植入式输液港在肿瘤化疗病人中应用的可行性研究

目的:探讨输液港在恶性肿瘤病人静脉化疗输液通路中应用的可行性.方法:60例肿瘤化疗患者随机分为经外周静脉穿刺中心静脉置管组(PICC组)和植入式静脉输液港组(VAP组).PICC组30例,常规置入PICC;VAP组30例,植入输液港;分别比较两组病人在植入后一周、一月、三月并发症的发生率.结果:VAP组并发症发生率为3.45%,明显低于PICC组(23.3%),有显著性差异(P<0.05).结论:在恶性肿瘤静脉化疗输液通路工具的选择中,输液港的应用安全、可行,有推广价值.     

输液港置入术后导管异位的处理及预防

目的:探讨经颈内静脉输液港置入术后导管异位的处理及预防。方法:回顾性分析2017年9月至2021年4月深圳市第三人民医院甲乳外科收治的105例经颈内静脉输液港置入患者临床资料。分析经左、右颈内静脉置管后导管异位发生的差异及异位情况,总结导管异位可能的原因并探讨处理方法及预防措施。结果:105例患者中术后导管异位患者7例...     

植入式静脉输液港在肿瘤化疗患者中的并发症原因分析及护理

目的:研究分析植入式静脉输液港在肿瘤化疗患者中的并发症原因,并总结相应的护理体会。方法:本次的研究对象选择于2015年7月1日至2016年11月30日期间,在我院植入式静脉输液港38例肿瘤化疗患者,分为实验组,以及采用外周置入中心静脉导管输液的38例肿瘤化疗患者,分为对照组,对两组患者的并发症情况进行对比。结果:实验组肿瘤化疗患者的并发症发生率为6%,明显低于对照组肿瘤患者的并发症发生率25%。P0.05认为差异具有统计学意义。结论:肿瘤患者在进性化疗治疗时,应用植入式静脉输液港,可有效的减低患者的并发症发生率,加强患者的治疗效果,值得在我院今后对于肿瘤患者进行化疗治疗时应用推广。     

消化系统恶性肿瘤患者经数字减影血管造影引导植入静脉输液港的应用

目的　探讨消化系统恶性肿瘤患者经数字减影血管造影（DSA）引导下植入静脉输液港的安全性、可行性及临床应用价值。方法　回顾性分析2013年4月至2016年1月在DSA引导下植入静脉输液港的15例消化系统恶性肿瘤患者的病例资料,记录输液港并发症、输液港留置时间,调查患者对输液港使用的满意度,用配对秩和检验比较输液港植入前后患者生活质量的差异。结果　15例消化系统恶性肿瘤患者完成静脉输液港植入术,手术成功率100%,一次性静脉穿刺成功率为100%。并发症的发生率为6.67％ (1/15),发生在植入术后第8个月,表现为颈部牵拉感。输液港留置时间2～28个月,中位留置时间9个月。对输液港的满意度为86.67%（13/15）。输液港植入前后患者生活质量好的比例分别为46.67%（7/15）、100%(15/15),差异有统计学意义（Z=-3.416,P=0.000）。结论　DSA引导下在消化系统恶性肿瘤患者中植入静脉输液港操作安全、可行,并发症少,提高患者生活质量和满意度,值得在临床上推广。     

