改良急诊患者留置导尿方法

在急诊抢救各种急、危、重患者中，导尿术及留置导尿是最常见的诊疗技术和护理措施。根据急诊抢救中体现急、快的特点，我科自2006-10起，对一次性导尿包的配置及操作的各个环节进行了全方位改良，较好的使用于急诊抢救中，现报告如下。     

留置导尿的舒适护理体会

留置导尿是常用的护理技术,广泛地应用于临床,在留置导尿过程中,因紧张、疼痛而降低患者舒适度,影响康复.为增加留置导尿操作的舒适度,减少插管困难和尿道损伤,现将长期留置尿管的护理总结如下.     

气囊导尿管留置导尿的相关问题与预防

我科自1997年开始使用气囊导尿管,与普通导尿管比较取得了满意的效果,使尿失禁患者保持会阴部清洁干燥,预防褥疮.但在使用过程中也存在着一些问题,现报告如下.     

硬膜外麻醉前后留置导尿的临床对比

留置导尿是外科手术前的常规准备，目的是排空膀胱以免手术中误伤，同时有利于观察尿最，以往留置尿管通常是在麻醉前进行。为了减轻患者的痛苦和紧张心理，提高护理服务质量，自2004-04以来，我们对部分硬膜外麻醉患者采取麻醉后留置导尿，并对硬膜外麻醉前后留置导尿术患者进行临床对比观察，现报告如下。     

留置导尿常见问题与对策

1　留置导尿的相关因素1.1　尿路感染　留置导尿引起患者泌尿系感染在临床上极为常见 ,细菌通过尿管逆行到膀胱及以上器官 ,引起尿路感染。日本广岛大学调查认为尿路感染占感染总数的 33% ,其中 93%是因尿道置管引起 [1 ]。国内研究 :留置导尿引起的感染占院内感染的第 2位 ,约占院内感染的 4 0 %左右 ,发病率 2 %～ 5 % ,约有90 %的患者有尿路器械检查史 ,其中 2 5 %～ 80 %的患者感染由导尿引起[2 ] 。老年人长期留置尿管的菌尿发生率几乎达 10 0 % ,且有多菌丛生长。在保留导尿的患者中 ,30 %出现有症状的尿道感染 ,10 0 %出现无症状的细…     

留置导尿术操作中常见的护理问题分析与对策

目的通过分析留置导尿术操作中的问题,掌握留置导尿术技巧,提高插管的成功率,减少并发症的发生。方法针对北京丰台医院泌尿科收治的患者及在全院其他科室行留置导尿术会诊的患者进行具体分析总结。结果 50例行留置导尿术患者中,插管不畅32例,留置尿管后出现血尿11例,意外拔管出现血尿5例,龟头水肿2例。结论通过熟悉气囊导尿管结构,规范气囊导尿管应用的技术培训,加强患者的评估与告知,根据不同患者个体差异,普及和掌握留置导尿术技巧。     

留置导尿并发症的护理进展

留置导尿是临床常见的护理技术,广泛应用于排尿困难、麻醉、术后患者尿量的观察等。现在临床上被广泛的应用,但也带来了一些并发症。现将这些并发症发生的原因、预防及护理进展综述如下。     

男性留置导尿两种插入气囊尿管长度对比分析

目的：探讨一种新的插管深度的方法。方法：选择160例需进行留置导尿的患者中随机分两组,实验组80例：使用气囊导尿管见尿后再插入2 cm,即27～29 cm;对照组80例：使用气囊导尿常规置入20～22 cm,见尿后再插入2cm。结果：实验组后尿道出血、留置时间、患者有恐惧心理的发生率均明显少于对照组（P〈0.05）,差异具有统计学意义。结论：气囊导尿管见尿后再插入2 cm即27～29 cm安全有效,达到留置导尿的目的。     

