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外周静脉置入中心静脉导管术在高原地区肿瘤患者中的应用观察

目的　探讨外周静脉置入中心静脉导管（PICC）术在高原地区肿瘤患者中的临床应用，为西藏地区更好开展PICC技术提供依据。 方法　回顾性分析2010年8月－2012年4月113例肿瘤患者临床资料。 结果　穿刺成功111例，失败2例，成功率为98.2%。发生相关并发症14例，发生率12.4%，其中导管异位6例（5.3%），导管相关性感染3例（2.7%），栓塞2例（1.8%），机械性静脉炎2例（1.8%），导管部分脱出1例（0.8%）。 结论　PICC置管是一种置管成功率高，保留时间长，并发症较少、可靠有效的静脉治疗新途径，可在高原地区广泛推广应用。

胃癌患者中心静脉导管的护理改进

【摘要】目的探讨改进胃癌患者中心静脉导管护理的可行性。方法从2009年开始对胃癌患者中心静脉导管的护理流程、导管附件、贴膜及贴膜更换时间等方面进行了改进。结果180例胃癌患者中心静脉导管留置期间出现并发症明显减少,特别在导管相关性感染方面取得很好效果,无大批感染。结论改进胃癌患者中心静脉导管护理可减少护理过程中的并发症。

日间化学疗法留置经外围静脉置入中心静脉导管带管出院患者依从性调查分析

【摘要】　目的　了解化学疗法中不同居住地点留置经外围静脉置入中心静脉导管（peripherally inserted central catheter，PICC）且带管出院患者的依从性问题。　方法　2009年5月-2010年4月采用自行设计的调查问卷，对100例行日间化学疗法的留置PICC患者，就影响带管出院依从性的各因素进行调查分析。　结果　本地化疗患者对PICC导管带管出院的依从性明显优于外地患者（Plt;0.05）。就影响因素而言，本地、异地化疗患者所担忧的问题不尽相同，异地化疗患者对带管出院的担忧主要集中在导管维护困难（81.8%）、并发症发生（67.3%）、导管维护质量（60.0%）等与治疗密切相关的几个因素。　结论　大力开展上臂PICC置管术即超声引导下的PICC置管术，以解决影响患者日常生活、美观、活动自如等问题。加大对区、县级医院护理人员PICC导管维护技能及并发症处理的培训，以提高外地患者PICC导管带管出院依从性。

X线透视引导下经外周静脉置入中心静脉导管误入胸壁静脉处置一例

超声引导下颈内静脉阻断法预防经外周静脉置入中心静脉导管异位颈内静脉的效果观察

目的　观察超声引导下颈内静脉阻断对预防外周静脉置入中心静脉导管（PICC）时发生颈内静脉异位的效果。 方法　2011年6月－12月将326例PICC置管的患者随机分为观察组和对照组各163例，观察组在送管时运用B型超声引导下阻断颈内静脉；对照组在送管时采用传统的偏头压肩法阻断颈内静脉。置管后通过胸部X线片比较两组患者导管异位率。 结果　观察组发生导管异位2例，对照组发生12例，两组导管异位率差异有统计学意义（χ2=7.537，P=0.006）。 结论　超声引导下颈内静脉阻断法对预防PICC置管时发生导管异位于颈内静脉具有较高的临床意义。

Clinical Efficacy of Comfeel Transparent Paste in Treating Peripheral Inserted Central Cathether-associated Allergic Dermatitis

ObjectiveTo investigate the efficacy and nursing strategy of Comfeel transparent paste in treating peripheral inserted central catheter (PICC)-associated allergic dermatitis. MethodsSixty patients with PICC puncture-associated local allergic dermatitis treated between June 2011 and March 2013 were randomly divided into experimental group and control group with 30 patients in each group. The experimental group was treated with dexamethasone sodium phosphate and Comfeel transparent paste, while the control group was treated with dexamethasone sodium phosphate and 3M transparent dressing. The curative effect was compared between the two methods. ResultsTwelve patients were cured with a curing rate of 40.0% in the control group and 22 patients were cured, and the curing rate was 73.3% in the experimental group. The difference between them was significant (P<0.05). ConclusionTreatment with dexamethasone sodium phosphate and Comfeel transparent paste for PICC-associated allergic dermatitis is quite effective, and the patients felt comfortable with low pains. In addition, it reduces the extubation rate of PICC and improves the care quality.