完全植入式静脉输液港三种不同植入方法的首次成功率比较

目的比较完全植入式静脉输液港不同植入方法的首次成功率。方法2002年4月至2012年5月在我院外科连续植入351例静脉输液港,其中头静脉切开植入234例,锁骨下静脉穿刺植入41例,B超引导颈内静脉植入76例,对不同植入方法的首次手术成功率进行比较。结果头静脉切开植入静脉输液港首次成功率为78.6%（184/234）,锁骨下静脉穿刺植入首次成功率为90.2%（37/41）,B超引导经颈内静脉植入首次成功率为100%（76/76）,头静脉切开组与锁骨下静脉穿刺组比较,差异无统计学意义（χ2=2.981,P=0.059）,B超引导颈内静脉穿刺组首次植入成功率高于头静脉切开组（χ2=19.362,P=0.000）和锁骨下静脉穿刺组（χ2=7.677,P=0.014）。头静脉切开组手术并发症发生率为2.2%(4/234),导管植入颈内静脉2例（1.1%）,术后伤口积液2例（1.1%）,另两组均未发生手术并发症。结论完全植入式静脉输液港不同植入方法手术并发症发生率均较低,首选B超引导颈内静脉穿刺植入法。     

7例植入式静脉输液港在儿童白血病化疗过程中的应用评价

目的探讨植入式静脉输液港在儿童白血病化疗过程中存在的问题和解决对策。方法在我院手术室为7例白血病患儿进行静脉输液港植入。结果 5例患儿出现了并发症,平均带港时间8个月。结论植入式静脉输液港在儿童白血病化疗过程应用中与PICC相比较,并发症多、带港时间短、费用高、护理较困难。     

超声引导下不同路径输液港植入术的比较

目的探讨超声引导下不同路径输液港植入术的应用效果。方法选取接受超声引导下经颈内静脉及经锁骨下静脉行输液港植入术患者共328例,分析不同路径的一次穿刺成功率、并发症发生率和非计划输液港拆除率。结果颈内静脉组及锁骨下静脉组的一次穿刺成功率分别为95.05%(192/202)和93.65%(118/126),比较差异无统计学意义(χ2=0.293,P=0.588);颈内静脉组的并发症总发生率、围手术期并发症发生率、远期并发症发生率、非计划输液港拆除率分别为11.39%(23/202)、3.96%(8/202)、7.43%(15/202)、4.95%(10/202),而锁骨下静脉组的分别为17.39%(22/126)、7.14%(9/126)、10.32%(13/126)、4.76%(6/126),比较差异均无统计学意义(P均>0.05);锁骨下静脉组的局部血肿形成及夹闭综合征发生率均高于颈内静脉组,差异具有统计学意义(P均<0.05)。结论超声引导下经颈内静脉及经锁骨下静脉输液港植入具有相似的准确性和安全性,但在经锁骨下静脉路径时,需警惕局部血肿形成及夹闭综合征等并发症的发生。     

抗栓药管理预防高龄患者静脉输液港并发症的效果

目的探讨抗栓药管理预防高龄患者静脉输液港并发症的效果。方法选取我院2015年9月至2018年9月行抗栓治疗后植入静脉输液港的高龄患者102例,随机分为对照组与观察组各51例。对照组采用常规护理,观察组在对照组基础上采用抗栓药管理。比较两组患者植入静脉输液港后并发症的发生率。结果观察组植入静脉输液港后并发症的发生率为5.88%,明显低于对照组的19.61%,差异有统计学意义(P <0.05)。结论抗栓药管理可明显降低高龄患者植入静脉输液港后并发症的发生率,为临床护理管理提供依据。     

完全植入式静脉输液港相关感染的危险因素

目的了解完全植入式静脉输液港相关感染发病情况,探讨其危险因素。方法选取河南省某三甲医院2013年1月—2016年12月使用完全植入式静脉输液港的2 098例乳腺癌患者为研究对象。采用巢式病例对照研究方法,以监测期间出现输液港相关感染的26例患者为病例组,按照1∶2的比例,随机选取同期进行该类手术的52例患者为对照组,比较两组在一般资料、研究指标方面的差异。采用logistic回归模型进行输液港相关感染的危险因素分析。结果监测期间,输液港植入患者共置管274 838 d,26例患者发生输液港相关感染,发病率为1.24%,日发病率为0.09‰;感染病原体以表皮葡萄球菌为主(占30.77%);有糖尿病史(OR=3.61,95%CI:1.27~10.11)、置港时长≥90 d(OR=4.71,95%CI:1.65~13.22)、手术时长≥40 min(OR=3.60,95%CI:1.34~9.64)为患者发生输液港相关感染的独立危险因素。结论应加强对植入输液港患者的监测和随访,特别是对患有糖尿病、置管时间长、手术时间长的患者更应密切关注,以利于输液港相关感染的预防与控制。     

