Management of central venous catheters in pediatric onco-hematology using 0.9% sodium chloride and positive-pressure-valve needleless connector

PurposeTo describe, in a sample of pediatric onco-hematological patients, the rate of occlusions in unused central venous catheters (CVC) flushed once a week with a 0.9% sodium chloride solution through a positive-pressure-valve needleless connector.MethodRetrospective cohort study. Subjects aged 0–17 years were identified through a manual search in medical and nursing records and were observed for two years or until the occurrence of one of the following events: start or resume of continuous infusion; CVC removal; death. The primary study outcome was the frequency of CVC occlusion (partial or complete).ResultsFifty-one patients were identified (median age 6 years). The median duration of follow-up was 169 days (IQR 111–305). During the follow up period, 14 patients (27%) had one CVC occlusion, in 2 cases (4%) the occlusion was complete, in 12 (23%) partial. All the occlusions were solved without the need for catheter removal. The lumen diameter ≤4.2 vs > 4.2 French showed a statistically significant association with occlusion at multivariate analysis (OR 4.0; 95% CI 1.1–14.7).ConclusionsOur findings are reassuring with respect to the management of the CVC using the adopted protocol. The study provides useful information for patient care, by verifying the performance of the adopted CVC management protocol and by identifying critical areas for nursing care.     

Achieving Near-Zero and Zero: Who Said Interventions and Controls Don't Matter?

BackgroundImplementation of the Institute for Healthcare Improvement's Central Line Bundle in 2005 did not result in attainment of 0 central line-associated bloodstream infections (CLABSIs).PurposeTo establish process improvements to eliminate CLABSIs.MethodsInfection Prevention and Intravenous Therapy Departments at our institution formed a collaborative partnership in 2008 to eliminate CLABSIs. Staff education, daily surveillance, and implementing evidence-based practice into policies, protocols, and product selection were utilized. A study designed to capture and track multiple interventions from the beginning versus time was implemented.ResultsThere were a total of 7 CLABSIs over 5 years, which trended down by year from 3 to 2 to 1 to 1 to 0. The average annual CLABSI rate of infections per 1,000 catheter line days declined from 1.068 to 0.849 to 0.508 to 0.449 to 0.000. The full 3-year simple average from 2009 to 2011, after all of the key interventions were phased-in, was 0.3048.ConclusionsCollaboration and commitment played a role in implementing changes. Empowering staff through education that increases knowledge, understanding, and skills improves patient safety and patient outcomes. Process changes and practice protocols supported by evidence-based practice along with efficacious products played a crucial part in getting to 0 CLABSIs. Layered kits with products placed in the correct order of use can increase aseptic technique compliance. Prompt identification of individual CLABSI episodes with prompt intervention to the specific individuals involved has been shown to be cost-effective and can be implemented in most hospitals.     

Traditional vs wireless intragastric pH monitoring: are the two techniques comparable?

Background Few data are available comparing intragastric pH measured with the traditional catheter‐based and the more recent wireless system (Bravo), and also comparing intraesophageal and intragastric pH during reflux events. Aims of our study were to elucidate these points. Methods Eleven subjects with functional dyspepsia underwent placement of a Bravo capsule 9 cm below the squamo‐columnar junction (SCJ) and of a dual‐electrode catheter, so that the distal electrode was located 9 cm below and the proximal one 6 cm above the SCJ. Key Results The wireless system showed lower intragastric pH than the traditional catheter in the postprandial period (median 2.2 wireless vs 2.7 catheter, P < 0.05) but not in the whole 24 h. Moreover, during the 24 h, minimum intraesophageal pH during reflux events was lower than the simultaneous pH in the gastric body recorded using the catheter (2.2 vs 2.4, P < 0.01) and in the postprandial period lower than the one recorded using both techniques (2.3 vs 2.8 wireless and 3.2 catheter, P < 0.001). Conclusions & Inferences (i) after meals, in the 1st 2 h postprandial pH in the gastric body is significantly lower when measured with the wireless capsule than with the traditional catheter, presumably because of less buffering by food in proximity of the mucosa, (ii) during reflux events intraesophageal pH is lower than pH in the gastric body, in accordance with the notion of greater intragastric acidity in the subcardial region.     

