彩色多普勒超声引导下经皮门静脉穿刺留置导管的临床应用

目的探讨彩色多昔勒超声引导下经皮经肝穿刺门静脉留置导管的临床应用价值。方法100例肝细胞癌或转移癌患者，在彩色多普勒超声引导下经皮经肝穿刺门静脉置人中心静脉导管，观察穿刺及置管成功率、导管留置天数、并发症发生率和治疗效果。结果在100例患者中，穿刺一次成功率和置管一次成功率为98．0％；早期导管留置天数为7-14d，平均9．2±2．7d，改进后为23-60d，平均44．7±13．5d；无严重并发症发生。经门静脉注药治疗原发性肝癌和转移性肝癌的疗效优于外周静脉给药。讨论该方法可重复门静脉给药，能增加局部药物浓度，提高药物治疗的效果．并且安全、可靠，无严重并发症。     

两种不同部位股静脉留置针在老年患者中的应用比较

我院老年病区住院患者多为高龄老人,患者多为脑卒中后遗症或心力衰竭合并肺部感染、多器官功能衰竭、老年痴呆症等,病情复杂多变,病程长,需要长期静脉输液治疗,外周输液难度大,使用深静脉置管,即减轻了患者的痛苦,又解决了穿刺困难问题。文献报道经锁骨下静脉和颈内静脉导管有发生血、气胸、心律失常等并发症的危险［1］,股静脉留置管相对穿刺风险小,护理人员便于操作。为了探讨股静脉留置针在不同穿刺部位的留置效果,我们对老年患者股静脉留置针情况进行了统计分析,报告如下。     

PICC和锁骨下静脉置管在重型颅脑损伤患者中的效果观察

目的观察外周静脉穿刺导入中心静脉置管（PICC）与锁骨下静脉置管两种方法在颅脑危重患者中的应用效果。方法76例置管患者随机分为PICC组38例和锁骨下静脉组38例，分别观察两种方法置管的1次置管成功率、并发症及置管时间的长短。结果PICC组一次置管成功率为100％，而锁骨下静脉置管组的一次置管成功率为63．8％，差异具有统计学意义（P〈0．05）；PICC组导管留置时间长于锁骨下静脉组，具有统计学意义（P〈0．01）；锁骨下静脉组发生导管相关性感染、邻近动脉损伤、导管脱落的例数较多，而PICC组发生静脉炎的例数则高于锁骨下静脉置管组。结论PICC导管的穿刺简便易行，并发症少，可长期留置。     

Y型静脉留置针在胸腔穿刺中的应用

改进动静脉留置针在胸腔穿刺中的应用[1],我科自2005年2月至2005年8月采用Y型静脉留置针替代金属胸穿针对20例患者行穿刺抽气及诊断性胸穿,取得较好效果,现介绍如下。1方法根据X线表现或B超探查,选定最佳穿刺点。采用苏州碧迪医疗器械有限公司生产的BD Intima-II密闭式静脉留置针(Y型)为穿刺针,选用规格均为18GAX1.16IN(其导管内径1.16mm、外径1.30mm、长度30mm;它由导管、Y接口、针翼、延长管、连接口等组成。如附图所示穿刺前准备、体位、消毒均同常规胸腔穿刺术。1.1气胸抽气用5ml无菌注射器抽取2%利多卡因5ml、去除针头,接延长管…     

套管针穿刺留置中心静脉导管治疗自发性气胸

自发性气胸是呼吸内科常见病之一，采用套管针穿刺留置中心静脉导管治疗自发性气胸，与常规手术插管引流相比，因其操作简单、对病人损伤轻、体位不受限制而受到重视，我们2002—08／2005—07治疗自发性气胸36例，经套管针穿刺留置中心静脉导管引流使肺复张，取得了较好的治疗效果，现总结报道如下。     

