医院同质化管理策略在携体外膜氧合患者转运质量监控中的效果评价

目的 构建并应用携体外膜氧合(ECMO)患者转运同质化管理策略，评价其实施效果。方法 2018年我院ECMO治疗团队通过基线调查与根因分析，制定了携ECMO患者标准化转运方案，并将方案应用于我院ICU、CCU和急诊科。在应用过程中逐步规范方案实施细则，并借助我院信息系统辅助，最终形成了携ECMO患者转运同质化管理策略。对比该同质化管理策略实施前(2016年1月—2017年11月)和实施后(2018年3月-2021年3月)携ECMO患者转运并发症发生率、转运时间；计算该策略实施后携ECMO患者转运前准备度、“Time out”执行率。结果 同质化管理策略实施后，携ECMO患者转运并发症发生率由32.26%降至13.73%(χ²=4.030,P=0.045);由ICU至CT室、急诊至ICU的转运时间均显著缩短(t值分别为2.541和8.663,P均<0.05);2018—2021年携ECMO患者转运前准备度与“Time out”执行率呈逐年上升趋势。结论 携ECMO患者转运同质化管理策略可降低转运并发症发生率，缩短转运时间，提高转运前准备度及“Time out”...     

ECMO团队合作在基层医院危重病人抢救和转运中的应用

本文总结了体外膜肺氧合(ECMO)团队对周边基层医院4例急危重症病人紧急建立ECMO循环并转运到上级医院进一步救治的组织和转运经验。重点介绍ECMO团队的人员组成、职责、管理,对基层医院危重病人ECMO适应证的选择,就地对危重病人建立ECMO循环及院间转运的团队配合及监护要点。认为良好的ECMO团队训练,分工合作,转运当中注意细节的把控,做好应急流程预案,可以减少转运风险,特别要关注转运ECMO病人时相关的并发症的观察及处理;只要有充足的电源和气源,ECMO病人在院间的转运可以不受限制,对于有救治希望的急危重症病人,ECMO团队到现场快速建立ECMO循环并转运到上级医院进一步救治,给更多病人予以生还的希望。     

15例体外膜肺氧合治疗病人行救护车院间转运的护理

目的:总结体外膜肺氧合(ECMO)治疗的危重病人实施救护车院间转运护理措施。方法:2017年8月—2019年2月对15例体外膜肺氧合(ECMO)治疗的危重病人实施救护车院间转运,转运前充分评估病情,加强急救车及急救物品的准备、人员的合理分工、转运途中病人生命体征的监护及ECMO机器设备的管理,给予精细的安排及护理,自行设计实施ECMO的物品核查单,杜绝纰漏,确保病人转运安全。结果:15例ECMO治疗的重症病人均经救护车顺利转运,转运距离5~600 km,ECMO机器转运途中运转时间1.0~8.0 h,转运途中病人生命体征平稳,ECMO机器运转正常,未出现相关并发症。结论:在专业技术人员和完善的仪器设备的支持下可以保证ECMO治疗的危重病人行救护车院间转运的安全。     

1例危重症VAV-ECMO支持病人陆地救护车超长途转运的护理

总结1例重症静脉-动脉-静脉体外膜肺氧合(VAV-ECMO)支持病人陆地救护车超长途转运的护理经验。主要包括转运前护理(转运设备检查、转运药物准备、转运前病人准备、转运预案演练)、转运过程护理(救护车转运途中护理、转运途中突发情况处理等)。本例体外膜肺氧合(ECMO)病人转运距离近3 000 km,转运时间长达31 h,在ECMO设备支持及专业护理下,顺利将病人转运至目标医院。     

基于VA-ECMO支持下1例危重症患者远程转运护理

目的:探讨基于体外膜肺氧合(ECMO)支持下危重症患者院际转运的护理经验,指出ECMO转运过程中的不足,并提出改进措施。方法:在转运前评估病情、仪器设备准备、ECMO转运团队人员配置及团队分工与协作;转运过程中严密监测患者基础生命体征和ECMO系统参数;对突发情况做出正确应急处理;在目的地到达后完成安全交接。结果:对1例危重症患者成功施行ECMO支持下长途转运,转运距离160 km,转运使用时间120 min。结论:在ECMO支持和专业护理下,危重症患者能够实现安全、长途转运,可显著提升危重患者的抢救效率和成功率,然而需进一步改进设备、规范操作及经验积累,实现技术全面成熟且在基层医院广泛推广和应用。     

11例重症患者应用ECMO院间转运的管理

目的 :总结2016年12月至2018年3月我院应用体外膜肺氧合(Extracorporeal Membrance Oxygenation,ECMO)院间转运重症患者的管理经验。方法 :转运前制定完善的预案,对转运途中可能出现的问题作好应对;转运过程中严密监测患者的生命体征、ECMO系统参数等变化,及时处理并发症或意外事件;转运到目的医院后认真交接;自行设计"ECMO重症患者院间转运查检表",防止遗漏要点,以确保转运过程安全有效。结果 :应用ECMO院间转运的11例重症患者经救护车顺利转至我院。转运距离6.5~400.0 km,ECMO运转时间1.0~4.5 h,转运过程中患者呼吸循环稳定,未出现并发症。结论:在完善的仪器设备支持和专业技术团队合作下,应用ECMO院间转运重症患者具有可行性和安全性,可为拯救患者生命争取宝贵时间。     

