桡动脉径路介入诊疗并发症产生的原因及对策

目的分析桡动脉径路介入并发症产生的原因及对策。方法收集1 580例经桡动脉径路进行血管介入诊疗的病例,对其并发症产生的原因进行分析。结果并发症发生率为5.6%,其中动脉痉挛2.4%;假性动脉瘤1.4%;出血或上肢肿胀0.9%;术侧手掌肿胀0.6%;桡动脉闭塞0.3%,无严重出血、动静脉瘘及皮肤破溃感染等发生。结论经桡动脉冠状动脉造影操作的并发症少,且均为非致命性;掌握局部血管解剖,熟悉操作技巧,严格操作规程,加强术后观察,可减少并发症的发生。     

经桡动脉行冠脉介入治疗的临床观察

目的:观察并探讨经桡动脉行冠状动脉介入术治疗冠心病的疗效。方法:对经桡动脉行冠状动脉介入术治疗的130例冠心病患者临床资料进行回顾性分析。结果:130例患者经桡动脉穿刺成功者125例,成功率达96.2%。术中无1例患者出现心脏并发症。130例患者中有单支血管病变者30例,有2支血管病变者61例,有2支以上病变者39例。130例患者手术均取得成功,介入手术平均时间(84±17)min,术后卧床平均时间(5.2±0.8)h。130例患者术后均未见假性动脉瘤、肢体缺血、动静脉瘤等并发症,且无1例患者死亡。结论:经桡动脉行冠脉介入治疗创伤小、术后止血相对容易、不需绝对卧床、安全有效。     

The Use of Virtual Reality Computer Simulation in Learning Port-A Cath Injection

Cost-benefit management trends in Taiwan healthcare settings have led nurses to perform more invasive skills, such as Port-A cath administration of medications. Accordingly, nurses must be well-prepared prior to teaching by the mentor and supervision method. The purpose of the current study was to develop a computer-assisted protocol using virtual reality (VR) in performing Port-A cath as a training program for novice nurses. A pre-tested and post-tested control group experimental design was used in this study. Seventy-seven novice nurses were invited from one large medical center hospital in North Taiwan. Thirty-seven and forty nurses were randomly assigned to experimental and control groups. First, we designed a 40 minute port-A cath injection VR simulation. Then, the experimental group practiced this simulation two times over 3 weeks. The control group attended the traditional class. The post-test 1 was right after completion of the simulation practice. The post-test 2 was after the second simulation practice in 3 weeks. The results showed that most novice nurses lacked Port-A cath experience both in the classroom and during the period of their practice training. The knowledge score regarding the Port-A cath technique was significantly higher in the nurses that participated in the simulation training than in the control group. The novice nurses were most satisfied with the reduction in their fear of performing the Port-A cath technique and their enhanced clinical skills. VR simulation significantly reduced error rates and increased correct equipment selection, showing that nurses who participated in the simulation may be better prepared for inserting Port-A cath.     

Complications of pediatric cardiac catheterization: A review in the current era

Objective: To determine types of complications and risks associated with pedatric cardiac catheterization in the current era. Background: Pedatric cardiac catheterization is an important diagnostic and therapeutic tool. Although in the last decade, there have been significant improvements in technology and equipment, the risk for complications remains, adversely effecting outcomes. Design: The clinical records of 11,073 children undergoing cardiac catheterizations between January 1994 and March 2006 were reviewed to identify procedures associated with complications within the first 24 h after catheterization. All children's electronic and paper chart records were reviewed to obtain demographic, procedural, and treatment data. Results: A total of 858 (7.3%) complications (classified as major or minor) occurred in 816 studies (510 males, 63%), in children ranging in age from 8 h to 20 years (median 4.13 years). There were 195 major (22%) and 663 (78%) minor complications. Vascular complications represented the majority (n = 278; 32.4%) and were major in 53 instances (P < 0.0001). Twenty‐five children died within 24 h (0.23% of total case numbers). Independent risk factors for a complication included young patient age (<6 months), male gender, inpatient status, and year of catheterization. Conclusions: Complications continue to be associated with pedatric cardiac catheterization, although overall incidence appears to be decreasing. Patient age, gender, and inpatient status continue to be risk factors for morbidity and mortality. Efforts at improving equipment for flexibility and size, and developing strategies for the use of alternative methods for catheter access should be encouraged. © 2008 Wiley‐Liss, Inc.     

