带手套穿刺对留置套管针一次成功率的影响

为探讨戴手套与不戴手套穿刺对留置静脉套管针一次成功率的影响 ,为护理人员的自身防护提供科学依据 ,选取冠状动脉搭桥术病人 12 0例 ,随机分为实验组和对照组 ,实验组采用戴手套穿刺法 ,对照组采用常规洗手后不戴手套穿刺法。结果两组一次穿刺成功率经χ2 检验 ,无统计学意义( χ2 =0 .5 6 3,P >0 .0 5 )。说明戴手套留置套管针并不影响一次穿刺成功率。     

Safe creation of pneumoperitoneum using an optical trocar

The blind insertion of the Veress needle and the first trocar may cause serious complications. Therefore, many surgeons perform a minilaparotomy to safely position the first trocar. However, especially in obese patients, the dissection may be difficult and time consuming. As an alternative, optical trocars can be safely positioned under direct visualization. We report on our experience with the Optiview trocar in 200 patients and describe our preferred insertion technique. In our opinion, optical trocars are safe and easy to handle, offering several advantages over the use of the Veress needle and the minilaparotomy. Received: 19 February 1998/Accepted: 28 May 1998     

Arthroscopic Ankle Arthrodesis with Intra-articular Distraction

Arthroscopic ankle arthrodesis has shown high rates of union comparable to those with open arthrodesis but with substantially less postoperative morbidity, shorter operative times, less blood loss, and shorter hospital stays. To easily perform arthroscopic resection of the articular cartilage, sufficient distraction of the joint is necessary to insert the arthroscope and instruments. However, sometimes, standard noninvasive ankle distraction will not be sufficient in post-traumatic ankle arthritis, with the development of arthrofibrosis and joint contracture after severe ankle trauma. In the present report, we describe a technique to distract the ankle joint by inserting a 4.6-mm stainless steel cannula with a blunt trocar inside the joint. The cannula allowed sufficient intra-articular distraction, and, at the same time, a 4.0-mm arthroscope can be inserted through the cannula to view the joint. Screws can be inserted to fix the joint under fluoroscopic guidance without changing the patient’s position or removing the noninvasive distraction device and leg holder, which are often necessary during standard arthroscopic arthrodesis with noninvasive distraction.     

Aortic injuries during laparoscopic gastric bypass for morbid obesity in Sweden 2009–2010: A nationwide survey

BackgroundIn Sweden, bariatric surgery has increased more than tenfold in the past decade, from 700 to 8,600 procedures annually, and laparoscopic gastric bypass (LRYGB) dominates (92% of all procedures). This expansion makes safety issues crucial. The aim of this nationwide survey was to identify aortic injuries in LRYGB.MethodsAll 41 centers performing LRYGB in Sweden were asked if an aortic injury had occurred during the years 2009–2010. Techniques for entering the first trocar and way of establishing pneumoperitoneum were evaluated. The total number of procedures was collected from the national quality registry, Scandinavian Obesity Surgery Registry (SOReg), and the National Patient Register.ResultsDuring the study period, 11,744 LRYGBs were performed. The analysis revealed 5 aortic injuries, all occurring in patients in whom an optical trocar had been placed before establishing pneumoperitoneum. Outcomes varied from no major sequelae to bilateral lower limb amputation and death. Based on the total number of LRYGBs, the risk for an aortic injury was .043% overall and .091% when an optical trocar was used.ConclusionAortic injury is a rare but serious complication in laparoscopic gastric bypass. In this survey, optical trocars constructed to reduce the risk of intraabdominal damage had been used in all 5 cases.     

静脉留置针临床应用的护理新进展

静脉留置针是一项新发展的护理操作,因其能减少体液外渗,保护血管,并减轻由于反复穿刺而给患者造成的痛苦,还能保证合理用药时间,并能减少护士的工作量,因而在临床上被广泛应用并得到进一步发展.本文介绍静脉留置针的使用方法,通过做穿刺前准备、穿刺方法的选择、穿刺后的固定等总结静脉留置针的正确使用方法,以减少静脉炎、导管堵塞、体液渗漏、皮下血肿、静血脉栓和静脉痉挛等并发症的发生,降低患者的痛苦,从而提高护理工作效率及质量.     

Ergonomic evaluation of three new principles for mono‐incision in laparoscopic surgery

Several instruments exist for performing a simple laparoscopic procedure through one trocar‐incision. However, all of these instruments have well‐known image‐related disadvantages. In order to solve these problems three principles have been developed for which a new device was designed. The functionality of this device was evaluated with regard to four parameters: duration of task completion, number of errors, image‐stability and preference by users.

Although the differences between the three principles were small, the tests clearly showed that the problems surgeons experienced before have been significantly diminished by the new device. Time measurements showed a preference for principles 1 and 2 (1: manual zoom camera in combination with a standard grasping device; 2: laparoscope with an angle of 45° in combination with a standard grasping device), the surgeons expressing preference for principle 2. Furthermore, the new trocar system is the first device for mono‐incision in which two standard instruments (currently available on the market) are used simultaneously without enlarging the incision. Finally, each surgeon can work with the new device using the principle he/she is preferring.     

Evaluation of a novel thoracic entry device versus needle decompression in a tension pneumothorax swine model

Introduction

Tension pneumothorax (tPTX) remains a major cause of preventable death in trauma. Needle decompression (ND) has up to a 60% failure rate.

浅静脉套管针临床应用方法的分析

探讨浅静脉套管针的临床应用方法。选用相对粗、直、富有弹性、血流丰富、无静脉瓣、避开关节且易于固定,长度适宜留置针的血管进行穿刺,选用细、短留置针操作,并进行护理。临床护理工作中,正确使用静脉套管针可使患者在整个输液过程中感觉舒适,减少痛苦,能够保持静脉管道的持续通畅,便于抢救,且能降低对浅表静脉的损伤。