脑卒中急性期应用精细输液器静脉注射甘露醇效果观察

目的使宫颈癌大出血患者能尽快得到有效的止血治疗及护理。方法采用高剂量率近距离后装腔内治疗宫颈癌大出血患者21例。做好后装放疗前充分的准备,对患者进行心理护理,操作过程中敏捷配合医生并密切观察患者情况,放疗后交待清楚阴道填塞纱布条数．指导患者保持外阴清洁预防感染。结果21例顺利完成后装放疗,治疗后无1例再发生阴道大出血及感染等并发症。结论后装腔内放疗能有效控制宫颈癌大出血,高质量的护理及与医生密切的配合,是患者能安全顺利完成治疗的保证。     

精密过滤输液器在中药静脉输液中的应用

目的 观察精密过滤输液器减少中药输液反应的效果。方法 将用中药制剂静脉滴注患者随机分为观察组（100例）和对照组（103例），观察组采用一次性精密过滤输液器输液，对照组采用一次性普通输液器输液，观察两组患者输液反应发生率。结果 观察组输液反应发生率（0．1％），显著低于对照组（1．5％）（P〈0．01）。结论 使用一次性精密过滤输液器能有效减少中药的输液反应。     

精密过滤输液器在中药静脉输液中的应用

目的 观察精密过滤输液器减少中药输液反应的效果.方法 将用中药制剂静脉滴注患者随机分为观察组(100例)和对照组(103例),观察组采用一次性精密过滤输液器输液,对照组采用一次性普通输液器输液,观察两组患者输液反应发生率.结果 观察组输液反应发生率(0.1%),显著低于对照组(1.5%)(P＜0.01).结论 使用一次性精密过滤输液器能有效减少中药的输液反应.     

多液路输液器的设计与应用

临床上,常常需要多液路滴药,以达到控制病情的目的.尤其是心血管内科、呼吸内科、重症监护室、院前急救的患者.应用特殊药物的频次多、滴速慢.在无药物配伍禁忌的情况下,我院自1999年至今经常采用输液嫁接法,将特殊用药输入,克服了医用三通安装时破坏输液器的密闭性、患者不舒服且易压伤皮肤的不足,但与使用三通一样,慢的液路要形成压力差,嫁接的液路才能滴入,且影响普通药物的输入;同时经验不足的护士常因寻找合适的压力差而延长操作时间.     

新型报警式输液器的研制与应用

临床输液时,护士必须不断地巡视病房,观察液体滴注情况,当液体滴完后要及时更换或拔针,如更换不及时需重新排气,不但加大了工作量,而且可使病人因害怕空气输入而产生紧张心理。为了减少上述弊端,笔者于2001年1月在现有普通输液的基础上加以改进,研制出新型报警式输液器(下简称报警输液器),并已获得国家专利。     

输液器药物注射孔的应用

静脉输液是临床治疗的主要方法之一，临床常因病情需要同时应用几种药物，常规方法是采用三通管或肝素帽进行多通道输液，此法操作步骤较多，易增加污染概率，同时连接处有少量空气进入患者体内。针对上述弊端，采用微量泵通过输液器注射孔给药的途径，效果满意，介绍如下。     

输液加压袋在甘露醇加压输注中的运用

20％甘露醇作为脱水剂,其用药速度十分重要,250 mL甘露醇应在15～20 min滴完[1],滴数最快可以控制在100～120 gtt/min.一般输液器配备7号半针头,既对血管的损害较大,不能满足20％甘露醇的输注要求.临床最常见的方法是使用50 mL注射器从输液器的空气管内插入,反复注入空气加压,带来潜在性微粒或病菌污染的风险[2].我科2010年12月起使用美国Merit Medical System公司生产的500 mL 输液加压袋进行加压输注甘露醇,操作简单,方便快捷,效果满意,现介绍如下.     