颈内静脉入路和锁骨下静脉入路输液港植入术对比分析

目的 通过对比分析颈内静脉入路和锁骨下静脉入路植入静脉输液港的临床效果,探讨两种手术方式的利弊.方法 620例患者分别存在长期输液及化疗等需求且周围静脉输注不便,采用锁骨下静脉入路植入静脉输液港398例,颈内静脉入路植入静脉输液港222例.回顾性分析两组患者一次性置管成功率和围术期、远期并发症的发生率.结果 620例患者静脉输液港均植入成功,锁骨下静脉入路组与颈内静脉入路组一次性穿刺成功率分别为97.24％ （387/398）与89.19％ （198/222）,两组一次性穿刺成功率比较差异有统计学意义（U=0.171,P＜0.01）.颈内静脉入路组围术期并发症发生率为0.90％ （2/222）,远期并发症发生率为1.80％ （4/222）;锁骨下静脉入路组围术期并发症发生率为1.26％ （5/398）,远期并发症发生率为2.01％ （8/398）,两组并发症发生率比较差异均无统计学意义（U值分别为0.041、0.025,P均＞0.05）.结论 颈内静脉入路和锁骨下静脉入路输液港植入术均比较安全、可靠,只要技术操作得当,极少引起严重并发症.     

Morbidity associated with central venous catheter-use in a cohort of 212 hospitalized subjects with HIV infection

Technical complications and nosocomial bloodstream infections associated with short-term central venous catheterization remain a heavy burden in terms of morbidity, mortality and cost in HIV-positive subjects. Between 1994 and 1997, 327 central venous catheters (CVCs) inserted in 212 patients for a total of 5005 catheter days were investigated. Forty-two technical complications (13%) occurred in 40 patients. Logistic regression analysis revealed that a high APACHE III score was associated with development of CVC-related complications (P = 0.01). One hundred and eight of 327 CVCs (33%) were suspected as being infected. However only 61 episodes (61/327, 19%) were finally diagnosed as CVC-related sepsis. Three variables affecting the rate of CVC-related sepsis were identified: 1) administration of TPN (P = 0.01); 2) low number of circulating CD4+ cells (P = 0.04); 3) high APACHE III score (P = 0. 04). Doctors responsible for AIDS patients should carefully consider the relative risks and benefits of CVC insertion in an individual patient.     

Clinical epidemiology and outcomes of peripheral venous catheter-related bloodstream infections at a university-affiliated hospital

Despite enormous clinical experience of using peripheral vascular catheters, there is still controversy over the incidence and clinical relevance of bloodstream infections caused by these devices and the measures for preventing them. We performed a prospective study to determine the clinical epidemiology and outcomes of nosocomial bloodstream infections caused by short- and mid-line peripheral venous catheters among a group of non-intensive care unit patients. Cases of peripheral venous catheter-related bloodstream infections (PVC-BSIs) were compared to cases of central venous catheter-related bloodstream infections (CVC-BSIs). From October 2001 to March 2003, 150 cases of vascular catheter-related bloodstream infections were identified among 147 patients. Seventy-seven episodes (0.19 cases/1000 patient-days) were PVC-BSIs and 73 episodes (0.18 cases/1000 patient-days) were CVC-BSIs. Compared with CVC-BSIs, patients with PVC-BSIs more often had the catheter inserted in the emergency department (0 vs 42%), had a shorter duration from catheter insertion to bacteraemia (mean: 15.4 vs 4.9 days) and had Staphylococcus aureus (33 vs 53%) more frequently as the causative pathogen. Among patients with PVC-BSIs, catheters inserted in the emergency department had a significantly shorter duration in situ compared with those inserted on hospital wards (mean: 3.7 vs 5.7 days). Patients with PVC-BSIs caused by S. aureus had a higher rate of complicated bacteraemia (7%) and higher overall mortality (27%) than patients with PVC-BSIs caused by other pathogens (0 and 11%, respectively). Bloodstream infections remain underestimated and potentially serious complications of peripheral vascular catheterisation. Targeted interventions should be introduced to minimise this complication.     

