留置针穿刺在烧伤患儿静脉输液治疗中的应用价值

目的:对比分析静脉留置针穿刺与表浅静脉普通穿刺输液在婴幼儿烧烫伤治疗过程中的应用价值,探讨婴幼儿烧烫伤早期较为理想的静脉输液方法.方法:对2006年1月～2008年1月期间,在我院住院治疗的婴幼儿烧烫伤病历资料进行回顾性调查分析,符合课题调查研究条件者共81例,均为烧烫伤后5天之内接受静脉输液治疗者.根据所采取的静脉输液方法分为表浅静脉留置针组(留置针组)和表浅静脉普通穿刺组(普通组);主要观察指标包括穿刺部位、穿刺成功率、输液通畅程度及治疗中的局部并发症等.结果:两组的穿刺部位、烧伤伤情及静脉穿刺成功率均无统计学差异(P＞0.05),但普通组的静脉穿刺次数明显大于留置针组,即相当留置针组的5倍之多;普通组的局部并发症发生概率明显大于留置针组,具有显著性差异(P＜0.05).结论:婴幼儿烧烫伤早期采用表浅静脉留置针穿刺,可延长穿刺针的留置时间,减少静脉穿刺次数,降低并发症,增加患儿舒适度,体现了以人为本的医疗服务理念.     

静脉留置针改良穿刺法30例效果分析

 套管针也被称为静脉留置针。与静脉头皮针相比,静脉留置针具有保护血管静脉、减轻患者痛苦的优点;在穿刺时可减少液体外溢,具有防止针刺血液污染工作人员的作用,大大提高了护理工作质量^[1]。同时,静脉留置针在留置过程中也存在缺点,如穿刺不当成功率较低、留置过久造成静脉炎、液体滴入不畅等缺点。我院2014-12至2015-06对妇科手术后患者采用改良穿刺方法,提高了穿刺成功率,延长了留置时间。     

小儿静脉留置针的穿刺方法与护理

随着社会的发展,人们对医疗护理的要求越来越高。为了减少了患儿的痛苦及恐惧心理,减轻家长的心理压力,同时提高护士的工作效率。我科2001年引进了美国B．D公司生产的小儿静脉留置针。静脉留置针作为头皮针的换代产品,因能高效率保持静脉通畅,减少反复穿刺的痛苦,得到了患儿家属和护理工作者的青睐。但因小儿好动、不易合作、血管较细、弯曲较多等原因,其留置较成人更易失败,2007年我科改进了小儿头皮静脉留置针穿刺方法,提高了穿刺成功率及留置时间,得到了家长的好评。现将结果报告如下。     

头皮静脉留置针的临床应用

在八十年代后期 ,静脉留置针方法已开始应用于临床 ,但材料和方法在逐年改进 ,近年来 ,我院使用静脉留置针用于婴幼儿及重危患儿的抢救 ,现就头皮静脉留置针的操作新方法简介如下 :1　材料与方法1.1　材料采用美国Ｂ -Ｄ公司生产静脉留置针 2 4Ｇ型号、静脉帽、3Ｍ透明胶及一般输液用物。1.2　方法　选择粗直易于固定的头皮静脉 ,剃净以穿刺点为圆心 ,2 5ｃｍ半径范围的毛发 ,消毒穿刺部位皮肤。松动外套管与针芯 ,左手小鱼际固定患儿头部 ,拇指、食指上下绷紧穿刺部位皮肤 ,固定穿刺血管 ,右手拇指与中指握住套管针回血腔两侧 ,食指轻按在…     

新鲜芦荟薄片外敷预防化疗性静脉炎的疗效观察

目的探讨新鲜芦荟薄片外敷预防化疗性静脉炎的作用。方法将使用留置针静脉滴注蟾蜍的100例行静脉化疗的患者随机分为2组,实验组：静脉化疗时用新鲜芦荟片在穿刺处外敷（避开针眼处）,对照组：静脉化疗时穿刺处未用任何方法外敷。观察两组静脉炎发生率及留置针的留置时间。结果实验组静脉炎发生率明显降低,静脉留置针留置时间明显延长（P〈0．01）。结论新鲜芦荟片外敷静脉留置针注射部位,可有效地预防静脉炎的发生,延长静脉留置针的使用时间,减轻患者的痛苦。     