老年男性无痛留置导尿38例分析

2003-01~2006-01我科对需要留置导尿老年男性患者38例采用了无痛法导尿,提高了一次插管成功率,效果理想,总结如下。1临床资料1.1一般资料本组无尿路感染史、意识清楚、能正确回答问题,平均年龄65.4岁,留置尿管时间3~21 d。1.2方法1.2.1无痛插管方法选择粗细合适、质量优质的尿管,用物准备除导尿常规外,另加5 m l一次性注射器1个,2%利多卡因注射液(0.1 g/5 m l)方法:按导尿常规消毒铺巾,持一次性注射器(带针头)抽吸利多卡因3~5 m l,弃针头后,左手将阴茎提起,露出尿道口将药液自尿道口注入,捏闭尿道口,待药液在尿道中1~2 m in,再将经灭菌液体…     

创意病员裤在泌尿外科留置导尿中的应用

泌尿外科大多数患者留置导尿管,但与之带来的导管护理也随之增多,传统的病员裤易使尿管扭曲、折叠、受压等,引流不畅情况屡屡出现,针对这一问题,本着＂人性化服务＂这一理念,我科进行了一次病员裤的改良。2008—04—2010-04经过2a多的临床实践,受到患者、家属及医护人员的一致肯定,现汇报如下。     

中心静脉导管胸腔置管患者的健康教育需求调查

目的调查中心静脉导管胸腔置管患者的健康教育需求。方法采用自行设计的问卷，对110例行中心静脉导管胸腔置管治疗大量恶性胸腔积液患者的健康教育需求进行调查。结果不同时期患者对健康教育的需求各有侧重，患者评价中心静脉导管胸腔置管的优点主要为抽液注药使用方便、安全、有效、微创、费用适中，缺点主要为出院后穿刺点护理困难、洗澡不便。结论应按照置管的不同时期制订健康教育计划，使得中心静脉导管胸腔置管患者的健康教育更加系统完善，从而能有效保证患者治疗的顺利进行，进而能提高治疗效果及患者的生活质量和生存时间。     

Emergency Medicine Education and Health Care Disparities

Education is the means by which learning occurs and, thereby, behavior is changed. One means of improving health care disparities is changing the behavior and understanding of key personnel in academic health centers. These individuals influence policy and procedure, design and evaluate health systems, and define curricular standards for graduate and undergraduate medical education. Emergency medicine provides many opportunities to educate at all levels, including faculty, residents, and students. In addition to our responsibilities in educating emergency medicine residents, the emergency department also provides an ideal learning environment for medical students and other health care providers. The broad issue of disparities in emergency health care may be approached from a variety of directions. The Consensus Group on Education chose to focus on cultural competency education at several levels as a means of tangibly changing its status for both the immediate and long terms.     

经股动脉心导管术后应用Angio—Seal血管封堵器与徒手压迫两种止血方法的随机对比分析

目的 :随机对比研究经股动脉心导管术后应用 Angio- Seal血管封堵装置 (VCD)与徒手压迫止血方法(MC)的优弱。方法 :将 2 0 0例患者随机分为 A、B两组 ,A组应用 VCD,B组为 MC,观察 :止血成功率、止血时间、加压包扎时间和肢体制动时间 ,以及穿刺部位并发症和全身并发症 (血管迷走神经反射、腰背不适等 )。结果 :两组止血成功率(A组 95 % ,B组 87% )、止血时间 (A组 3.19min± 1.6 4 min,B组 18.71min± 6 .87min)、加压包扎时间 (A组 0 h,B组6 .0 8h± 2 .4 3h)和肢体制动时间 (A组 2 .92 h± 1.4 2 h,B组 2 1.4 h± 2 .5 h)均有显著差异 (P<0 .0 0 1)。并发症的发生率 A组明显低于 B组。结论 :应用 VCD可以明显降低术后患者的不适程度和并发症的发生率 ,减轻医护人员的负担 ,尤其适于一些穿刺处并发症高危患者或不能耐受长时间制动的患者。     