Biofilms,Infection, and Parenteral Nutrition Therapy

Parenteral nutrition therapy is used in patients with a contraindication to the use of the gastrointestinal tract, and infection is one of its frequent and severe complications. The objective of the present study was to detect the presence of biofilms and microorganisms adhering to the central venous catheters used for parenteral nutrition therapy by scanning electron microscopy. Thirty‐nine central venous catheters belonging to patients with clinical signs of infection (G1) and asymptomatic patients (G2) and patients receiving central venous catheters for clinical monitoring (G3) were analyzed by semiquantitative culture and scanning electron microscopy. The central venous catheters of G1 presented more positive cultures than those of G2 and G3 (81% vs 50% and 0%, respectively). However, biofilms were observed in all catheters used and 55% of them showed structures that suggested central venous catheters colonization by microorganisms. Approximately 53% of the catheter infections evolved with systemic infection confirmed by blood culture. The authors conclude that the presence of a biofilm is frequent and is an indicator of predisposition to infection, which may even occur in patients who are still asymptomatic.     

A new simple technique for the insertion of cuffed central venous catheters: an initial experience

BACKGROUND: Although tunneled polyurethane catheters with polyester cuffs are useful when prolonged central venous access is necessary but their insertion still remains challenging at times. We report the first study of a new cuffed polyurethane catheter (Seldicuff) that can be easily inserted using the Seldinger technique without the need of a vein dilator and that incorporates a tunneling needle onto the catheter. A Seldicuff catheter was placed in 15 patients (mean age: 53 +/- 11 years) who required prolonged parenteral nutrition. All catheters were inserted into the right subclavian vein. The procedure lasted 6.4 +/- 0.8 minutes and no complication directly related to catheter placement was noted. Catheters remained in position for a mean duration of 103 days (range, 58 to 220 days). During this period, no infectious or mechanical complications were observed. CONCLUSION: These results demonstrate that placement of this novel cuffed catheter is as simple as inserting a conventional central venous catheter.     

Complications of the deep venous approach in vascular surgery]

Cultures were made of the distal ends of 101 venous catheters removed from the same number of patients recently operated on for vascular disorders, and 7.9 per cent of the cultures were positive. The most frequently found germ was negative coagulase staphylococcus (4.9%). In these patients, 5.9 per cent of hemocultures were positive, the most frequent germ being positive coagulase staphylococcus (1.9%). There was no coincidence between the patients with positive hemocultures and those with positive cultures of the distal ends of the removed venous catheters. There were no infective or non-infective complications. Also, there no reports of early or late infection of the vascular prosthesis implanted on the patients operated on up to now.     

Efficacy of antiseptic-impregnated catheters on catheter colonization and catheter-related bloodstream infections in patients in an intensive care unit

