Long-term central venous catheters: issues for care.

Long-term central venous catheters allow the safe administration of chemotherapy, blood and blood products, total parenteral nutrition, fluids, and other medications. Despite their benefits, the risk of certain complications (e.g., fibrin sleeve and mural thrombus formation, infection, catheter occlusion, extravasation, and catheter malposition) exist for every person who has a catheter. Thus, preventative measures, recognition of early signs and symptoms of complications, and adequate care of utmost importance.     

Infection control related to central venous catheter impregnated with antiseptics: an integrative review

The use of central venous catheter is pointed out as a risk factor to blood stream infection. The objective of this study was to reach scientific evidence on infection control related to central venous catheter impregnated with antiseptics, used in hospitalized adult patients. Studies were selected from the LILACS, CINAHL and MEDLINE databases. Nine articles were selected by means of integrative literature review. The publications on the use of catheters impregnated with antiseptics showed statistically significant differences regarding the reduction of microbial colonization; however, only one study showed reduction in the occurrence of infection. The analysis of the studies revealed there is a need for further research in different patient populations in order to obtain general conclusions.     

Reducing central venous catheter infections.

This article reviews the current literature in relation to the management of central venous catheters and the prevention of catheter related infection. Sources and factors influencing catheter related infection are reviewed. In some areas of catheter management, there are clear recommendations such as the choice of skin preparation and catheter site. Other areas don't have clear guidelines; this results in varying practices and the need for further research. The latest research has been in the areas of impregnated catheters with studies showing some benefits. Recent research has also analysed the effect of the method of fluid and line changes as well as their frequency in relation to catheter related infections. A summary is given outlining interventions which have evidence supporting their practice in the reduction of catheter related infections along with interventions which may be effective in reducing catheter related infection and the need for further research.     

中心静脉置管术后导管相关性感染的预防及护理

[目的]预防中心静脉导管感染。[方法]选择重症监护病房中心静脉置管病人201例,分为两组,实验组100例,在中心静脉置管处放置一个纱球,上面覆盖3M无菌透明敷料固定;对照组101例,置管处用3M无菌透明敷料固定。比较两组置管时间及感染情况。[结果]两组置管时间、感染率比较差异有统计学意义(P<0.05)。[结论]采用3M无菌透明薄膜覆盖消毒小纱球及置管处的护理方法,可延长置管时间,降低感染率。     

Chlorhexidine versus povidone-iodine for central venous catheter site care in children

The number of children receiving central venous catheters (CVCs) for the administration of medications is at an all-time high. Unfortunately, placement of these CVCs is not without risks. Infection of CVC insertion sites is one of the most common, yet often preventable, causes of nosocomial bacteremia in both children and adults worldwide. Throughout the years, multiple practice recommendations have been made regarding the proper site care of CVCs. The most popular antimicrobial solution used for site care has traditionally been povidone-iodine. Chlorhexidine gluconate solution, however, has been shown to be more effective than povidone-iodine in preventing CVC-related infections in adults. There continues to be controversy regarding the efficacy and safety of antimicrobial solutions for pediatric CVC site care. An evidence-based approach was used to determine current recommendations for CVC site care in children.     

Increasing the executive rate of standard central venous catheter care

The purpose of this project was to increase the executive rate of standard nursing care of central venous catheters. The average rating of the procedure used by our nurses in caring for central venous catheters in our unit was 58.5%. Reasons why our rating failed to reach 100% included: (1) there was no clear, detailed explanation of the aseptic technique of standard nursing care of central venous catheters; (2) nurses were too busy to complete the detailed steps necessary to the procedure; (3) nurses were unfamiliar with standard nursing care of central venous catheters. Observation, analysis, literature review and discussions with the Infection Control Team were the measures we adopted to improve the standard nursing care of central venous catheters in our unit. Through the application of what we learned we increased our average rating of standard nursing care of central venous catheters to 100%.     

The wandering central venous catheter

A subclavian central venous catheter wandered spontaneously between the superior caval and the internal jugular veins. The case supports the routine of regular X-ray checks for catheter position.     

ICU患者中心静脉导管堵塞的危险因素分析

目的探讨重症加强治疗病房(intensive care unit,ICU)中心静脉置管(central venous catheter,CVC)堵塞发生情况及其危险因素。方法由专人负责调查本院ICU 133例CVC患者发生堵塞情况;比较发生CVC堵塞与无发生CVC堵塞组患者置管部位、留置导管日、选择的封管液、血小板计数(blood platelet,PLT)、凝血酶原时间(prothrombin time,PT)、国际标准化比值(international normalized ratio,INR)、活化部分凝血活酶时间(activated partial thromboplatin time,APTT)、凝血酶时间(thrombin time,TT)和纤维蛋白原(fibrinogen,FBG)的差异。结果导管通畅117例,占88.0%;发生导管堵塞16例,占12.0%,其中部分堵塞10例,发生率为7.5%,完全堵塞6例,发生率为4.5%。中心静脉导管堵塞发生与导管留置时间及PLT、FBG水平有关(均P0.05);与置管位置、封管方式及PT、INR、APTT、TT水平无关(均P0.05)。结论患者导管留置时间长,血小板、纤维蛋白原凝血水平高是ICU CVC患者堵塞的危险因素。     

中心静脉导管用于心包积液引流的护理

恶性心包积液是恶性肿瘤常见的并发症之一，多见于肺癌晚期病人。局部治疗包括反复心包穿刺排液、心包腔内化疗或免疫制剂治疗。此方法因多次穿刺，病人倍感痛苦，且感染发生率高。我科自2004年1月-2006年8月采用中心静脉导管穿刺并留置于心包腔内，间断引流心包积液并注入免疫制剂治疗恶性心包积液，疗效满意。现报告如下。     

中心静脉导管用手心包积液引流的护理

恶性心包积液是恶性肿瘤常见的并发症之一,多见于肺癌晚期病人[1].局部治疗包括反复心包穿刺排液、心包腔内化疗或免疫制剂治疗.此方法因多次穿刺,病人倍感痛苦,且感染发生率高.我科自2004年1月-2006年8月采用中心静脉导管穿刺并留置于心包腔内,间断引流心包积液并注入免疫制剂治疗恶性心包积液,疗效满意.现报告如下.     

留置中心静脉导管治疗结核性胸膜炎的舒适护理

[目的]探讨舒适护理对中心静脉导管治疗结核性胸膜炎的影响,为该类病人的护理提供参考。[方法]70例拟采用中心静脉导管治疗结核性胸膜炎的病人随机分成观察组与对照组,观察组36例应用舒适护理模式,对照组34例则按常规护理,对比两组病人的焦虑、疼痛程度、满意度等指标差异。[结果]观察组在焦虑、疼痛程度方面明显低于对照组(P<0.01),在满意度方面明显高于对照组(P<0.01)。[结论]舒适护理运用于结核性胸腔积液的治疗,使病人在生理、心理方面均获得满足感,体现了"以人为本"的护理理念。