灵敏回血型输液器的应用介绍

以往传统型一次性输液器使用过程中,很多情况下回血很难观察,尤其心脏疾病、休克、脱水、年老体弱、低血压患者或深静脉穿刺时,成功率很难保证。我科自2008年开始应用灵敏回血型输液器（北京禹神医疗器材有限责任公司生产）,基本解决了上述问题,有效提高了穿刺一次成功率,减轻了患者痛苦,介绍如下。     

精密输液器180度翻转过滤盘排气法效果探讨

目的提高精密过滤输液器一次性排气成功率及减少排气失液量。方法对57例静脉输液患者,每天按随机法分为过滤圆盘180度翻转排气组(翻转组)、过滤圆盘平行排气组(平行组)、过滤圆盘U型排气组(U型组)各62例次;准备输液过程中分别采用各组方法排气。结果翻转组一次性排气成功率显著高于另两组(均P0.0167),失液量显著少于另两组,平行组显著少于U型组(均P0.05)。结论 180度翻转过滤圆盘排气法可提高一次性排气成功率、减少药液浪费;在静脉输液操作中不建议采用过滤圆盘U型排气法,以免影响工作效率、浪费药液。     

A disposable device for infusion analgesia

The performance of the Travenol infusor when used to administer an intravenous infusion of analgesic after surgery has been investigated. Mean flow was very similar to the manufacturer's quoted figure of 2 ml/hour, but there was a large interindividual variation. Results from a laboratory study suggest that this was due to variation in the manufacture of the infusor.     

Acute renal failure following massive mannitol infusion

Mannitol overuse-induced acute renal failure (ARF) has rarely been described. We report four cases, all male, between the ages of 20 and 42 years, who developed acute renal failure (3 anuric, 1 nonoliguric) after receiving mannitol 1,172 +/- 439 g (mean +/- SD) during a time period of 58 +/- 28 h. The infusion rate was 0.25 +/- 0.02 g/kg/h. The onset of acute renal failure was detected 48 +/- 22 h after infusion. In 2 of the 3 cases in which urinary cytology was evaluated, the presence of vacuole-containing renal tubular cells was observed. All patients had hyponatremia (120 +/- 11 mEq/l), and hyperosmolality (osmolar gap 70 +/- 11 mosm/kg water). No other factors could be pointed to as causing acute renal failure. In the 3 anuric cases in which hemodialysis was performed, immediate recovery of diuresis was observed. Two patients recovered renal function on the fifth and sixth days, and 2 died due to endocranial hypertension - one of them while recovering - on the fourth and sixth days. In the present report, mannitol-induced ARF occurred at clustered doses of 0.25 mg/kg/h.     

Adsorption of local anesthetic into disposable infusion balloon

BACKGROUND: The aim of this study was to investigate the adsorption of local anesthetics lidocaine and ropivacaine, into disposable infusion balloons made from various kinds of plastics. METHODS: The concentration of local anesthetic that flows out of a balloon was measured. RESULTS: The concentration of both lidocaine and ropivacaine in clinical formula decreased only 4.5 percent regardless of infusion balloons. However, the concentration of lidocaine pH 7.4 decreased by 10 percent in the Syrinjector made from polypropylene and polyvinyl chloride, and that of 18-20 percent in other infusion balloons (Surefuser, Baxtor Infuser, DIB Catheter made from isoprene rubber and polyvinyl chloride, isoprene rubber and polyvinyl chloride, silicon and polyvinyl chloride, respectively). CONCLUSIONS: The adsorption of local anesthetic into infusion balloons has little effect in clinical situation. Whereas, in case of lidocaine pH 7.4, the adsorption depends on the specific type of plastics.     

Cerebral blood flow velocity after mannitol infusion in children

Purpose

There is conflicting evidence as to whether the effect of mannitol on brain bulk arises from haemodynamic, rheologic, or osmotic mechanisms. If mannitol alters cerebral haemodynamics by inducing vasoconstriction, this change should be reflected in cerebral blood flow velocity (CBFV) in the middle cerebral artery (MCA). The purpose of this study was to evaluate the effect of mannitol on CBFV in children.

Methods

Children scheduled for intracranial surgery were enrolled. After a loading dose of 10 μg · kg^?1 of fentanyl, general anaesthesia was maintained with fentanyl (3 μg · kg^?1 · hr^?1), 66% nitrous oxide, and isoflurane (0.2–0.5% inspired). Mean and systolic CBFV (Vm and Vs) and pulsatility index (PI) were recorded with a transcranial Doppler (TCD) directed at the M1 segment of the MCA. Mannitol was administered, 1 gm · kg^?1 iv over 15 min. The osmolality (Osm), haematocrit (Hct), mean arterial pressure (MAP), heart rate (HR), and TCD variables were recorded before and 15, 30, 45, and 60 min after the mannitol infusion.