急诊科开展特色健康教育工作的做法

探讨如何构建适合急诊特点、满足急诊人群需求、优质高效且具有可操作性的急诊健康教育工作方法。在分析急诊健康教育工作特点、综合市场对健康教育需求的前提下,确立急诊健康教育服务的主体意识;针对性制定急诊科健康教育职责制度、实施方法和标准化工作程序;有的放矢地实施专职服务、提供规范服务、营造满意服务、建立互动服务、推行延伸服务等,创建出富有特色的急诊健康教育服务。经1年多的运作,主动满足急诊人群的健康需求,提高了护理质量和患者满意度,拓宽了急诊护理服务市场。     

Global Health Education in Emergency Medicine Residency Programs

Background

Interest in global health and international electives is growing among Emergency Medicine (EM) residents in the United States (US). The majority of EM residency programs offer opportunities for international electives. The degree of participation among residents and type of support provided by the residency program, however, remains unclear.

Study Objectives

To explore the current state of global health education among EM residents who participate in international electives.

Methods

A 12-question survey was e-mailed to the program directors of the 192 EM residency programs in the US. The survey included questions about the number of residents participating in international electives and the types of preparation, project requirements, supervision, and feedback participating residents receive.

Results

The response rate was 53% with 102 responses. Seventy-five of 102 (74%) programs reported that at least one resident participated in an international elective in the 2010–2011 academic year. Forty-three programs (42%) report no available funding to support any resident on an international elective. Residents receive no preparation for international work in 41 programs (40%). Only 25 programs (26%) required their residents to conduct a project while abroad. Forty-nine programs (48%) reported no formal debriefing session, and no formal feedback was collected from returning residents in 57 of 102 (59%) programs.

Conclusion

The majority of EM residencies have residents participating in international electives. However, the programs report variable preparation, requirements, and resident supervision. These results suggest a need for an expanded and more structured approach to international electives undertaken by EM residents.     

两种不同的健康教育方式用于首次静脉化疗患者的效果比较

目的:探讨两种不同的健康教育方式对首次静脉化疗患者的影响效果。方法:按随机分配的原则将患者分为实验组和对照组。实验组则采用健康教育手册结合交谈方式进行健康教育,而对照组采用单纯的口述方式进行健康教育,并将两组病员对健康教育内容的掌握情况进行比较。结果:实验组的病员对健康教育内容的掌握情况、配合能力明显优于对照组。结论:采用健康教育手册加交谈法的方式进行健康教育,更利于病员掌握有关卫生保健知识,值得在临床上推广。     

胃肠道肿瘤患者两种PICC置管点的比较

目的观察肘关节上段及下段静脉两个不同部位PICC置管点对胃肠道肿瘤患者化疗时影响。方法50例胃肠道肿瘤住院患者按照住院号单双号随机分为两组,每组25例,分别在肘关节上段贵要静脉及肘关节下段前臂正中静脉穿刺行PICC置管术,观察两组患者在行FOLFOX4方案化疗的完成时间、舒适度的差异及是否存在导管断裂。结果两组不同PICC置管点在按时完成化疗方案的时间及舒适度上有统计学差异。结论PICC置管于肘关节上段比下段能更好地完成化疗方案且不受日常生活影响。     

几种深静脉置管方式的比较

目的：比较不同部位、不同方式深静脉置管的优缺点。方法：根据患者病情及能否配合操作,分别采用锁骨下静脉穿刺置管术、颈内静脉穿刺置管术、股静脉穿刺置管术并将三种术式的优缺点及所致的并发症进行比较。结果：276例深静脉置管术中（1）经锁骨下置管者220例,占79．71％。其中术后感染2例,占0．91％;误入动脉2例,占0．91％;纵膈血肿1例,占0．45％;（2）经颈内静脉置管者35例,占12．68％。其中术后感染3例,占1．40％;误入动脉者1例,占2．86％;气胸1例,占2．86％;术后导管脱落者1例,占2．86％;（3）经股静脉置管者21例,占7．60％。其中术后感染5例,占23．8％;误入动脉者1例,占4．76％。结论：几种深静脉穿刺术中,尤以经锁骨下穿刺者并发症相对较少,是深静脉置管方式中的首选。     