1例体外膜肺氧合辅助非体外循环下患儿行冠状动脉去顶手术的护理配合

总结1例体外膜肺氧合（extracorporeal membrane oxygenation,ECMO）辅助非体外循环下患儿行冠状动脉去顶手术的护理配合经验。护理要点如下:术前病情讨论、手术间准备、ECMO下患儿的院内转运,术中护理配合和应急预案制订以及术后管理。该例患儿成功完成心脏手术,术后继续ECMO支持,14 d后顺利脱机,术后27 d出院。     

自制体外膜肺氧合转运架的研制与应用

目的 制作ECMO转运架,弥补ECMO原装设备占用空间大、质量重、占用医务人员多、不方便转运等临床应用局限。方法 自行设计制作ECMO转运架,其结构包括底板、立柱、支撑架、盖板、把手等,通过将ECMO主机、泵头、膜肺固定架取出固定在自制ECMO转运架上,经临床应用转运30例患者,观察其效果。结果 使用自制ECMO转运架后,转运时间只需要10 min,可节省2名医务人员;使用自制ECMO转运架之前,转运期间突发事件（管路扭曲、停机报警等）发生率7%,低于转运前的27%。结论 自制ECMO转运架节省空间,减少人力,能缩短转运时间,提高转运效率,降低转运风险。     

体外膜肺氧合支持患者院际转运管理的证据总结

目的 总结体外膜肺氧合(ECMO)患者院际转运管理的相关证据,为临床ECMO转运管理实践提供指导。方法 运用循证护理方法检索国内外数据库关于ECMO患者院际安全转运的相关文献,检索时限为建库至2022年6月,由2名研究者对所纳入的循证文献进行质量评价和资料提取、证据归纳总结。结果 共纳入文献10篇,包括指南3篇、系统评价2篇、专家共识3篇、队列研究1篇、类实验性研究1篇。最终整合归纳了6个方面共22条证据,包括转运组织管理、团队组成与培训、转运决策、装备管理、转运过程管理(转运前准备、转运中监测、转运后处理)、质量控制。结论 医务人员应用相关证据时应结合医院实际情况,针对性筛选证据,保障ECMO患者院际转运安全管理,提供高质量的循证依据,降低转运不良事件发生率,保证患者安全。     

体外膜肺氧合辅助危重患者院际转运27例临床经验

目的:总结我院ECMO团队实施体外膜肺氧合(ECMO)辅助重症患者院际转运的临床经验。方法:回顾性分析2017年2月—2021年4月期间我院ECMO团队在ECMO支持下实现院际转运的27例危重患者的临床资料。记录患者疾病种类、插管地点、插管方法、院际转运距离、转运方式、患者转运期间不良事件发生情况以及临床转归。结果:27例患者均由我院心外科ECMO团队在外院置管后转至本单位。其中男24例,女3例;平均年龄52.5岁;转运距离4~300 km。1例患者采用直升机转运,26例患者采用地面救护车转运。转运过程中无死亡事件发生,但发生8例不良事件。ECMO顺利撤机18例,患者顺利出院14例。结论:ECMO辅助下危重患者的院际转运是安全而有效的,充分而周密的准备工作可有助于减少ECMO转运途中不良事件的发生。     

Referral and transportation for neonatal extracorporeal membrane oxygenation.

Data from 32 patients who were transported for neonatal extracorporeal membrane oxygenation (ECMO) over a 66-month period were reviewed. One ground ambulance transport had to be postponed because of poor weather conditions; the patient died. One patient was excluded for ECMO on arrival at the ECMO centre. Of the remaining 30 infants, 20 (67%) required ECMO treatment, of which four (20%) died. All 10 (33%) patients who were treated with conventional therapy survived. During transportation all children remained stable in terms of oxygenation. Early referral and transportation by an experienced and well-equipped transport team allows safe transport of these critically ill neonates.     

Physical stresses related to the transport of the critically ill: optimal nursing management.

The critically ill patient's physical well being is constantly at risk. This fragile physical state means the patient is vulnerable to a host of hazards within the critical care setting, none of which are more relevant to patient outcome than the hazards awaiting them should the patient require transportation. The stresses exerted on the human body and the vulnerability of the critically ill to various means of movement, transport and subsequent environmental changes are explored through this review. The review includes a brief history of the evolution of patient transportation, which has provided a basis for the inception of formal strategies in patient management related to transportation. Within this framework current optimal nursing management minimising the detrimental effects of transport on the critically ill is reasoned to its scientific base. The basic laws of physics are an important consideration in all modes of patient movement or transport and play an integral role in the critical care nurses' practice. A clear understanding of pathophysiological and technological processes involved in caring for the critically ill and applying the principles of physics to effective contextual practice enhances the capability of the critical care nurse.     