手法辅助在防止肺癌患者经外周静脉置入中心静脉导管置管颈静脉异位中的临床应用

<正>经外周静脉置入中心静脉导管(peripheralyin-serted central cathete,PICC)因其置管操作简易,留置时间长,携带方便,留置安全,痛苦性小以及授权护士操作等优点,临床上已广泛用于中长期静脉输液、肿瘤化疗、肠外营养、外周静脉穿刺困难等患者~([1-3])。我院呼吸内科肺癌患者居多,PICC的使用较为普遍。但PICC置管过程中由于各种因素影响会遇见各种问题与并发症,常见有导管异位(即尖端不位于上腔     

锁骨下静脉穿刺置管感染原因及预防

锁骨下静脉穿刺置管技术(CVC)主要用于危重患者的抢救及外周静脉穿刺困难的患者。随着使用材料的不断更新，导管的使用时间明显延长，但感染率随之增加。为探讨感染原因及留置导管过程中需注意的问题，现对接受CVC的60例患者进行回顾性分析。     

两种静脉留置针穿刺中送管方法效果的比较

静脉留置针在临床上广泛应用，既减少了反复穿刺给患者造成的痛苦，又保护了血管，减轻护士的工作量，特别是急诊科急、危、重患者可随时建立静脉通路，及早用药，提高抢救成功率。但在留置针穿刺送管过程中，常因一些因素，如：留置针针芯较粗、长或患者血管细、脆等因素，易出现软管曲折、送管不顺，造成穿刺失败，我科在实践中总结出新的穿刺送管方法，对48例患者进行浅静脉穿刺，效果满意，现报告如下。     

颈外静脉穿刺留置针的临床应用与护理

颈外静脉是颈部最粗大的浅静脉,由于仅被皮肤、浅筋膜及颈阔肌覆盖,位置表浅,管径较大。在临床上外周静脉穿刺困难或需建立静脉通路进行抢救而无中心静脉导管时,经常选用颈外静脉穿刺留置针进行临床治疗。本文报告2006年1月至12月采用颈外静脉穿刺留置针建立静脉通路30例患者的体会。1资料与方法1.1临床资料外周静脉穿刺困难18例,无中心静脉导管急需建立静脉通路进行抢救治疗的12例,合计30例,其中男性21例,女性9例,年龄33～82岁,平均年龄(56±8.7)岁。1.2穿刺方法选用威海洁瑞医用制品有限公司生产的22G×22mm一次性使用静脉留置针,连接一…     

静脉留置针在消化道肿瘤化疗患者的临床应用

目的观察静脉留置针在消化道肿瘤患者化疗中应用的效果。方法将52例消化道肿瘤化疗患者分成观察组和对照组(各26例),其中观察组选用密闭式静脉留置针输液化疗,对照组选用普通7号头皮针输液化疗。结果观察组在避免穿刺失败、药物渗漏、预防静脉炎及患者心理顾虑等方面明显优于对照组。结论消化道肿瘤化疗患者应用静脉留置针,既可以提高静脉穿刺一针见血的成功率,保护血管,同时有效地减轻了患者的痛苦及护理人员的负担,提高了患者及家属的满意度。     

Side effects and indwelling times of subcutaneous catheters for insulin injections: a new device for injecting insulin with a minimum of pain in the treatment of insulin-dependent diabetes mellitus

For 2 months we observed side-effects and indwelling times when using a subcutaneous catheter (Insuflon, Viggo AB, Sweden) for insulin injections. This method is used by approximately 600 children and adolescents with IDDM in Sweden today. 22 children and adolescents aged 4-19 years with a diabetes duration of 4.0 +/- 3.0 (mean +/- SD) years participated. Their HbA1c was 5.8 +/- 1.0%. All used 4-6 dosages of insulin per day. The catheter was placed subcutaneously in the abdominal wall, and replaced by parents when home tests showed increased blood or urine glucose, when the child experienced pain or when skin changes were observed. The 22 patients used 239 catheters with a mean time between changing catheters of 4.8 +/- 2.2 (range 0.5-17) days (= 1147 catheter days). Noted side effects were (% of catheter days): fixation problems, 5.6%; minor infection/irritation (= redness greater than 1 mm), 5.6%; pain, 2.8%; sore skin from plastic wings, 2.4%; itching/dry skin, 2.0%; eczema from band-aid, 1.7%; blocked catheter/injection needle, 1.6%; leakage of insulin, 1.3%, transient lipohypertrophies, 1.1%; hematoma/blood in catheter, 0.8%, and moist skin, 0.3%. No major infections requiring surgical or antibiotic treatment occurred. In conclusion, the use of indwelling insulin catheters seems to be a safe method to lessen the pain of insulin injections with a low frequency of side effects. The long-term metabolic control was not altered in this group of well-controlled children. We therefore find that we can recommend the use of indwelling catheters to children and adolescents who have difficulties with injections because of needle phobia or pain, particularly when using MIT.     

