完全植入式静脉输液港外露伤口的手术治疗

目的：探讨完全植入式静脉输液港外露伤口的手术治疗效果。方法：2021年12月-2022年10月,笔者对医院肿瘤术后放置完全植入式静脉输液港外露伤口的患者进行回顾性分析,根据创面的大小、暴露的时间、感染的严重程度,选择清创后直接缝合、囊袋重置或输液港取出的方法进行处理,探讨手术治疗效果。结果：完全植入式静脉输液港外露患者共13例,其中清创后直接缝合6例,囊袋重置5例,输液港取出2例。输液港外露到伤口愈合的时间为7～10?d,平均时间为8.5?d,所有伤口均一期愈合,无并发症发生,瘢痕隐蔽。术后随访6个月,患者总满意率为92.31%。结论：完全植入式静脉港外露伤口手术治疗疗效较好,值得临床推广。     

经颈内静脉完全植入式输液港在乳腺癌化疗中的应用

目的总结经颈内静脉放置全植入式输液港(TIVAP)作为乳腺癌化疗静脉输液通路的使用经验。方法对2013年6月~2015年12月486例行输液港植入术的乳腺癌化疗患者进行回顾性研究,观察其术后及远期并发症。结果全部病例均在术中成功完成输液港植入。l例出现心悸不适,2例穿刺点周围局部血肿,1例囊袋内港体周围血肿,2例气胸,3例导管相关性感染,2例导管堵塞,1例导管断裂。至末次随访,65例带管时间4~30个月,中位带管时间15个月。本组未出现导丝断裂、pinch-off综合征等严重并发症。结论经颈内静脉放置全植入式输液港是乳腺癌化疗安全、有效的输液途径。     

乳腺癌术中放置输液港的临床体会

目的:探讨乳腺癌患者术中放置输液港的临床疗效。方法:对46例乳腺癌患者术中放置输液港,观察其临床症状及并发症的状况。结果:46例放置输液港的癌症患者中,取出5例,注射座表面皮肤感染2例,输液港堵塞1例。结论:在乳腺癌术中完成输液港的放置,避免了患者遭受再次手术的痛苦,操作简单方便、安全可靠、并发症少,是首选的置管方法。     

超声引导下经锁骨下静脉植入输液港的可行性

目的 观察超声引导下经皮穿刺锁骨下静脉（SCV）植入输液港的可行性。方法 选取196接受输液港植入术的恶性肿瘤患者,其中98例于超声引导下（超声组）、98例于DSA引导下经SCV植入输液港（DSA组）;对比2组总穿刺次数、一次性穿刺成功率,以及术中、术后（随访12个月）并发症发生率。结果 超声组总穿刺次数100次、一次性穿刺成功率97.96%(96/98),DSA组总穿刺次数117次、一次性穿刺成功率89.80%(88/98);超声组总穿刺次数少于DSA组（P=0.02）,一次性穿刺成功率高于DSA组（P=0.02）。超声组1例术中出现心律失常,DSA组术中臂丛神经损伤3例、误穿动脉2例、气胸2例;术后随访12个月,超声组2例发生导管异常,DSA组4例静脉血栓形成、3例导管异常、2例切口感染、2例输液座外露;超声组术中及术后并发症发生率均低于DSA组（P均<0.05）。结论 超声引导下经SCV植入输液港穿刺成功率高、并发症发生率低,具有高度可行性。     

静脉输液港穿刺座冲洗量的体外实验

目的探讨静脉输液港穿刺座冲洗量。方法在静脉输液港输完250ml脂肪乳后，用10ml注射嚣抽吸0.9％氯化钠溶液进行脉冲式冲管，观察冲洗液量及输液港内脂肪乳的残留量。结果冲洗到5ml后输液港的穿刺座和导管清亮。结论用静脉输液港输注脂肪乳后或者输入2种不相容药物中间必须用0．9％氯化钠溶液10ml进行脉冲式冲管，以冲净输液港内的残留物，保证永久性导管的通畅。     

静脉输液港输液外渗的原因分析及对策

目的分析植入静脉输液港患者发生输液外渗的原因,提出护理对策,为临床护理提供参考。方法 3 514例植入静脉输液港中17例发生输液外渗,原因为纤维蛋白鞘形成、无损伤针型号选择及穿刺不当、反复穿刺致穿刺隔损伤、导管破裂、导管断裂等,均行对症处理。结果 3例导管破损、2例导管断裂、1例输液港注射座周围组织坏死者取出静脉港,11例继续使用至疗程完成。结论静脉输液港药物外渗原因有导管材质、患者体质、不当活动及医护失误等,通过加强健康宣教、规范操作流程、严密观察,可早期发现、及时处理,有利于患者用药安全。     

静脉输液港穿刺座冲洗量的体外实验

目的探讨静脉输液港穿刺座冲洗量.方法在静脉输液港输完250 ml脂肪乳后,用10 ml注射器抽吸0.9%氯化钠溶液进行脉冲式冲管, 观察冲洗液量及输液港内脂肪乳的残留量.结果冲洗到5 ml后输液港的穿刺座和导管清亮.结论用静脉输液港输注脂肪乳后或者输入2种不相容药物中间必须用0.9%氯化钠溶液10 ml进行脉冲式冲管,以冲净输液港内的残留物,保证永久性导管的通畅.     