A Comparison of Door-to-balloon Times and False-positive Activations between Emergency Department and Out-of-hospital Activation of the Coronary Catheterization Team

Objectives:  The objectives were to compare the proportion of false-positive activations and intervention times between emergency department (ED) and field-based activation of the coronary catheterization laboratory (cath) team for emergency medical services (EMS) patients identified by out-of-hospital (OOH) 12-lead electrocardiogram (ECG) with ST-segment elevation myocardial infarction (STEMI).
Methods:  This was a retrospective review of prospectively collected continuous quality improvement data at a single, urban, academic medical center. By protocol, weekday activation of the cath team occurred based on OOH notification of a computer-interpreted OOH ECG indicating potential STEMI. Night and weekend activation occurred at the discretion of the attending emergency physician (EP) after advanced ED notification and after patient arrival and assessment. Basic demographic information and cardiac risk factors were recorded, as well as door-to-balloon (DTB) and ultimate diagnosis.
Results:  From May 2007 through March 2008, there were 23 field activations and 33 ED activations. There was no difference in demographic or clinical characteristics between the two groups. In the field activation group, 9/23 (39%) were false-positives, while 3/33 (9%) were false-positives in the ED activation group (30% higher absolute difference in the field activation group, 95% confidence interval [CI] = 8% to 52%, p = 0.02). OOH times and time spent in the ED were similar between the two groups. DTB times were 77 minutes for field activation and 68 minutes for ED activation, respectively (difference 9 minutes, 95% CI = −9 to 27).
Conclusions:  Emergency physician activation of the cath team results in a lower proportion of false-positive activations without clearly sacrificing DTB time when compared to field activation based solely on the results of the OOH ECG.     

Multicenter Study of Preferences for Health Education in the Emergency Department Population

Objectives: Emergency departments (EDs) are increasingly proposed as high‐yield venues for providing preventive health education to a population at risk for unhealthy behaviors and unmet primary care needs. This study sought to determine the preferred health education topics and teaching modality among ED patients and visitors. Methods: For two 24‐hour periods, patients aged 18 years and older presenting to four Boston EDs were consecutively enrolled, and waiting room visitors were surveyed every 3 hours. The survey assessed interest in 28 health conditions and topics, which were further classified into nine composite health education categories. Also assessed was the participants’ preferred teaching modality. Results: Among 1,321 eligible subjects, 1,010 (76%) completed the survey, of whom 56% were patients and 44% were visitors. Among the health conditions, respondents were most interested in learning about stress and depression (32%). Among the health topics, respondents were most interested in exercise and nutrition (43%). With regard to learning modality, 34% of subjects chose brochures/book, 25% video, 24% speaking with an expert, 14% using a computer, and 3% another mode of learning (e.g., a class). Speaking with an expert was the overall preferred modality for those with less than high school education and Hispanics, as well as those interested in HIV screening, youth violence, and stroke. Video was the preferred modality for those interested in learning more about depression, alcohol, drugs, firearm safety, and smoke detectors. Conclusions: Emergency department patients and visitors were most interested in health education on stress, depression, exercise, and nutrition, compared to topics more commonly targeted to the ED population such as substance abuse, sexual health (including HIV testing), and injury prevention. Despite many recent innovations in health education, most ED patients and visitors in our study preferred the traditional form of books and brochures. Future ED health education efforts may be optimized by taking into account the learning preferences of the target ED population. ACADEMIC EMERGENCY MEDICINE 2010; 17:652–658 © 2010 by the Society for Academic Emergency Medicine