This study was conducted to evaluate the impact of central venous catheters impregnated with chlorhexidine and silver sulphadiazine on the incidence of colonization and catheter-related bloodstream infection in critically ill patients. One hundred and thirty-three patients requiring central venous catheterization were chosen at random to receive either an antiseptic-impregnated triple-lumen catheter (N=64) or a standard triple-lumen catheter (N=69). The mean (SD) durations of catheterization for the antiseptic and standard catheters were 11.7 (5.8) days (median 10; range 3-29) and 8.9 (4.6) days (median 8.0; range 3-20), respectively (P=0.006). Fourteen (21.9%) of the antiseptic catheters and 14 (20.3%) of the standard catheters had been colonized at the time of removal (P=0.834). Four cases (6.3%) of catheter-related bloodstream infection were associated with antiseptic catheters and one case (1.4%) was associated with a standard catheter (P=0.195). The catheter colonization rates were 18.7/1000 catheter-days for the antiseptic catheter group and 22.6/1000 catheter-days for the standard catheter group (P=0.640). The catheter-related bloodstream infection rates were 5.3/1000 catheter-days for the antiseptic catheter group and 1.6/1000 catheter-days for the standard catheter group (P=0.452). In conclusion, our results indicate that the use of antiseptic-impregnated central venous catheters has no effect on the incidence of either catheter colonization or catheter-related bloodstream infection in critically ill patients.     

心血管外科术后300例中心静脉插管致病菌分析

目的了解心血管外科术后中心静脉导管相关的致病菌分布状况. 方法 1998年6月及2001年9月、2002年10月间,分别3次对共计300例中心静脉导管全部进行尖端半定量、皮下段的定性培养. 结果中心静脉导管尖端致病菌感染率12.3%,导管尖端致病菌定居率8%,皮下段致病菌培养阳性率14%,革兰阳性球菌>80%;中心静脉导管致病菌检出率与导管的留置时间明显相关(>5 d). 结论中心静脉导管作为重要的致病菌感染途径,应引起足够的重视.     

Nasogastric hyperalimentation through a polyethylene catheter: an alternative to central venous hyperalimentation.

We performed nasogastric hyperalimentation with polyethylene catheters and appropriate feeding solutions in 12 cachectic patients who had been referred as candidates for central venous hyperalimentation. Most patients had primary gastrointestinal disease. The duration of hyperalimentation averaged 31 days. Seven patients obtained rapid weight gain (average 0.3 kg/day) with the nasogastric hyperalimentation alone. An additional two were successfully repleted with the addition of parenteral fluids via peripheral veins. In the nine repleted patients, serum albumin rose by average 19%, 24-hr urine creatinine by average 21%, and triceps skinfold by average 46%. The nature of the weight gain in the nine successful cases was analyzed by the metabolic balance study technique. Average composition of the increment in weight was: 50% protoplasm, 48% extracellular fluid, 19% adipose tissue, and less than 1% bone. We conclude that nasogastric hyperalimentation can replace central venous hyperalimentation in a substantial proportion of patients now receiving the latter type of treatment.     

Peripherally inserted central catheters for parenteral nutrition: a comparison with centrally inserted catheters

BACKGROUND: Central venous access is crucial for the provision of adequate parenteral nutrition (PN). The type of central venous access device (CVAD) has evolved over the past 10 years. The most recent trend has been to use peripherally inserted central catheters (PICCs). This development has occurred without controlled clinical trials. METHODS: Over a 10-year period, the nutrition support service at a single institution has prospectively collected data on CVADs used for providing PN. The types of CVAD used for providing PN were analyzed, and the major complications associated with CVADs, thrombosis and line sepsis, were compared over three different time periods: 1988-1989; 1992-1993; 1996-1997. In addition, complications associated with PICCs were compared with other CVADs. RESULTS: The following were the dominant CVADs over each of the three time periods: 1988-1989: tunneled catheters, 80%; 1992-1993: nontunneled catheters, 46%; and 1996-1997: PICCs, 48%. There was a decreased incidence of sepsis and pneumothorax in 1996-1997 and an increase in severed or leaking catheters and phlebitis. In a comparison of PICC and non-PICC catheters over the past 3 years, there was a trend toward decreasing sepsis with PICC catheters but an increase in malposition, inadvertent removal, and severed or leaking catheters. CONCLUSIONS: PICCs have replaced tunneled and nontunneled central catheters as the most commonly used CVAD for providing PN. PICCs do not result in increased line sepsis or thrombosis but have an increased incidence of local complications such as leaking catheters, phlebitis, and malposition.