急诊危重患者院内安全转运管理进展

文章阐述了急诊危重患者院内安全转运过程中存在的不良事件及并发症,分析了急诊危重患者转运的病情、转运、人员、药物及设备、沟通等相关危险因素,提出制订转运及相关护理文书规范、加强转运的沟通与交接、完善转运前准备、加强转运中的监测与护理等安全措施,为提高急诊危重患者院内转运的安全性提供参考。     

Ambulance nurses’ experiences of nursing critically ill and injured children: A difficult aspect of ambulance nursing care

BackgroundAmbulance nurses work daily in both emergency and non-emergency situations that can be demanding. One emotionally demanding situation for ambulance nurses is to nurse children who are ill.AimThe aim of this study was to describe ambulance nurses’ experiences of nursing critically ill or injured children.MethodEight specialist ambulance nurses were interviewed and the interviews were analyzed using qualitative content analysis.FindingsThe analysis resulted in one theme, a difficult aspect of ambulance nursing care, with five categories. The security of both child and parents was considered to be paramount. Ambulance nurses felt relieved when they handed over the responsibility and the child to the receiving unit. The ambulance nurses felt that more training, education and follow-up was desirable in order to increase their security when nursing children.ConclusionAmbulance nurses are subject to stressful feelings while nursing children. As providing reassurance to the child and its parents is a cornerstone of the treatment, it is important for the ambulance nurses to take the time to build up a trusting relationship in such an encounter. Skill development in the area might lead to increased security and reduce the mental burden resulting from negative stress.     

体外膜肺氧合联合连续性肾脏替代治疗危重症患者的护理

本文总结了应用体外膜肺氧合(ECMO)联合连续性肾脏替代治疗(CRRT)的90例危重患者的护理措施。ECMO联合CRRT治疗危重症患者中,相关设备管路正确连接与维护、对血液抗凝的密切监测和管理、灌注量监测是治疗成功的关键。护理人员在熟练掌握ECMO相关护理措施的基础上,要进一步了解CRRT治疗原理,熟知治疗过程中易发生的并发症以及可能产生的突发意外情况,积预防并发症的发生。     

Extracorporeal membrane oxygenation: current use and future directions

Extracorporeal membrane oxygenation (ECMO) is the process of using prolonged cardiopulmonary bypass to support patients with reversible respiratory and/or cardiac failure who are refractory to maximal conventional therapy. This process has been used extensively for critically ill neonates, with encouraging results. The use of ECMO in the pediatric population has been limited but is increasing. The history, mechanics, and current applications of ECMO are discussed in this article. Critical care nursing management of the pediatric or neonatal ECMO patient focuses on optimizing recovery of the pulmonary and/or cardiac system while preventing complications. A case study of a pediatric ECMO patient is presented which illustrates the complex nursing care issues related to use of this intervention. Future directions for ECMO are addressed.     

ICU新型冠状病毒感染防护及管理的最新文献评价及汇总

目的检索并获取ICU新型冠状病毒感染防护及管理的相关证据,为临床提供借鉴。方法根据患者及医务人员的具体情况,提出所要解决的临床问题,全面检索BestPractice(BMJ)、Up To Date、JBI、世界卫生组织、美国国家疾病控制与预防中心、中华医学会、中国疾病预防与控制中心、国家卫生健康委员会办公厅和国家中医药管理局办公室、Cochrane Library、PubMed、丁香园、中国知网、万方数据库等网站,提取新型冠状病毒救治相关的证据,并结合临床医务人员专业判断、患者意愿、临床情境等要素,为患者及医务人员制定防护及管理方案。采用美国约翰霍普金斯大学/医院的文献评价标准对非研究型文献进行质量评价。结果共纳入21篇文献:1篇临床决策,6篇临床指南、2篇证据总结,11篇专家共识,1篇专家意见,围绕呼吸治疗、血糖控制与管理、隔离与防护、营养支持、标本采集、转运、医用产品使用、医护人员职业防护、心理与社会支持和教育与培训等10个方面进行了证据总结,共形成48条新型冠状病毒救治及管理相关的最佳证据。结论本研究汇总了目前ICU新型冠状病毒感染防护及管理的文献,为ICU医护人员在诊疗和护理病...     

Follow new pediatric guidelines or risk inappropriate care, liability

If you don't comply with new guidelines for pediatric emergency care jointly developed by the American College of Emergency Physicians and American Academy of Pediatrics, you risk adverse outcomes and lawsuits. When transferring a critically ill or injured child, use transport services with specific pediatric training. Have a physician and nursing coordinator ensure compliance with the guidelines. Ensure that staff are trained in pediatric resuscitation, and provide age-specific competencies for neonates, infants, children, and adolescents.