(P0.01或P0.05)。结论实施下肢深静脉血栓导管溶栓临床护理路径可以有效促进患者康复,节约医疗资源     

Low-dose aspirin for the prevention of venous thromboembolism in breast cancer patients treated with infusional chemotherapy after insertion of central vein catheter

BACKGROUND: We previously demonstrated a high incidence (7.7%) of venous thromboembolism (VTE) in breast cancer patients treated with infusional chemotherapy after insertion of central vein catheters (CVC). The aim of this study was to evaluate the efficacy and safety of low-dose aspirin for the prevention of VTE. PATIENTS AND METHODS: In a monocentric prospective study, patients with stage II-IV breast cancer, who underwent CVC insertion for continuous infusional chemotherapy, were assigned to receive low-dose aspirin (100 mg daily). Treatment was started after CVC implantation and continued until the last day of chemotherapy. Patients were assessed for safety and for the incidence of symptomatic deep venous thrombosis (DVT) confirmed by color-Doppler ultrasonography. RESULTS: Between April 2000 and March 2004, 188 consecutive patients were included in the study. Median age was 48 years (range 22-83), 31 patients (16%) had concomitant hypertension, and 14 patients (7.4%) were smokers. Median duration of treatment with aspirin was 3.6 months (range 0.4-5.7). A DVT confirmed by color-Doppler ultrasonography was observed in four patients (2.1%; 95% confidence interval, 0.58-5.35%). Side effects included mild epistaxis (three patients, 1.5%) and mild gastric pain (two patients, 1%). No major bleeding complication or International Normal Ratio alteration occurred. CONCLUSIONS: Administration of low-dose aspirin is safe and seems to correlate with a low risk of DVT in breast cancer patients treated with infusional chemotherapy. Further randomized studies comparing low-dose aspirin with other anticoagulative agents are warranted.     

临床护理路径在乳腺癌围手术期护理中应用的效果评价

目的 探讨临床护理路径在乳腺癌围手术期护理中的应用效果,特别是在乳腺癌术后及出院后患肢功能锻炼中的指导作用.方法 严格按照临床护理路径的准入和退出标准,选取普外科乳腺癌患者102例,按照入院单双日随机分为实验组50例和对照组52例.实验组采取临床护理路径指导下的"一线式"护理服务模式,对照组采用传统的整体护理模式.统计2组患者对疾病相关知识的掌握程度、出院后自护能力及患者对护理服务满意度,并进行统计分析.结果 实验组患者对围手术期相关知识的掌握程度和出院后自护能力评分明显高于对照组,且患者对护理服务满意度达98.92%,显著高于对照组.结论 临床护理路径指导下的"一线式"护理服务模式在乳腺癌患者围手术期护理中的应用,取得了良好的效果,督促了乳腺癌患者术后的患肢功能锻炼,促进了疾病的恢复,缩短了住院时间,节省了住院费用.

Abstract：

Objective To explore the effect of clinical nursing pathway (CNP) in perioperative nursing for breast cancer,especially the instructive important role in the rehabilitative excises postoperation and after discharge.Methods In accordance with the standard for the entry and exit of the CNP,102 patients with breast cancer were randomly divided into the experimental group (50 patients) and the control group (52 patients),the experimental group received the care of clinical nursing pathway and the control group received the traditional care.The effect of clinical nursing pathway on the following aspects such as the level of mastering knowledge about hospitalization,self-care ability after discharge,the degree of satisfaction about nursing were compared between the two groups.Results Compared with the control group,the level of mastering knowledge about hospitalization and self-care ability after discharge in the experimental group were significantly better,the degree of satisfaction about nursing reached 98.92%,which was higher than that of the experimental group.Conclusions Application of the full care model with CNP demonstrated good effect on the perioperative nursing for breast cancer,it encourages patients to do the limb functional training,promotes the recovery of disease,and then shortens hospital stay and saves hospital costs.     

手术后患者下肢深静脉血栓的预防研究进展

文章针对手术患者下肢深静脉血栓发病率呈不断上升的趋势,归纳了手术患者下肢深静脉血栓形成研究中的关键问题,对其发病率、危险因素、机械预防方法、化学预防方法及护理预防措施进行了综述,阐述了手术患者下肢深静脉血栓形成研究的主要进展,为预防下肢深静脉血栓的发生提供依据.     

集束化护理对ICU留置中心静脉导管患者护理质量及感染预防的影响

目的 探讨集束化护理对ICU留置中心静脉导管患者护理质量及感染预防的影响.方法 选取2013年1月至2015年12月我院ICU留置中心静脉导管患者180例为研究对象,随机分为观察组和对照组各90例.观察组实施集束化护理,对照组实施常规护理.比较两组患者的护理质量及感染预防效果.结果 观察组患者穿刺点感染、导管相关性血流感染率均低于对照组,差异有统计学意义(P<0.05);观察组患者导管脱出、堵管、血栓及非计划性拔管发生率均低于对照组,差异有统计学意义(P<0.05);观察组患者导管留置天数和住院天数均均短于对照组,差异有统计学意义(P<0.05);观察组患者护理满意度明显高于对照组,差异有统计学意义(P<0.05);观察组患者经护理后的各项生活质量评分均明显高于对照组,差异有统计学意义(P<0.05).结论集束化护理能够降低和预防ICU留置中心静脉导管患者的感染率及其他并发症发生率,减少非计划性拔管发生率,缩短置管时间和住院时间,提高患者护理满意度和生活质量,建议在临床上推广应用.     

Nonpharmacologic interventions for prevention of catheter-related thrombosis: A systematic review

Purpose

The aim of this study was to summarize randomized controlled trials (RCTs) of nonpharmacologic interventions for prevention of catheter-related thromboses (CRTs).

Methods

MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were systematically searched for RCTs examining any nonpharmacologic intervention to prevent symptomatic or asymptomatic CRT. Titles and abstracts were screened by a single reviewer, followed by full-text screening by 2 independent reviewers. Data were extracted and quality assessed by a single analyst and audited by a second analyst. Strength of the evidence for each intervention was assessed using the Grading of Recommendations Assessment, Development and Evaluation.

Results

Ten RCTs enrolling 1,378 patients were included. Moderate- to high-quality evidence suggested peripherally inserted central catheters and insertion of central venous catheters (CVCs) at the femoral site increased CRT when compared with other catheter types or insertion sites, respectively. Evidence comparing CRT in CVCs inserted at the jugular vs the subclavian site as well as the placement of the CVC tip was of low quality and inconclusive. Low-quality evidence suggested that valved ports and silver-coated catheters had no effect on CRT. No RCT evidence was identified for other interventions.

Conclusions

Peripherally inserted central catheters and femoral insertion of CVCs should be avoided if possible. Randomized controlled trials are needed to ascertain the effects of other nonpharmacologic interventions to prevent CRT.     

接受中心静脉导管置入的恶性血液疾病患者中导管相关性血栓的研究进展

导管相关性血栓(CRT)是接受中心静脉导管(CVC)置管的恶性血液疾病患者的严重并发症之一.然而,目前CRT的危险因素、发生机制及治疗方案等尚未明确.CRT的发生主要与患者内在因素、疾病及治疗相关因素、导管相关因素及其他导管事件相关.目前,暂不推荐在恶性血液疾病患者(多发性骨髓瘤患者除外)中对CRT进行预防性药物治疗.当患者明确出现CRT时,则应根据具体情况选择抗凝血药物治疗或直接拔管.