Cannulating LIMA graft using right transradial approach: Two simple and innovative techniques

Angiography and intervention of a LIMA (left internal mammary artery) graft cannot be performed easily while working through right transradial approach (TRA), because of complexity in anatomical relations of right and left subclavian arteries with arch of aorta. We demonstrate two simple and innovative techniques for the same using right TRA. © 2012 Wiley Periodicals, Inc.     

A single center experience with same‐day transradial‐PCI patients: A contrast with published guidelines

Objectives: Our goal was to compare recently published Consensus Statement from the SCAI/ACC on appropriateness for same‐day PCI with patient characteristics from a real‐world same‐day PCI experience in the United States. Background: Recent practice statement published by the SCAI /ACC in 2009 describes patients suitable for outpatient PCI procedures. Whether this practice statement reflects actual real‐world practice in the setting of advances in transradial catheterization needs further exploration. Methods: Pre‐existing, deidentified, quality assurance data from 100 sequential patients undergoing transradial PCI, and same‐day discharge were compared with criteria in SCAI/ACC statement on outpatient PCI. Each had been identified post‐PCI as uncomplicated and therefore eligible for same day discharged. Specific attention was placed on whether the patients carried any exclusion to same‐day discharge. Results: One hundred six procedures were recorded in 100 patients including 11 women and 89 men, median age 62 (55,71) years all with stable ischemia. Early follow up was done for medication compliance. None were readmitted nor had post‐PCI complications. Only 15% met appropriateness criteria for same‐day discharge. Older age, distance from the hospital, greater than simple PCI, and the need for specific antiplatelet therapy represented the dominant contraindications to discharge. Conclusions: Using transradial approaches and structured early follow up by advance practice nurses, same‐day discharge can be accomplished successfully in a broad range of patients outside of those suggested by the SCAI/ACC 2009 Consensus Document. Confirmation of these results could result in shorter hospitalizations for US patients and align advances in catheterization technology to optimize heath care delivery. © 2011 Wiley Periodicals, Inc.     

介入导管室护士职业危害因素与应对策略

目的浅析介入导管室护士的职业危害因素及应对策略。方法根据介入导管室护士的执业危害因素进行分析研究。结果介入导管室护士的执业危害较多,可通过相应的防护避免或减少对介入护士身心造成的危害。结论减少或消除造成职业危害的各种因素是防护措施的关键。     

Repeat percutaneous mitral balloon valvuloplasty for patients with mitral valve restenosis

Objectives : To determine immediate and long‐term clinical outcome, as well prognostic factors in patients who underwent repeat percutaneous mitral balloon valvuloplasty (PMBV). Background : Repeat PMBV may be a method of treatment for symptomatic patients with restenosis after successful initial PMBV, but data regarding its long term safety and efficacy are scarce. Methods : The study group consisted of 67 patients (mean age 52.1 ± 10.5 years). All PMBV procedures were performed using the Inoue balloon system. Results : Repeat PMBV resulted in significant increase in MVA from 1.17 ± 0.16 cm² to 1.63 ± 0.22 cm² (P < 0.001). Good immediate result (MVA ≥1.5 cm², mitral regurgitation ≤2) was obtained in 52 (77.6%) patients and was not predicted by any analyzed factors. During follow‐up (mean time 4.9 ± 2.9 years) six patients died, nine underwent mitral valve replacement, four—third PMBV, and four developed heart failure. The 3‐, 5‐, and 8‐year good functional results (survival free of mitral valve replacement, third PMBV or heart failure ≥ NYHA III) by Kaplan–Meier estimates were 89.3, 75.6, and 52.6%, respectively. These results were significantly superior in patients with good immediate results and echo score <7. In the entire population multivariate Cox regression analysis identified echo score <7 and absence of prior surgical commissurotomy as the independent predictors of event‐free survival. Conclusions : Repeat PMBV is safe and provides good immediate results in patients with restenosis after successful first procedure. Long‐term results of repeat PMBV are satisfactory and related mainly to the echo score and quality of the procedure. © 2010 Wiley‐Liss, Inc.