导尿管尖端培养在肾移植术后留置导尿相关感染监测中的作用

留置导尿管引起的相关感染(CAUTI)是临床上常见的医源性感染。由于肾移植病人的免疫抑制状态以及肾移植术后常规留置导尿管,导致CAUTI的发生率一直较高。而CAUTI的早期发现,病原菌的早期分离成为临床护理工作中需要高度重视的问题。回顾性分析我中心2004年8月—2005年8月72例肾移植病人的CAUTI检出情况,报道如下。1资料2004年8月—2005年8月我中心肾移植病人72例,其中男48例,女24例;年龄18岁～68岁,平均39.7岁。供肾热缺血时间≤5min,冷缺血时间≤10h,平均手术时间2.2h。术前均行单剂免疫诱导治疗,术后应用三联免疫抑制剂。在移植术…     

肾移植术后留置导尿管引起相关感染的护理72例

留置导尿管引起的相关感染(catheter associated urinarytract infection,CAUTI)是临床上常见的医源性感染。由于肾移植患者的免疫抑制状态以及肾移植术后常规留置导尿管,导致CAUTI的发生率一直较高,患者的临床症状一般较轻或仅表现为尿液检查异常或无症状性菌尿,故容易被临床所忽视,但这些患者易发生严重的并发症而威胁其生命,因而CAUTI的临床护理工作需要高度重视[1]。为此,本研究回顾性的分析了我中心2004年8月-2005年8月72例肾移植患者术后留置导尿管引起相关感染的护理经验,现报道如下。临床资料1.一般资料。2004年8月-2005年8月…     

留置导尿相关感染的研究进展

留置导尿管引起的相关感染(Catheter-associated urinary tract infection CAUTI)是临床常见的医院感染。近年来,许多学者对留置导尿相关感染现状进行了多方面研究。本文对此做一综述。     

品管圈活动对降低留置导尿管病人导尿管相关性尿路感染发生率的效果分析

[目的]探讨开展品管圈活动对降低神经内科留置导尿管病人导尿管相关性尿路感染(CAUTI)发生率的效果。[方法]应用品管圈活动,结合循证护理研究实践,按照品管圈实施的步骤及方法,通过文献查证,整合可得的最佳科学知识与护理经验,将最佳的预防CAUTI的临床护理证据应用到留置导尿管病人日常维护中。[结果]留置导尿管病人留置天数由活动前的11.83d降至活动后的8.36d,CAUTI发生率由活动前16例/1 000个留置导尿管日降至活动后的5例/1 000个留置导尿管日。[结论]开展品管圈活动有助于降低留置导尿管病人CAUTI的发生率。     

PDCA循环管理模式对长期留置导尿管老年患者尿路感染的作用

目的采用PDCA循环管理模式对长期留置导尿管的老年患者进行感染控制管理,分析其对降低导尿管相关尿路感染(CAUTI)发生率的作用。方法对2017年1月~2017年12月该院老年医学科收住的需留置导尿管的486例患者实施PDCA循环模式的管理,与2016年1月~2016年12月实施PDCA循环管理模式前的462例需留置导尿管的患者进行对比,比较实施PDCA循环管理模式前后CAUTI的发生率及各项改进护理措施执行的情况。结果各项针对CAUTI的护理改进措施较实行PDCA循环管理模式前得到有效改善,CAUTI的发生率也明显下降,差异有统计学意义(P<0.05)。结论在长期留置导尿管的老年患者的护理工作中,采用PDCA循环管理模式后,可明显提升各种护理改进措施的有效执行率,降低CAUTI的发生率。     

肾移植术后留置导尿管的护理

肾移植术后因多种原因需常规留置导尿管5d～7d,而此期间导尿管的护理直接影响到病人的术后恢复情况。现结合我院肾移植情况从导尿管的置管、留管及拔管等多方面较详细地介绍了肾移植术后留置导尿管的护理,对临床实践有一定指导意义。     

肾移植术后留置导尿管的护理

肾移植术后囡多种原因需常规留置导尿管5 d～7 d,而此期间导尿管的护理直接影响到病人的术后恢复情况.现结合我院肾移植情况从导尿管的置管、留管及拔管等多方面较详细地介绍了肾移植术后留置导尿管的护理,对临床实践有一定指导意义.     