Uso del drenaje pleural permanente en el manejo ambulatorio del derrame pleural maligno recidivante

Background and objective

To analyse the effectiveness and safety of the indwelling pleural catheter in the management of recurrent malignant pleural effusion.

Patients and methods

A prospective multicentre study was performed in 63 consecutive outpatients from four Spanish hospitals. A total of 43 men and 20 women were included, with a median age of 67 years. In seven of the cases treatment with pleurodesis had failed; in five other cases their lung was trapped; in another five cases after repeat therapeutic thoracocentesis, and the rest of them as a preference choice to pleurodesis. All patients had an indwelling pleural catheter inserted (PleurX^®, Denver Biomedical).

Results

Most of patients (94.5%) reported an improvement in their respiratory symptoms (cough and dyspnoea) and their ability to function independently. Average length of the catheterisation was 45 days (6–222). Average amount of drained pleural effusion was 75 ml, with a frequency of drainage of between 3 and 4 times per week and once fortnightly. Spontaneous pleurodesis was achieved following 34.9% of procedures. No complications occurred during the insertion of the catheter. The post-catheterisation complications were empyema (3 cases), chest pain (2 cases), and tumour metastasis (3 cases).

Conclusions

The use of an indwelling pleural catheter is an effective palliative treatment in the outpatient management for patients suffering malignant pleural effusion. It is also a simple treatment that can be easily applied, does not require hospitalisation and can be easily managed by the patient at home, with a low rate of complications.     

Clinical utility of blood cultures drawn from indwelling central venous catheters in hospitalized patients with cancer

BACKGROUND: Because of concern about low specificity, the American College of Physicians guidelines and expert opinion discourage the use of a central venous catheter when obtaining blood for culture for bacteremia or fungemia. However, data on the reliability of cultures done with blood obtained from a central venous catheter are conflicting. OBJECTIVE: To determine the sensitivity, specificity, and positive and negative predictive values of cultures done with blood obtained through a central venous catheter compared with peripheral venipuncture. DESIGN: Retrospective cohort study of hospitalized patients with cancer in whom samples for paired cultures were drawn through a central venous catheter and peripheral venipuncture. SETTING: Tertiary care, university-affiliated medical center. PATIENTS: 185 patients hospitalized on a hematology-oncology ward between August 1994 and June 1996. MEASUREMENTS: Blinded assessments of culture results done by infectious disease experts were used as the gold standard. Sensitivity, specificity, and positive and negative predictive values were compared for culture of blood from central catheters and culture of blood from peripheral venipuncture. RESULTS: Of 551 paired cultures, 469 (85%) were catheter-negative/venipuncture-negative, 32 (6%) were catheter-positive/venipuncture-positive, 17 (3%) were catheter-negative/venipuncture-positive, and 33 (6%) were catheter-positive/venipuncture-negative pairs. For the 82 paired cultures with at least one positive result, blinded determination of true bacteremia or fungemia was made by two infectious disease specialists. For catheter draw compared with peripheral venipuncture, sensitivity was 89% (95% CI, 79% to 98%) and 78% (CI, 65% to 90%) (difference, 11 percentage points [CI, -6 to 28 percentage points]), specificity was 95% (CI, 93% to 97%) and 97% (CI, 96% to 99%) (difference, -2 percentage points [CI, -5 to 0.2 percentage points]), positive predictive value was 63% (CI, 50% to 75%) and 73% (CI, 60% to 86%) (difference, -10 percentage points [CI, -26 to 5 percentage points]), and negative predictive value was 99% [CI, 97% to 100%]) and 98% (CI, 96% to 100%) (difference, 1 percentage point [CI, -0.5 to 3 percentage points]). CONCLUSIONS: In hospitalized hematology-oncology patients, culture of blood drawn through either the central catheter or peripheral vein shows excellent negative predictive value. Culture of blood drawn through an indwelling central venous catheter has low positive predictive value, apparently less than from a peripheral venipuncture. Therefore, a positive result from a catheter needs clinical interpretation and may require confirmation. However, the use of a catheter to obtain blood for culture may be an acceptable method for ruling out bloodstream infections.     

