夹板固定在小儿手部静脉输液中的应用

目的探讨夹板固定在小儿手部静脉输液中的合理有效应用,以改善夹板固定效果,保证患儿输液顺利进行。方法将300例手部静脉输液的患儿,随机分为实验组和对照组,各150例。实验组采用改良固定法。对照组采用传统固定法。比较两组手部静脉输液穿刺后夹板固定手部的舒适度和固定的满意率。结果实验组手部不适和输液不畅发生率显著低于对照组（P〈o．05,P〈O．01）。实验组手部舒适度和固定的满意率明显高于对照组（P〈O．05）。结论采用夹板改良固定法可明显减少固定处皮肤破损或疼痛、手指麻痹、针头移动或滑脱、药液渗漏、输液针软管反折或与针头交叉缠绕的发生,提高患儿手部的舒适度和固定的满意率。     

自制手部固定托板在高龄艾滋病患者静脉输液中的应用

目的 探讨自制固定托板在老年艾滋病患者静脉输液中的应用效果.方法 选取216例60～78岁手背静脉输液的住院患者按照住院的先后顺序分为对照组(采用硬纸板固定或者不固定)和实验组(采用自制固定手部托板),观察两组患者的肢体随意改变程度、配合度、满意度、舒适度等,并对结果进行对比分析.结果 在皮肤肿胀方面,实验组优于对照组,但两组比较差异无统计学意义(P>0.05);在一次性穿刺成功并顺利输液完毕、药液外渗、针头移动或脱出方面,实验组均优于对照组,两组比较差异有统计学意义(P<0.05),尤其在肢体的随意改变程度、配合度和舒适满意度方面实验组有明显优势(P<0.05).结论 自制的手部静脉输液固定托板在临床的使用中方便、有效,能显著提高老年艾滋病患者的输液舒适程度、输液安全和满意度,值得临床推广应用.     

巧用新型医用高分子夹板制作小儿手部输液固定夹板

正小儿手部输液是临床上常见的护理操作,由于小儿对静脉输液的恐惧、好动不配合,所以在临床上穿刺成功后为保证治疗顺利完成,常就近取材多采用医用纸盒、木板或绷带制成适宜的夹板进行输液肢体的固定。但由于这些材料易变形、表面粗糙生硬,造成固定效果不好,增加输液不通畅发生和重新穿刺的机会。舒适度、透气性差可使小儿在输液过程中躁动、哭闹,均会造成护理工作量增加。为此本人从安全、方便、舒适、环保等方面出发,利用我科石膏固定患者使用剩余的医用高分子夹板制作成小儿     

自制静脉输液支具减少腕、手部输液所致漏液的效果观察

目的探讨自制静脉输液支具对减少腕、手部输液所致漏液的效果。方法将2006年3月至2006年6月行腕、手部关节部位穿刺的患者356例随机分为两组,对照组（178例）采用废弃的长条形针剂硬纸盒固定穿刺部位,观察组（178例）采用自制腕、手部静脉输液支具固定穿刺部位,观察两组患者的舒适度、漏液情况及局部皮肤受损情况。结果对照组在输液期间有31例（17.4%）出现漏液,而实验组仅出现2例（1.1%）;两组患者在输液4h和12h内的漏液发生率均有统计学差异（P〈0.05）;观察组患者在输液过程中自感舒适,局部无疼痛、红肿和压痕,对照组患者在输液后主诉局部疼痛、麻木,皮肤有压痕。结论腕、手部静脉输液时使用自制支具后,既增加了患者的舒适度,又降低了漏液发生率,保证输液的安全性。     

自制手腕静脉输液保护器在儿科中的应用

目的:探讨自制手腕静脉输液保护器在小儿四肢静脉输液中的固定效果。方法:将需要静脉输液的300例患儿据家长的意愿使用普通头皮针或静脉留置针者,分别随机分为观察组及对照组,观察组穿刺成功后使用新型的手腕保护器固定,对照组使用小夹板固定。结果:普通头皮针观察组一次完成输液349次,重新穿刺11次,对照组一次完成输液329次,重新穿刺31次;留置针组通畅情况比较有统计意义。结论:手腕静脉输液保护器应用于小儿四肢末端静脉输液的固定,较普通夹板固定效果,确保了输液通畅,延长了留置针的保留时间,也增加了患儿的舒适度。     

唇腭裂患儿术后及静脉输液肘部制动装置的设计与应用

唇腭裂患儿术后要注意防止患儿抓挠唇部的术区伤口,且术后输液多在头皮静脉,因此对此类患儿均需要注意对其手臂肘部的固定.以往临床上均使用自制纸盒或夹板的方法来固定小儿手臂,但是采用纸盒固定胶布容易脱落,自制夹板工序复杂且需要重复清洗消毒使用,这样既增加了医疗成本,绷带和胶布的固定又常常使患儿的皮肤发红,感到不舒服.2007年9月-2008年4月我科开始使用一种矿泉水瓶改装的固定装置,试用于72例3个月～2岁的唇腭裂术后患儿,效果满意,现报道如下.     