血液病患儿静脉输液港的临床运用

静脉输液港(venous port access)是一种长期留在人体内的静脉输液装置,主要由供穿刺的注射座和静脉导管两部分构成,经手术植入皮下,用于静脉输注各种药物、输液输血、采集血样等.     

可视化超声用于输液港植入全流程医护一体化管理

目的 观察可视化超声用于输液港植入前、中、后全流程医护一体化管理的价值。方法 选取133例于化学治疗前接受输液港植入的恶性肿瘤患者,其中106例经颈内静脉、27例经腋静脉植入;并观察植入前、中、后的临床及超声资料,分析超声对其全流程医护一体化管理的价值。结果 133例患者中,术前超声发现一侧颈内静脉狭窄4例,一侧颈内静脉先天走行变异2例,一侧颈内静脉血栓2例。133例均成功一次性穿刺植入输液港。术后发现27例经腋静脉植入输液港中,导管异位于右侧颈内静脉1例;106例经颈内静脉植入输液港中,导管附壁血栓13例,导管折断并异位3例,注射座周围皮下软组织感染2例,注射座翻转1例;以相应措施干预后,患者一般情况均良好。结论 可视化超声可于植入输液港前评估拟穿刺血管、于植入中实时引导穿刺、于植入后密切监控,实现输液港植入全流程医护一体化管理。     

乳腺癌患者上臂输液港植入方式改进

目的探讨超声联合改良塞丁格技术在乳腺癌患者上臂输液港植入的应用效果。方法选取73例乳腺癌患者为研究对象,采用超声引导联合改良塞丁格技术植入上臂输液港,即血管超声下穿刺成功后送入0.018英寸导丝,插入5Fr微插管鞘,退扩张器及微导丝,送入含支撑导丝(0.035英寸)的5Fr导管,并行导丝引导腔内心电图定位确定导管长度,制作囊袋放入港体,缝合皮肤并固定。观察植港操作时间、成功率及植港即刻并发症发生率。结果患者上臂输液港植港成功率为95.89%,植入操作时间为15～45(25.46±6.22)min。患者植港术中疼痛评分为(1.63±0.74)分,术后24 h为(2.94±0.67)分,仅有1例误穿神经。结论采用超声联合改良塞丁格技术植入输液港,在保证成功植入的同时,可缩短操作时间,改善患者疼痛程度,且有效预防植港并发症发生。     

静脉输液港植入与管理多学科专家共识（2023版）

完全植入式静脉给药装置（TIVAD）又称静脉输液港，是一种新兴的中心静脉输液通路装置，主要应用于肿瘤化疗、肠外营养支持，近年来的应用证实该技术可靠有效。目前国内对该技术的应用主要集中于大型医疗机构，不同地区植入手术和维护存在较大差异，造成实际应用效果差异较大、相关并发症的发生率高、患者满意度差别大。专家组集合了在静脉输液港工作方面具有丰富经验的来自不同专业的多位专家，结合最新研究结果，充分讨论制定了《静脉输液港植入与管理多学科专家共识（2023版）》，适用于从事静脉输液港工作的医护人员，内容涵盖了静脉输液港的植入和维护全部流程，目标是减少植入和使用的并发症，提高使用静脉输液港患者的安全性和满意度。     

The trapezius port: a novel approach for port access

Placement of long-term central venous access in breast cancer patients who have undergone bilateral mastectomy presents a unique challenge. The standard anterior chest wall placement of the port may be compromised by factors such as a fresh surgical site, the possibility of postoperative radiation therapy, or the immediate reconstruction field. To avoid the potential for complications that impact the surgical field or subsequent therapy, we have developed a unique new technique for central venous port placement: the trapezius port. By placing the port in a subcutaneous pocket over the trapezius muscle, the risk of infection or cross-contamination of the surgical site is avoided.     