小儿静脉留置针中止留置原因分析及护理观察处理

目的分析小儿静脉留置针输液中止留置原因,探讨护理方法。方法对98例住院患儿采用静脉留置针输液治疗,观察不同部住留置针管留置的时间和静脉炎、堵管、针体滑出等的发生率。结果头皮静脉留置时间最长,与手背静脉比较差异无显著性（P〉0．05）,但头皮静脉与大隐静脉、足背静脉留置时间比较;差异均有显著性（P〈0．01）。手背静脉与大隐静脉、足背静脉比较差异均无显著性（P〉0．05）。大隐静脉与足背静脉比较差异也无显著性（P〉0．05）。而留置针的置管部位与静脉炎、堵管、针体滑出等无明显关系。结论婴幼儿穿刺以头皮静脉为首选,其次是手背静脉,掌握正确的穿刺技术及固定好套管针可以提高静脉留置效果。     

专科重症监护室护士浅静脉留置针置管术现状分析及对策

目的：了解专科重症监护室护士浅静脉留置针置管术掌握情况,分析相关因素并探讨对策,为提高ICU护士静脉穿刺能力提供依据。方法按统一标准同期对我院普通外科普通病房护士及重症监护室护士进行浅静脉留置针置管操作考核,比较两组护士的穿刺技能。结果监护室护士浅静脉留置针置管术流程熟练度、穿刺手法、穿刺成功率等考核成绩均差于普通病房护士（P<0.05）,普通病房各病区护士考核成绩差异无统计学意义。普通病房及监护室高年资护士考核成绩均优于低年资护士（P<0.05）,流程熟练度差异无统计学意义。结论 ICU护士缺乏临床穿刺经验、工作年限低、心理素质不过硬等是影响浅静脉穿刺技术掌握的主要因素。科室管理者应该加强思想教育、强化技能培训、重视细节管理,制订分层级、全面、系统的技能培训与考核方案,提高科室整体救护能力。     

静脉留置针向上反折外套管末端防渗血法与静脉留置针头固定改良法

静脉留置针穿刺是现代临床常用的护理操作技术之一,然而,由于传统的静脉留置针穿刺和静脉留置针头同定在实际操作中存存不少弊端,不仅增加静脉输液护理操作难度,也增添患者的痛苦,埋下护患纠纷隐患我们通过临床实践与探索,对静脉留置针手指压迫防渗出法改为静脉留置针向上反折外套管末端防渗出,以及对静脉留置针头固定法进行改良,取得很好的护理效果。介绍如下。     

芦荟胶外涂预防康莱特致静脉炎及延长留置针留置时间的探讨

目的 探讨芦荟胶外涂防治输注康莱特所致静脉炎及延长静脉留置针留置时间的影响.方法 将82例行静脉留置针输注康莱特的患者随机分成实验组和对照组进行对照观察,实验组患者在使用静脉留置针输注康莱特时将芦荟胶涂搽于留置针输液穿刺点上方的皮肤上;对照组不做任何处理,观察两组静脉炎发生情况.结果 实验组静脉留置针留置时间≥4d 30例,占73.17％,对照组静脉留置针留置时间≥4 d 21例,占51.22％.结论 使用静脉留置针输注康莱特时外涂芦荟胶可明显延长留置针留置时间并有效预防静脉炎的发生.     

浅谈浅静脉留置针在临床中的应用及护理

浅静脉留置针又称套管针,作为头皮针的换代产品,广泛运用于临床。留置针穿刺减少了血管穿刺的次数,有效防止药物渗漏,保证了各种药物通畅输入,减少了对表浅静脉的破坏,减轻了患者的痛苦,同时也减轻了护士的工作量,提高了工作效率,另外,抢救危重患者时需要药物种类较多,如无配伍禁忌,可在留置针的Y型管给予多路液体通道,保证抢救工作顺利进行,赢得了抢救时间。留置针在急诊抢救中至关重要。如何正确使用静脉留置针是护理工作者研究的新内容。现将静脉留置针应用技术的研究情况综述如下。     

Catheter-related focal FDG activity on whole body PET imaging

INTRODUCTION: Whole body FDG positron emission tomography (PET) scan is increasingly being used in the management of a variety of cancers and infections. Cancer patients and other very sick patients have central venous catheters, which could be associated with common complications like thrombosis and infections. We describe catheter-related focal FDG uptake on whole body FDG PET scans in 4 patients. MATERIALS AND METHODS: Four patients underwent whole body FDG-PET scanning 60 minutes after intravenous injection of F18-FDG (2 for localization of site of infection, 1 for primary cancer site localization, and 1 for restaging of colon cancer). The whole body PET images were compared and correlated with the patients' history, radiology and laboratory tests. RESULTS: Focal and intense FDG activity is seen in all 4 patients at the distal end of the intravenous catheter. The average SUV of this activity was 6.3 (n = 3). Catheter-related thrombosis was identified as the cause of FDG activity in 3 patients, whereas catheter-related infection was considered in one patient. CONCLUSION: Focal and intense FDG activity, in relation to the distal end of a central venous catheter, has a benign etiology, usually seen with catheter-related venous thrombosis and can be seen with catheter related infection.     