手部静脉输液固定带的制作及应用

临床上对昏迷病人、极度烦躁病人及小儿静脉输液穿刺成功后采取常规方法固定及加用一般小夹板固定,或用小纸盒代替夹板固定,其结果是,操作费时,胶布耗量大,病人感觉不舒适、不美观,固定效果不佳;经常因夹板移位等原因导致液体外溢,留置针头软管折叠,甚至穿刺针头脱出.由此,为减少病人因穿刺固定不妥而反复穿刺所造成的痛苦及血管损伤的次数和护士工作量,特设计了手部静脉输液固定带,经临床应用,效果满意,现介绍如下.     

卡通式小夹板在小儿四肢静脉输液中的应用

[目的]探讨卡通式小夹板在小儿四肢静脉输液中的应用效果。[方法]将行四肢静脉输液的患儿随机分为对照组和实验组,对照组采用传统夹板;实验组采用卡通式小夹板。比较两组患儿一次穿刺成功率、二次穿刺率、患儿配合情况和家长满意度。[结果]实验组二次穿刺率、患儿配合程度、家长满意度明显优于对照组(P<0.05)。[结论]卡通式小夹板在小儿四肢静脉输液中应用效果较传统夹板有很大的优势,提高了患儿配合度及家长满意度。     

一种手套式过腕输液固定器的设计

正输液是能迅速达到治疗目的的给药途径,为保证病人输液顺利进行,除具备好穿刺技术,做到一针穿刺成功外,输液部位的固定也尤为重要。手背是静脉输液较为常用的部位。传统的手部固定方法是静脉穿刺成功后先用夹板或空药物纸盒垫于病人掌部,再以多条胶布缠绕固定,在这个过程中病人手掌必须长时间放平、伸直,这样才能借助夹板或纸盒的硬度起到固     

小儿大隐静脉输液穿刺固定法的临床研究

目的探讨小儿大隐静脉输液用小夹板固定踝关节后再行静脉穿刺的临床效果。方法将1055例次输液患儿随机分成实验组和对照组,实验组采用固定踝关节后再行静脉穿刺,对照组采用传统的静脉输液方法先穿刺后固定。结果2组进行对照,实验组的成功率明显优于对照组(P<0.05)。结论大隐静脉输液用先固定再行静脉穿刺的方法,能有效地提高穿刺成功率、减少重复穿刺,从而减轻病人的痛苦。     

Brief or new: two pronation splints

For two years we have made pronation splints to assist quadriplegic patients who lack adequate forearm pronation but who have enough upper extremity strength to feed themselves and perform other self-care or functional activities. We have found the splints to be an appropriate alternative to the MAS. The first pronation splint fits underneath the arm, is simple in design and fabrication, and is hidden. However, occasionally the lever of the splint hangs up in the shirt, catches on the post of the wheelchair, or slips out from underneath the arm when the patient reaches away from the body. To eliminate these problems, we designed a second splint. But, this splint requires more time to make and adjust, has two parts to put on instead of one, and is more noticeable because it is worn on top of the arm rather than underneath it. When a patient uses either splint, the degree of pronation may be adjusted according to the activity by slightly rotating the splint either way when strapping it on. For example, full pronation may be required for feeding, but only half the range is necessary to operate the keyboard of a computer or typewriter. Once the Velcro straps are applied, the splints do not slip. The splints are not interchangeable from left to right and assistance is always needed to put them on. For patients with "weak" or "absent" wrist extensors, a wrist support and cuff splint may be used along with the pronation splint or a universal cuff, if wrist extension is adequate. The pronation splints are appropriate for those patients whose forearms supinate when they reach their hand to or near their mouth.     