老年血液透析患者中心静脉临时置管感染分析

目的 分析老年血液透析患者中心静脉导管相关性感染的发生率、危险因素、病原学,探讨护理干预措施及对策.方法 回顾性分析山东大学齐鲁医院桓台分院128例老年血液透析患者资料,并作统计学分析.结果 20例患者确诊为导管相关性感染,感染率为15.63％,中心静脉导管留置方法、留置时间、合并糖尿病为感染的危险因素,葡萄球菌是老年血透患者导管相关感染的最常见细菌.结论 老年人中心静脉导管存在较高的感染率,严格遵守操作规程,缩短留置时间,及早发现感染迹象并及时给予有效的应对措施,做好导管的维护和居家护理宣教,可有效减少导管相关性感染的发生,延长导管使用寿命.     

Catheterization-associated complications of intraperitoneal chemotherapy in advanced gastric cancer

AIM: To assess the catheterization-associated complications during intraperitoneal chemotherapy (IPCT) for advanced gastric cancer.METHODS: From 1998 to 2002, 80 patients with advanced gastric cancer received a total of 320 courses of IPCT using a large bore central venous catheter and associated complications were analyzed.RESULTS: Catheterization-associated complications occurred in 11 of the 80 patients (13.8%), including abdominal pain caused by catheter in 2 cases (0.63%), insertion failure in 2 cases (0.63%), bowel perforation in 1 case (0.31%) and abdominal pain during chemotherapy in 6 cases (1.88%).No serious complications required surgical intervention.CONCLUSION: IPCT using central venous catheters can be performed safely and simply without severe associated complications.     

111例长期深静脉留置透析导管患者相关并发症的分析

目的 通过分析111例长期深静脉留置透析导管患者相关并发症的临床资料,探讨其防治措施。方法 选择我院2001年1月～2003年3月新留置长期深静脉双腔透析导管使用时间大于6个月的患者111例,导管留置总时间为1090个患者月,平均已留置时间为9．8个月。所有导管均选用Quinton Permcath带cuff长期留置透析导管,插管部位首选右颈内静脉,其次为左颈内静脉、髂外静脉。出现导管并发症(感染、血栓等)予对症处理。结果 局部血肿的发生率为8．1％。导管位置不良的发生率为4．5％。111例患者中有6例发生导管感染,感染率为5．4％,2例为细菌感染,抗生素治疗有效;4例为真菌感染,1例治愈,3例拔管并重新置管。导管血栓形成的发生率为18、9％,发生血栓时导管平均留置时间为36d;20例患者尿激酶溶栓后导管恢复通畅,成功率为95．2％,其中18例再次发生导管血栓,5例患者加服血小板抑制剂后能保持导管长期通畅,13例仍多次发生血栓,改服华法林后,9例有效,另4例改建内瘘或移植血管。溶栓及联合抗凝治疗使16例患者的导管使用寿命平均延长了6个月。结论 深静脉双腔透析导管的留置和长期应用是安全有效的,导管血栓形成是其最为常见的并发症,溶栓及联合抗凝治疗可显著延长导管的使用寿命。     