Results

Mannitol infusion resulted in an increase in Osm and decrease in Hct (P < 0.05). Heart rate, MAP and arterial carbon dioxide tensions did not change (P > 0.05) during the measuring period. The Vm did not vary from baseline. The Vs and P1 both increased briefly (P < 0.01 at 15 min and P < 0.05 at 30 min) after the mannitol, suggesting an increase in resistance distal to the MCA.

Conclusion

The time course of CBFV changes produced by mannitol corresponds with previous animal data concerning cerebrovascular tone. Our results suggest that mannitol briefly increases cerebrovascular resistance and thereby diminishes cerebral blood volume.     

The infusion rate of most disposable,non-electric infusion pumps decreases under hypobaric conditions

Purpose

To examine the delivery rates of four disposable, nonelectric infusion pumps during hypobaric conditions.

Methods

Four models categorized by three different driving forces, one vacuum unit (Coopdech Syringector), one spring unit (Linear-fuser), and two elastomeric balloon-powered units (Multirate Infuser LV and Large DIB), were tested. Each infusion pump was placed in an airtight container, and the pressure in the container was decreased to 1,000, 900, and 800 hPa. The catheter tip of each pump was exposed either to atmospheric pressure (1,000 hPa) or to similar hypobaric conditions (800–1,000 hPa).

Results

Under normal atmospheric pressure, each pump showed an accurate delivery rate in the range of ?2% to +8% of the set infusion rate (4.0–5.0 mL·hr^?1). With the catheter tip exposed to atmospheric pressure, the infusion rate of each pump was reduced from 35% in the case of the Large DIB to 64% in the case of the Coopdech Syringector, depending on the magnitude of change in hypobaric pressure. When the pressure acting on the catheter tip was reduced to a level similar to that exerted on the pump body, infusion rate was reduced (by 19%–27%) in all three types of pump, and the Large DIB showed no significant difference in performance compared to normal atmospheric pressure.

Conclusion

The infusion rates of disposable infusion pumps are reduced under hypobaric conditions. Even though we still do not know how the epidural pressure changes under hypobaric conditions, clinicians should be aware that the infusion rate of disposable infusion pumps is decreased under hypobaric conditions.     

自制推注式微量泵专用输液器的临床应用

目的改制推注式微量泵输液器,以简化操作程序。方法将110例住院新生儿按随机数字表法分为为观察组和对照组各55例,两组均采用推注式微量泵输液,由同一护士操作。对照组采用普通输液器连接注射器输液,连接前用无菌剪刀将莫菲氏滴管上端部分剪断,再将断端与注射器的乳头连接;观察组使用由普通输液器改装的推注式微量泵专用输液器连接注射器输液。结果对照组从拆开输液器包装至输液排气毕的操作时间为(31.80±6.92)s,观察组为(17.50±1.27)s,两组比较,差异有统计学意义(P<0.01)。结论推注式微量泵专用输液器的使用,简化了操作程序,安全、方便,节省了人力和时间。     

Influence of microcatheter length on flow rates of disposable infusion kits

BACKGROUND AND OBJECTIVE: Continuous spinal analgesia (CSA) offers considerable pain relief, and has been used in various procedures such as for surgery and cancer pain control. In Japan, portable and disposable infusion kits are increasingly employed for continuous epidural analgesia and CSA. In CSA, the use of a microcatheter is expected to reduce the incidence of spinal headache previously encountered with larger catheters. However, the flow rate of disposable infusion kits is reduced when used in conjunction with a microcatheter. METHODS: This study aimed to investigate the influence of catheter length on the flow rate of two different devices: 20- or 91-cm 28-G microcatheters connected to balloon- or syringe-type infusion pumps were examined (50 mL, 1 mL h(-1)). There were four groups each of 10 experiments: Group A: balloon-type infuser, 91 cm catheter; Group B: balloon-type infuser, 20 cm catheter; Group C: syringe-type infuser, 91 cm catheter; Group D: syringe-type infuser, 20 cm catheter. RESULTS: The mean flow rate in Group A was significantly less than that in Group B and the mean flow rate in Group C was significantly less than Group D (P < 0.05). CONCLUSION: These results indicated that the use of a shorter microcatheter achieves a better flow rate during CSA.