阳性强化法在社区门诊小儿静脉输液中应用效果的研究

目的:研究阳性强化法在社区门诊小儿静脉输液中的应用效果。方法:选择2013年1月至2013年9月在哈尔滨市某社区卫生服务站静脉输液的患儿280例,随机分为干预组和对照组,每组患儿140例。干预组患儿在静脉输液前给予阳性强化法,对照组患儿在输液前进行常规安慰与鼓励,干预2天后评估患儿配合程度、疼痛程度、一次穿刺成功率、家属满意率并进行组间比较。结果:干预组患儿的配合程度、一次穿刺成功率、患儿家属的满意率高于对照组(P0.05),患儿的疼痛程度低于对照组(P0.05)。结论:阳性强化法可提高患儿配合度,降低患儿对疼痛的敏感度,减少穿刺失败因素,从而提高了小儿静脉穿刺成功率和护理工作效率。     

虚拟现实技术在小儿静脉留置中的应用

目的:探索虚拟现实(virtual reality,VR)技术应用于小儿静脉套管针留置中的实践效果。方法:选择50例4~12岁需行留置针置管操作的小儿患者,美国麻醉医师协会(American Society of Anesthesiologists,A SA)分级为I~II级,采用随机数字表法分为对照组与试验组,每组各25例。对照组在常规程序下接受留置针置入;试验组在常规操作的基础上,于留置针置入前5 min熟悉并使用VR设备,直至留置针置入结束。采用Wong-Baker面部表情量表对留置针留置过程中3个时间点的疼痛进行评估,分别为绑扎止血带时(T0)、留置套管针时(T1)、置入套管针后1 min(T2)。比较两组留置针留置一次成功率。结果:试验组小儿接受常规方法留置针置管时,T1和T2时间点对疼痛感知程度显著低于对照组(P<0.05)。两组留置针留置一次成功率差异无统计学意义(P>0.05)。结论:采用VR设备能有效改善患儿留置针置管中的疼痛,可在临床中推广使用。     

便携式输液泵在心绞痛患者输液中的应用

目的探讨便携式输液泵在心绞痛患者持续输液中的应用。方法将60例心绞痛患者随机分为用便携式输液泵组和人工调速组,比较两组输液效果。结果两组输液速度符合率、患者的舒适率、护理满意率比较,便携式输液泵组明显好于人工调速组。结论使用输液泵持续输入,液体速度精确,患者的舒适率、护理满意率高,降低了护士的劳动强度,提高了患者临床治疗效果。     

Factors that influence the duration of splint wear in peripheral nerve lesions

OBJECTIVE: To assess the weekly frequency and overall duration of wear for splints used to treat peripheral nerve lesions and factors that possibly influence splint wear. DESIGN: A total of 78 patients (23 women, 55 men) who had been treated with a hand splint for peripheral nerve palsy were interviewed by telephone, based on a preformulated questionnaire. The duration of wear, reasons for terminating use, the effect of the splint, the patients' assessment of splint treatment, the patients' instruction, and the patients' level of education were recorded. Survival analysis for the entire period of wear and logistic regressions to determine factors that influence splint wear were performed. Comparison of effect scores between lesions in the dominant those in the nondominant hand were carried out with a test. RESULTS: The median duration of wear was 6 mo for daytime and 4 mo for nighttime splints. Daytime splints were worn by 85% and nighttime splints by 84% of patients for 5-7 days per week. The reported effect of the splint was the only significant factor that influenced the frequency of wear. The splint was reported to be significantly more effective in the dominant hand than in the nondominant hand. Numerically, radial nerve lesions and cock-up wrist splints were most common. CONCLUSION: Regular splint wear was registered in the majority of patients and was positively influenced by a good effect of the splint, which was reported to be better in the dominant hand.     

Splinting versus casting of “torus” fractures to the distal radius in the paediatric patient presenting at the emergency department (ED): A literature review

AimTo compare outcomes regarding splinting versus casting of paediatric torus fractures in the ED with the aim of establishing the preferred treatment.MethodsEvidence was collated using electronic databases; Pubmed, Ovid, Medline and Cochrane library. Search terms included [torus fractures; buckle fractures; splinting distal radius fractures; paediatric wrist fractures; paediatric forearm fractures/injuries; cast versus splint]. Searches identified papers published between 1984 and June 2008.ResultsThe review demonstrated that children with removable splints preferred them to casts, in terms of improved physical functioning and lower pain scores reported after initial injury than those with casts. Children demonstrated this by using their wrists in the first week after injury to shower and bathe more easily. The cast group reported unscheduled visits to ED due to problems with the cast, such as discomfort or re-application of the cast from getting it wet. Using a splint will have considerable economic implications, money was found to be saved in terms of time and resource management. Radiographs taken at 4 weeks in both the cast and splint group confirmed that all fractures healed without significant change in alignment, suggesting that neither clinical nor radiographic follow-up is necessary for injury.ConclusionTorus splints in all the studies were consistently better than plaster immobilisation in terms of clinical outcome, patient preference and cost, with the exceptions of young children or children with special needs who can easily remove the device. Splinting torus fractures may reduce cost, time and resource management if used instead of casting in the ED.     