肾移植术后肺部感染的诊治体会

目的：提高肾移植术后肺部感染的早期诊断和治愈率。方法：我院自1998年12月-2001年4月共收治89例肾移植。对其中伴有严重肺部感染的15例的临床资料进行回顾性总结，结果：15例肾移植术后肺部感染病人的早期临床表现不典型，一旦出现高热，干咳等症状即很快进入呼吸衰竭，对上述病人进行多次痰培养并作血巨细胞病毒（CMV）检查，结果均为阴性者4例，单纯CMV感染者4例，CMV合并细菌感染者2例，单纯细菌感染3例，霉菌感染2例，经治疗后治愈12例，结论：对肾移植术后肺部感染患者在抗炎，抗病毒，抗霉菌治疗同时，果断减少或暂停免疫抑制剂，有利提高感染的治愈率。     

肾移植受者留置导尿管时间探讨及护理对策

目的探讨肾移植受者留置导尿管时间与发生尿路感染的关系，并总结预防尿路感染的有效护理措施。方法选取2006年1月～2007年12月在本科室行同种异体肾移植手术的受者83例。所有患者术前留置导尿管，于拔除导尿管前行尿培养。观察患者拔除尿管当天的症状，对尿培养结果进行分析。结果患者尿培养结果阳性23例。其中留置导尿时间10d以上的患者尿培养阳性率明显高于留置导尿时间10d内（含10d）的患者，差异有统计学意义（P〈0．05）。结论建议肾移植受者留置导尿管拔除时间为术后第9～10d，而执行环境消毒措施、预防逆行性感染，保持出入量平衡是预防尿路感染的有效护理措施。     

品管圈活动对重症监护室留置导尿病人导尿管相关性尿路感染发生的影响

[目的]探讨品管圈活动对重症监护室(ICU)留置导尿病人导尿管相关性尿路感染(CAUTI)发生的影响。[方法]选取2016年1月—2016年4月深圳市香港大学深圳医院ICU收治的64例留置导尿病人(对照组)及2016年7月—2016年10月深圳市香港大学深圳医院ICU收治的70例留置导尿病人(观察组)作为研究对象,观察组病人实施品管圈活动,对照组病人采用传统护理。观察两组病人留置导尿管必要性评估、留置导尿操作规程、维护、拔管指证评估、手卫生等环节质量合格率及CAUTI发生率。[结果]观察组病人在留置导尿管必要性评估、留置导尿操作规程、维护、拔管指证评估、手{JP3卫生等环节质量合格率明显高于对照组(P0.01);观察组病人CAUTI发生率明显低于对照组(P0.05),而发生CAUTI时间较对照组明显延长(P0.05)。[结论]品管圈活动能提高护理人员预防CAUTI依从性和留置导尿管必要性评估、操作规程、维护、拔管等环节质量合格率,有效降低ICU留置导尿病人发生CAUTI风险。     

Remote magnetic navigation-assisted catheter ablation enhances catheter stability and ablation success with lower catheter temperatures