耐高压注射型双腔PICC导管在头颈部肿瘤患者中的应用与护理

目的探讨耐高压注射型双腔PICC导管在头颈部肿瘤患者中的应用与护理。方法回顾性分析158例置入耐高压注射型双腔PICC导管患者在头颈部肿瘤患者中的应用效果。结果158例患者中导管堵塞及皮肤过敏样改变发生率为34．8％及13．2％，导管相关感染及导管脱出发生率各为4．4％，穿刺点渗液发生率为5．0％．静脉炎和静脉血栓发生率为0％及1．2％。结论耐高压注射型双腔PICC导管与普通PICC导管相比，可以同时满足两路静脉输液的需要、可注射造影剂，值得在临床上推广应用。     

探讨心房颤动导管消融术后早期复发与炎症反应和细胞外基质生物标志物的关系

目的探讨心房颤动导管消融术后早期复发与炎症反应和细胞外基质生物标志物间的关系。方法选取我院自2014年1月~2015年1月间收治的进行心导管消融术患者62例作为研究对象,测定该组患者手术前后高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶抑制剂-2(TIMP-2),对比术后早期复发患者和未复发患者各指标的水平差异。结果复发组患者和未复发组患者的房颤类型、性别、年龄差异无统计学意义(P0.05);复发组患者术前IL-6、hs-CRP、MMP-2均显著高于未复发组,组间比较差异有统计学意义(P0.05);两组术前TIMP-2指标差异无统计学意义(P0.05)。结论心房颤动患者行RFCA治疗后早期复发与机体炎症反应、MMP-2水平变化息息相关,因此可以作为防治复发的判断依据。     

Successful Foley catheter tamponade of an epigastric vessel trocar injury in a toddler – A case report

Introduction and importanceInjuries to the inferior epigastric vessels during laparoscopic surgery are rare but reported. They can lead to significant morbidity. We report the successful tamponade of a bleeding epigastric vessel during laparoscopic inguinal hernia repair in a child using a Foley catheter. A Foley catheter has not been routinely used in pediatric surgery for this indication so far.Case presentationA 32-month-old boy underwent laparoscopic left inguinal hernia repair. During insertion of a 2 mm trocar, the left inferior epigastric vessels were lacerated, leading to a brisk bleed into the abdominal wall and into the abdomen through the trocar site during the procedure. When the hemorrhage was noted, the trocar was removed. The trocar tract was slightly dilated using a blunt forceps and a 12 F Foley catheter was introduced into the abdomen. The balloon was insufflated with 10 ml of water and the catheter was retracted towards the abdominal wall, tamponading the bleed. The inguinal hernia repair was completed, and after desufflating the catheter at the end of the procedure, the hemorrhage had stopped.Clinical discussionPostoperatively, the hemoglobin had dropped by 1.5 g/dl to 9.3 g/dl. The patient was observed and then discharged on the same day. Besides an additional 2 mm scar in the right lower quadrant, he had no further sequellae or adverse effects.ConclusionHemorrhage resulting from trocar injury of the inferior epigastric vessels during laparoscopy can be controlled by Foley catheter insertion and tamponade in children. Pediatric surgeons should be aware of this useful maneuver to manage this complication.     

全程健康教育在PICC置管患者中的应用

目的：探讨全程健康教育在PICC置管患者中的应用效果。方法：选取2011年9月～2013年3月在我院采用PICC置管的112例患者为研究对象,将其随机等分为对照组和观察组,对照组进行常规健康教育,观察组则给予全程健康教育,然后将两组患者的置管相关不良情况发生率及教育后的置管知识掌握程度进行比较。结果：观察组置管相关不良情况总发生率低于对照组（P〈0.05）,教育后的置管知识掌握程度明显优于对照组（P〈0.05）。结论：全程健康教育在PICC置管患者中的应用效果较好,不仅可有效控制置管相关不良情况的发生,且有助于改善其生存状态。     

无接触无菌技术在妇科病人PICC维护中的应用效果观察

目的:探讨无接触无菌技术在经外周静脉置入中心静脉导管(PICC)日常维护中应用的临床效果。方法:按住院号的单双号把80例病人分成对照组及试验组,对照组使用PICC专门换药包进行PICC导管维护,试验组不使用换药包但执行无接触无菌技术。结果:两组病人在导管维护耗时、使用物料成本方面比较差异有统计学意义(P<0.05),试验组优于对照组,在并发症发生、病人满意度比较方面差异无统计学意义(P>0.05)。结论:无接触无菌技术用于PICC导管日常维护可以节省护士工作时间及物料消耗。