超声引导下顺行静脉穿刺一站式治疗血栓性髂静脉压迫综合征的临床探讨

目的探讨超声引导下顺行静脉穿刺联合AngioJet血栓抽吸导管及髂静脉支架植入术一站式治疗血栓性髂静脉压迫综合征的临床应用体会。方法回顾性分析2018-06~2020-01入住该科确诊的血栓性髂静脉压迫综合征的患者16例,所有患者均在下腔静脉滤器的保护下采用超声引导下顺行穿刺左下肢腘静脉或小隐静脉建立通路,采用AngioJet血栓清除技术后置入溶栓导管,一期或二期植入髂静脉支架。结果16例血栓性髂静脉压迫综合征患者中有11例患者选择左侧腘静脉穿刺,5例患者选择左侧小隐静脉穿刺,穿刺成功率为100.00%,平均抽吸量为(178.20±14.20)ml,技术成功率为100.00%,尿激酶用量为(150.59±60.92)万U。7例患者一期植入髂静脉支架,9例患者为溶栓后植入髂静脉支架,血栓清除率Ⅲ级患者13例,血栓清除率Ⅱ级患者3例。无致命性出血、症状性肺栓塞等严重并发症发生。结论超声引导下顺行左下肢静脉穿刺联合AngioJet血栓抽吸导管及髂静脉支架可以为血栓性髂静脉压迫综合征患者提供一站式解决方案,简化手术流程,提高手术成功率;同时可提高远期效果,降低远期血栓形成后综合征的发生。     

重症监护室老年患者中心静脉导管相关血流感染的危险因素

目的探讨重症监护室（ICU）老年患者导管相关血流感染（CRBSI）的危险因素。方法ICU90例老年住院患者接受中心静脉置管,分为导管相关性血流感染（CRBSI）组和无感染（对照）组。CRBSI组患者为ICU住院的行深静脉置管伴CRBSI的病例（n=45）,而对照组为同期ICU住院的行深静脉置管但无CRBSI的病例（17=45）,采用回顾性和病例对照的研究方法,对两组患者进行风险困素分析。结果两组患者基础疾病构成、年龄、性别、感染前导管留鼍时间、机械通气、完全肠外营养、尿管留置等的差异无统计学意义（P〉0．05）。与对照组比较,CRBSI组使用碳青霉烯类抗生素、操作熟练程度、置管部位、低白蛋白血症、贫血、APACHEII评分差异有统计学意义（P〈0．01、P〈0．05）。使用碳青霉烯类抗生素、操作者、低A蛋白血症、APACHEII评分是CRBSI独立危险因素。结论碳青霉烯类抗生素使用、操作者人员熟练程度、低白蛋A血症及APACHEII评分是ICU老年患者CRBSI的独立危险因素。     

海普林肝素钠软膏预防静脉留置针致静脉炎的研究

为探讨海普林肝素钠软膏预防静脉留置针所致静脉炎 ,延长留置时间的效果 ,将我院同期使用静脉留置针输液的 6 6例患者随机分为试验组和对照组 ,每组 33例。试验组在穿刺部位涂抹海普林肝素钠软膏 ,对照组按常规操作。结果 ,试验组静脉炎发生率为 9.5 9% ,静脉针留置时间为 6～ 9天 ;对照组静脉炎发生率为 2 9.2 3% ,留置时间为 3～ 5天 ,两组静脉炎发生率比较有显著差异 (P<0 .0 1)。认为穿刺部位涂抹海普林肝素钠软膏 ,能预防静脉留置针所致静脉炎 ,延长留置时间     

中心静脉导管置入胸腔治疗结核性胸膜炎临床疗效分析

目的探讨中心静脉导管置入胸腔持续引流替代反复多次胸腔穿刺抽液治疗结核性胸膜炎临床应用价值。方法对我院2005年1月～2008年10月收治的结核性胸膜炎病例中经胸部X线和／或胸部超声检查确诊为中或大量胸腔积液的病例87例，随机分成2组（治疗组40例及对照组47例），分别用中心静脉导管持续胸腔引流和反复多次的胸腔穿刺抽液治疗，对这两种治疗方法的效果、出现并发症情况、住院费用进行比较。结果两种方法相比：胸水吸收时间、胸膜反应、胸水包裹发生率、气胸发生率、住院费用、治疗后第三个月的胸膜厚度等各项指标对比其差异均有统计学意义（P〈0．05）。结论中心静脉导管置入胸腔持续胸腔引流治疗结核性胸膜炎方法简单、方便、安全、经济，患者痛苦少、效果好，值得基层医院推广。