螺旋CT表现遮盖法及多平面重组对骨病变的诊断价值

目的：探讨螺旋ＣＴ三维（３Ｄ）表面遮盖法（ＳＳＤ）和多平面重组（ＭＰＲ）立体和多方位显示骨病变,比较与常规ＣＴ的优缺点。材料与方法：选择３０例典型病例,均经临床或手术病理证实。全部数据输入工作站进行图像处理。结果：ＳＳＤ很好地立体展现了骨病变,ＭＰＲ可从任意平面观察并能进行位置调整。结论：ＳＳＤ和ＭＰＲ在影像显示上有独特的优势,可立体或任意平面观察病变,改变了影像思维方式,有助于影像与实际解剖相结合。     

Marker alignment for Guglielmi detachable coil embolization: practical considerations

BACKGROUND AND PURPOSE: Aneurysm embolization is not without risk: numerous technical aspects are considered before, during, and after the procedure. The purpose of this study was to show the position of the detachment zone of a Guglielmi detachable coil (GDC) with respect to the catheter tip for various microcatheters and marker alignments. METHODS: Six types of commonly used microcatheters were tested (Excel-14, Excelsior, FasTracker-10, Prowler-10, Prowler-14, and Rebar-14). First, the catheter markers and the distance from the catheter tip to the distal end of the proximal and distal markers of each catheter were compared. Second, the coil maker was aligned with the catheter marker. Third, the distal 3 cm of the microcatheter was modified by random shaping, with or without steaming. Last, marker alignment was tested with resterilized microcatheters (ethylene oxide gas sterilization). RESULTS: The length of the catheter marker and the distance between the catheter tip and the distal end of the proximal and distal catheter markers varied among the microcatheters. Sometimes, they varied even within the same microcatheter type. When a GDC was advanced until the proximal end of the marker on the delivery wire was exactly distal to the proximal catheter marker, the coil detachment zone was positioned at approximately 1.0 to 1.5 mm outside the catheter tip. Steaming or shaping of the distal 3 cm of the microcatheters resulted in the GDCs protruding more from the catheter tip. Resterilization also had an effect of marker distance shortening. Microcatheters were easily stretched by usual handling, such as removing a shaping mandrel from the catheter tip. CONCLUSION: Our study shows that proper marker alignment is influenced by many factors, including microcatheter type, steaming, shaping, sterilization, and manual handling.     

Injection rate threshold of triple-lumen central venous catheters: an in vitro study

RATIONALE AND OBJECTIVES: Computed tomographic angiography (CTA) requires the rapid injection of contrast media ideally through an 18-gauge intravenous line in the antecubital fossa. Patients with CVCs undergoing CTA, however, are typically injected at low rates for two reasons: the potential for catheter failure and because of the lack of manufacturer recommendations for high injection rates typically used during CTA. The purpose of the study is to measure the injection rate thresholds of CVC. The results suggest that CVC can be used at high injection rates that are now typically used with peripheral intravenous catheters during CTA. MATERIALS AND METHODS: We used 16-cm-long catheters and 20-cm-long catheters in six groups (n = 5 for each catheter length). After the catheters were placed into a water bath, each group was injected at 5, 10, 15, 20, 25, and 30 ml/sec. New contrast, pressure tubing, and catheters were used for each test. RESULTS: No catheter ruptures were encountered during the experiment, but there was one episode of power injector tubing rupture during the injection of a 16-cm catheter at an injection rate of 30 ml/sec. CONCLUSION: No catheter failures were demonstrated in this study using injection rates well above those used in conventional CTA. Power injector tubing failure was demonstrated at an injection rate of 30 ml/sec, which generated mean pressures in the 16-cm catheters of 920 psi (tubing rating per manufacturer is 300 psi). This study demonstrated no catheter or injector tubing failure at injection rates of 5 to 25 ml/sec.     

Olbert dilatation catheter system: Complication due to inexpert handling

A complication of inexpert handling of the Olbert catheter system is presented. The balloon was inflated while the clamp at the proximal end of the catheter was closed. This resulted in kinking of the distal end of the catheter within the balloon. Difficulty in catheter removal resulted but was overcome by an improvised coaxial sheath technique.     