带线穿刺缝合器在腹腔镜胆囊切除术切口缝合中的应用

目的:探讨带线穿刺缝合器在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)戳孔缝合中的应用价值。方法:回顾分析2015年1月至2015年6月660例LC术中应用带线穿刺缝合器缝合穿刺孔的临床资料。结果:本组660例患者采用两枚10 mm Trocar孔用带线穿刺缝合器顺利完成缝合,缝合时间1~2 min,缝合过程中无腹腔内脏器损伤。15例患者术中Trocar孔出血,术毕均用带线穿刺缝合器跨过出血点缝合打结止血成功。术后发生切口感染8例,无一例发生切口出血。本组660例患者中607例获得随访,随访21~27个月,平均(23.9±1.8)个月,未发生戳孔疝。结论:LC术中用带线穿刺缝合器缝合穿刺孔简单、方便、安全且有效,可减少穿刺孔并发症的发生。     

Rate of contamination of intravenous indwelling cannulae with sideport access

136 cannulae with valved side injection port were introduced intravenously into patients from the general surgery, urology and dermato-surgical service under clinical routine conditions. The cannulae were used from 1 up to 4 days for anaesthesia purposes as well as peri- and postoperative infusion therapy and injection of drugs through the sideport. After use the cannulae were removed following an aseptic procedure and examined microbiologically. 37 cannulae (27.2%) were found contaminated, 25 of these (18.3%) with more than 25 colonies. The infusion line (border of the conus, the interior of the conus and the lumen of the cannula) was 21 times (15.4%), the side injection port 6 times (4.4%) and the intravasal capillary surface 17 times (12.5%) contaminated. Contamination of the cannula or of parts of the cannula did not correlate well with observed signs of inflammation at the puncture site (45 patients = 33%). If, however, the contamination of the cannula is considered to be an infection risk, the addition of a side injection port to such a cannula does not increase the risk of infection. This risk is much greater via the infusion line.     

Percutaneous placement of a venous access port in a pediatric patient population

Venous access for administration of therapeutic agents and blood sampling has been difficult in the pediatric age group. A subcutaneous injection venous access port, the Infuse-A-Port (Infusaid Corp, Norwood, Mass) has been placed by percutaneous means in 29 patients aged 2 to 24 years. Placement has been under general (16) and local (13) anesthesia. There have been five problems (extravasation 2, suspected sepsis 1, and hematoma 2) during a total of 2,927 days of exposure. The convenience, reliability, safety, and patient acceptance of this venous access port makes this method the preferred choice for prolonged venous access in the pediatric age group.     

出院护理指导模式在肿瘤患者植入式静脉输液港的运用

目的观察出院护理指导在肿瘤患者植入式静脉输液港的运用效果。方法筛选我院100例使用植入式静脉输液港的肿瘤患者,按照不同护理方法将其分为常规组(50例)与观察组(50例),常规组运用常规护理,观察组强化出院护理指导,对比两组的护理效果。结果两组均未见皮下气肿、血肿及气胸等并发症,而导管堵塞、感染并发症中,常规组发生率是14.0%,观察组是6.0%,观察组低于常规组,对比差异有统计学意义(P0.05);常规组的护理满意度是86.0%,观察组是98.0%,观察组高于常规组,对比差异有统计学意义(P0.05)。结论出院护理指导在肿瘤患者植入式静脉输液港的运用效果显著,可有效降低导管堵塞、感染等并发症,显著提升护理满意度。     

蝶翼无损伤针在植入式静脉输液港应用中的常见问题及对策

目的探讨蝶翼无损伤针在植入式静脉输液港应用中的常见问题及对策,旨在提高护理技能。方法对14例应用植入式静脉输液港患者采用蝶翼无损伤针穿刺658次。结果 658次操作中,遇到问题50次,包括针刺伤、重复穿刺、患者自行拔针和输液不畅等。结论目前蝶翼无损伤针配合静脉输液港使用的临床护理经验尚不足,通过总结护理经验有助于提高护理技能。     

Peripheral parenteral nutrition: effect of a standardized compounded mixture on infusion phlebitis.

The incidence and severity of infusion phlebitis was evaluated prospectively in 142 surgical patients who received peripheral parenteral nutrition (PPN) for a total of 700 days. In a first study phase 83 patients were given PPN for a total of 424 days. All nutrient solutions were delivered over a 12-h period from a 3-litre bag and the infusion sites rotated daily. These methods resulted in an incidence of phlebitis of 18 per cent, 75 per cent of the patients being fed successfully by PPN until resumption of oral nutrition. In an attempt to assess the importance of the method of delivering nutrient solutions, the next 59 patients were randomized to receive PPN as a compounded mixture or by a conventional technique with simultaneous infusion from separate bottles. Infusion phlebitis was significantly more frequent (P less than 0.001) in patients infused with separate bottles. There was no difference between the groups with regard to duration of nutrition or the need to establish central venous access. We conclude that PPN is a safe and cost-effective means of providing total parenteral nutrition in most surgical patients. The use of compounded mixtures significantly reduces the incidence of phlebitis without increasing total costs.