童趣化诱导在学龄前儿童静脉穿刺中的应用研究

目的探讨童趣化诱导对学龄前儿童静脉穿刺的影响效果。方法将300例静脉输液治疗的学龄前儿童分为实验组和对照组各150例,对照组患儿予以常规护理干预,实验组患儿分别通过视觉、听觉和语言童趣化的方式进行诱导干预,观察两组患儿在静脉穿刺过程中1 min内停止啼哭率、穿刺一次成功率和家属满意度。结果实验组患儿1 min内停止啼哭率、穿刺一次成功率和家属满意度均高于对照组(P0.01)。结论童趣化诱导干预不仅可减少患儿对静脉输液的恐惧,提高静脉输液穿刺的成功率,也使医务人员的工作效率和患儿家属的满意度得到提高。     

Comparison of custom-made and prefabricated neoprene splinting In patients with the first carpometacarpal joint osteoarthritis

Aim: The objective of this study was to compare the effect of prefabricated and custom made thumb splints on pain, function, grip strength and key pinch In patients with basilar joint osteoarthritis. Method: Volunteer patients (n = 35) with first carpometacarpal joint osteoarthritis were assigned randomly to wear either a prefabricated or custom-made thumb splint or assigned to a control group. This was designed as a cross over study with two 4-week treatment periods, 2 weeks of wash out time for intervention groups between the test conditions and 10-weeks follow-up for the control group. All parameters were measured at the first visit and during the 4th, 6th and 10th weeks In the three groups. Results: In the control group, paIn increased and pinch strength decreased but no statistically significant differences were found In function and grip strength. Both splints changed grip strength with no significant differences between them. PaIn was reduced with the splints, and functions and pinch strength increased significantly as compared to the baseline and control groups. In comparing the two splints only significant differences were observed In pain. Conclusion: In comparing two splints, paIn was the only significantly different parameter between tested parameters; with the custom-made splints demonstrating better results In paIn reduction.

Implications for Rehabilitation

• A high level of disability has been reported In those patients with thumb carpometacarpal joint osteoarthritis.

• Custom-made and prefabricated neoprene splinting is an effective method to improve pain, pinch strength and function by patients with the first carpometacarpal joint osteoarthritis.

• The custom made splint demonstrated better results In paIn reduction.

     

山莨菪碱凝胶防治得力生所致静脉损伤的研究

目的 探讨山莨菪碱凝胶涂搽防治输注得力生所致静脉损伤的效果.方法 将100例静脉输注得力生的患者随机分为实验组和对照组各50例.实验组患者在静脉输注得力生前3～5 min将2%山莨菪碱凝胶沿静脉走向均匀地涂搽于输液穿刺点上方的皮肤,对照组不做任何处理,观察输注得力生后2组静脉损伤的情况.再对2组有静脉损伤的患者用2%山莨菪碱凝胶涂搽于输液穿刺点上方的皮肤,观察其对静脉损伤的治疗效果.结果 实验组静脉内疼痛的发生率为4%,无静脉输液不畅、输液部位红肿的发生;对照组静脉输液不畅的发生率为34%,局部红肿的发生率为42%,静脉内疼痛的发生率为68%.对照组39例及实验组2例发生静脉损伤患者经过治疗后静脉损伤症状全部消失.结论 2%山莨菪碱凝胶涂搽能有效防治输注得力生所致静脉损伤的发生.     

“洞察-应答-支持”情绪疏导法在小儿静脉输液中的应用

目的:探讨“洞察-应答-支持”情绪疏导法在小儿静脉输液中的应用效果。方法:将2020年6月1日~9月1日在门诊进行静脉输液的101例患儿作为对照组,给予常规静脉穿刺护理;将2020年10月1日~12月1日101例静脉输液患儿作为研究组,在对照组基础上给予“洞察-应答-支持”情绪疏导法。比较两组患儿穿刺依从性(采用穿刺依从性问卷)、疼痛程度[采用儿童疼痛行为评估量表(FLACC)]、一次性穿刺成功率、输液时脱针、渗漏及家属配合度。结果:研究组穿刺依从性、一次性穿刺成功率及家属配合度均高于对照组(P<0.05);研究组FLACC评分、输液脱针及渗漏率均低于对照组(P<0.05)。结论:“洞察-应答-支持”情绪疏导法对静脉穿刺患儿的治疗依从性和穿刺成功率有明显改善作用,同时能够提高家属满意度。