恶性肿瘤所致上腔静脉压迫综合征的介入治疗

目的：探讨采用介入方法治疗恶性肿瘤所致上腔静脉阻塞综合征（SVCS）的疗效及临床意义。方法：24例上腔静脉阻塞综合征患者,经右侧股静脉入路,以猪尾巴导管于狭窄段近端或远端造影,明确狭窄部位、长度、程度,无局部血栓形成者直接置入Wallstent支架（Boston Scientific,USA）,合并血栓病例留置溶栓导管局部溶栓后再置入支架。结果：24例全部开通成功,手术成功率100%,狭窄段平均长度4.6 cm（3～7 cm）。3例置入2枚支架,其余患者均置入1枚支架。9例在支架置入前行溶栓治疗。开通前后梗阻远侧卧位测静脉压,术前（27.3±1.8）cmH2O,术后降至（4.5±0.8）cmH2O,置入支架后造影示侧支静脉完全消失,上腔静脉阻塞症状于术后即刻至术后3 d完全消退。随访8～26个月,11例术后5～10个月内死亡,13例存活,所有病例上腔静脉阻塞症状未再复发。结论：上腔静脉支架置入术联合导管局部溶栓是治疗恶性肿瘤所致上腔静脉阻塞综合征有效的微创治疗方法。     

医源性静脉血管内异物五例的微创清除

目的 探讨用微创介入方法清除医源性静脉血管内异物的疗效、技术要点及并发症防治.方法 5例由静脉置管引起的医源性血管内异物均采用右股静脉入路,选用不同规格的抓铺器抓取异物.结果 所有病例均成功取出异物,手术成功率100%,未发生血管破裂、肺动脉栓塞等严重并发症.结论 微创方法用抓铺器取医源性静脉置管血管内异物创伤小,成功...     

Experience with a modified Gray-St. Louis catheter for percutaneous gastrojejunostomy.

PURPOSE: To determine if design modifications to the Gray-St. Louis gastrojejunostomy catheter would improve its deployment and utilization characteristics. METHODS: A modified catheter and the Gray-St. Louis catheter were alternately inserted in consecutive patients requiring gastrojejunostomy. At the time of insertion, the anatomic locations of the fenestrated end of the catheter and the Cope retention loop were recorded. At the time of removal or exchange, catheters were assessed for the position of the fenestrated end and the retention loop, the presence of catheter tears, leakage of injected contrast medium and evidence of catheter blockage. RESULTS: Of the 250 catheters we assessed in a 3-year period, 141 (56%) were modified catheters and 109 (44%) were Gray-St. Louis catheters. At insertion, the retention loop of the modified catheter was in the duodenum in 132 (94%) patients, whereas the retention loop of the Gray-St. Louis Catheter reached the duodenum in 29 (27%) (p < 0.05). At the time of catheter removal or exchange, the retention loop of the modified catheter was in the duodenum in 72 (60%) patients, whereas the retention loop of the Gray-St. Louis catheter was in the duodenum in 13 (14%) (p < 0.05). CONCLUSION: The design modifications to the Gray-St. Louis catheter improved the likelihood of the retention loop residing in the duodenum, while continuing to allow the fenestrated portion of the catheter to reside in the jejunum.     

Intra-Arterial and Intravenous Contrast-Enhanced Ultrasonography in Prostate Artery Embolization: A Case Series

This retrospective case series details early experience with intra-arterial (IA) and intravenous (IV) contrast-enhanced ultrasound (CEUS) in 8 patients (mean age, 70.4 years) who underwent prostatic arterial embolizations from July 2014 to March 2017. Technical success was achieved in 7 of the 8 patients. IA CEUS demonstrated ipsilateral prostatic perfusion in 15 out of 20 interrogated prostatic arteries (PAs), confirming proper catheter placement. Four of the 20 interrogated PAs demonstrated extraprostatic perfusion. One PA was not successfully interrogated owing to a localized wire perforation. IV CEUS, performed on 4 of the 8 patients, demonstrated decreased enhancement after embolization in all 4 patients, confirming the procedural end point.     

Intravascular foreign bodies: percutaneous retrieval

Percutaneous retrieval of an intravascular foreign body was performed in 20 patients. There were 14 through-the-needle intravenous catheter fragments. In four patients the embolized foreign body was a broken diagnostic catheter. One patient had a ventriculovenous broken catheter and another patient had a bullet in the pulmonary circulation. Eight foreign bodies were located in the superior vena cava, six in the pulmonary artery, two in the right side of the heart, one in the subclavian vein, one in the thoracic aorta, and two in the aortoiliac segment. Percutaneous retrieval was successful in 95% of the attempts. In one case the procedure was performed to dislodge the foreign body into a better position for surgical retrieval.