Background: It has been suggested that remote magnetic navigation (RMN) may provide enhanced catheter stability and substrate contact to aid in ablation. To date, no study has examined this claim. Accordingly, we compared the characteristics of the successful ablation of atrioventricular reentry tachycardia (AVNRT) using RMN with a matched population ablated using a conventional (CON) manual approach.
Methods: Sixteen patients who underwent RMN-assisted ablation of typical AVNRT were matched with 16 patients who had a CON-AVNRT ablation.
Results: All patients had successful slow pathway modification without complication. The mean catheter temperature achieved with the successful ablation was significantly lower with RMN than with CON (42 ± 7°C vs 47 ± 3°C, P ≤ 0.05). Time to junctional tachycardia (JT) was significantly earlier (5.7 ± 4.1 s vs 11.2 ± 8.9 s, P ≤ 0.05) and variation in catheter temperature with the successful ablation (0.89 ± 0.45 vs 1.45 ± 0.49, P < 0.01) was significantly reduced in the RMN group than in the CON group. There was no significant difference between RMN and CON in terms of the total number of lesions and the mean power achieved during the successful lesion.
Conclusions: Although the construction of the ablation catheters is similar, ablations with RMN catheters resulted in a lower mean temperature, earlier time to JT, and less variability of temperature during ablation, suggesting greater catheter stability. This study indicates that ablation with RMN can achieve success with lower catheter temperatures.     

Suprapubic catheter removal: the cuffing effect of deflated catheter balloons

Supra-pubic catheterization plays an important role in patient care and management when this method of indwelling catheterization is required. However, one area of concern often experienced by nurses is the problem removing supra-public catheters or not being able to remove it. Catheter balloons, when deflated, incur crease or ridge formation. Removing supra-public catheters, a 'cuffing' effect occurs as the catheter is being removed. This seems to affect 100% silicone catheters more than non-silicone catheters. This article looks at the changes 100% silicone catheter balloons undergo following deflation and removal.     

留置气囊导尿管烧伤患儿尿管嵌顿的护理

目的 探讨烧伤患儿留置导尿管嵌顿后的正确处理方法.方法 将26例留置导尿管嵌顿的烧伤患儿根据病情及嵌顿的位置进行分析,其中2例留置导尿时嵌顿在尿道膜部,22例嵌顿在膀胱部,2例嵌顿在尿道内口.对不同嵌顿分别应用导丝刺入法、针刺法和外科手术法进行处理.结果 26例患儿经处理均可拔除气囊尿管,其中19例采用导丝刺入法,4例采用针刺法,3例采用经会阴尿道切开取异物术,术后患者恢复较好.1例手术患者术后再次留置气囊尿管,留置2周后正常拔除气囊尿管,顺利出院.结论 护理人员应熟练掌握男性患儿的生理解剖特点,气囊导尿管的结构、性能、特点、操作方法及注意事项,正确掌握气囊尿管的拔管方法,才能使拔管顺利.     

减少导尿管使用的管理策略研究进展

文章通过对导尿管临床使用与管理现状及减少导尿管使用管理策略的相关研究进行综述,分析与探讨了合理使用导尿管的管理策略,包括建立并执行留置导尿管的适应证标准、加强医护人员的培训、设置拔管提醒系统、运用导尿管管理模型等措施,旨在为临床有针对性地采取措施提供借鉴与参考。     

Urethral catheter audit

An audit was undertaken in one children's hospital to evaluate practice relating to indwelling urethral catheterisation of children. The records of 47 patients admitted over an eight-month period were reviewed to obtain information regarding catheter use. A questionnaire was sent to 384 qualified nursing staff and 174 medical staff to identify what training they had received and their level of knowledge about catheterisation practice. In the absence of national guidelines for urethral catheter care, locally developed standards were used for comparison in the audit. Timing and location of catheter insertion were noted. Duration of catheterisation ranged from one to 38 days but in 13 per cent of cases it was not possible to identify duration because of lack of documentation. Both nursing and medical staff reported low levels of training and areas of limited understanding of practice. A majority of nursing staff had never catheterised a child or did so less than once a year. Novel approaches to education are required to maintain knowledge and skills in this area of practice. Documentation needs to improve and include the use of computerised care plans and catheter care pathways.     

Urethral catheter selection

Many patients undergo urethral catheterisation. Selecting the most appropriate catheter for an individual patient requires knowledge and a practical understanding of the types of catheter available. A number of factors should be considered in catheter selection, including patient needs, indications for catheterisation, the type of material, the balloon size and the length and diameter of the catheter. The aim of this article is to provide information that will clarify some of the concerns nurses might have regarding urethral catheterisation.