Investigation of Caregivers' Self-nursing Ability for Children with Peripherally Inserted Central Catheter

ObjectiveTo investigate the knowledge and need of caregivers who perform self-nursing for children with peripherally inserted central catheter (PICC), in order to provide evidence for health education for children in-patients and children discharged from hospital with central venous catheter. MethodsSelf-designed questionnaire was used to investigate 364 caregivers who performed nursing for 162 PICC pediatric in-patients bwtween December 2013 and July 2015. The investigation was carried out on the general information, nursing knowledge, and the acquisition approach of caregivers' existing nursing knowledge. ResultsThe majority of indwelling PICC pediatric caregivers were elderly people, and the common care model was alternate caring carried out by core family members. The children were cared by the elderly in 59 families (36.42%). Twenty-one families had the parents of the children as the major caregivers (12.96%), and alternate caring by parents and the elderly happened in 82 families (50.62%). The total score of the investigation was ranged from 5 to 29 with an average of 11.37±5.68. Nineteen children were discharged with catheter, whose caregivers got a score from 6 to 11, averaging 8.41±4.33. ConclusionThe ratio of self-nursing knowledge in caregivers for pediatric PICC patients is generally low, especially in those caregivers for patients discharged with central venous catheter. Nursing administrators should pay attention to training of the nurses, trying to improve the knowledge of nurses on PICC health education. Different forms of health education should be carried out for different caregivers. Finally, health education model should also be continuously improved to raise the quality of PICC pediatric nursing.

新生儿外周静脉置入中心静脉导管堵管原因分析

目的探讨新生儿经外周静脉置入中心静脉导管（PICC）堵塞原因，寻求措施以减少堵管发生率。 方法对2010年1月－2013年3月97例留置PICC发生管道堵塞的患儿资料进行分析，总结堵管原因并提出护理对策。 结果97例PICC置管患儿中，17例发生堵管，发生率17.5%，堵管后再通成功12例。低年资护士维护者堵管发生较多；夜间堵管较多。 结论针对新生儿PICC堵管的主要原因给予相应护理干预能降低PICC堵管率。

弹力绷带在经外周静脉置入中心静脉导管置管中的固定作用及效果

目的　讨论弹力绷带在经外周静脉置入中心静脉导管（PICC）置管中的固定作用及对减少局部渗血、渗液和预防机械性静脉炎的效果。 方法　选择2011年6月－2012年3月在某三甲医院重症医学科（ICU）行PICC置管的100例患者，按穿刺时间先后顺序单号纳入对照组，双号归于试验组,每组各50例。对照组置管后在穿刺局部放置8层无菌方纱，外用 10 cm×12 cm的透明敷料外固定；试验组在对照组的基础上增加弹力绷带固定,分别观察两组患者置管后24、72 h局部渗血、渗液、机械性静脉炎的发生情况。 结果　在24、72 h两个时间点，试验组渗血、渗液发生率少于对照组（χ2=4.57，P＜0.05）；静脉炎发生率在24 h时低于对照组（χ2=4.00，P＜0.05），但在72 h差异无统计学意义。 结论　PICC置管患者使用弹力绷带固定不仅可防止穿刺点渗血渗液，减少机械性静脉炎的发生，而且可减轻护士工作量，值得临床推广使用。

Application of Suprapubic Catheterization by Using Central Venous Catheter in Middle and Low Rectal Cancer Surgery

ObjectiveTo investigate the effect of suprapubic catheterization(SPC) by using central venous catheter (CVC) on the perioperative complications in middle and low rectal cancer surgery. MethodsThe clinical data of 141 patients with middle and low rectal cancer underwent operation in Shengjing Hospital of China Medical University from April 2012 to January 2015 were collected. There were 65 patients performed SPC by using CVC, 76 patients performed routine transurethral catheterization(TUC). The incidences of bacteriuria and urinary retention, recatheterization rate, duration of catheterization, and catheter-related pain were analyzed and compared between these two groups. Results①Compared with the TUC, the SPC by using CVC could significantly reduce the incidence of bacteriuria(P=0.002), espe-cially in female(P=0.006), ≥60 years old(P=0.001), low rectal cancer(P=0.003), open surgery(P=0.018), Miles(P=0.016), and Dixon(P=0.032).②There was no significant difference in the incidence of urinary retention(P=0.464) between the SPC by using CVC and the TUC.③Compared with the TUC, the SPC by using CVC could significantly reduce the inci-dence of recatheterization rate(P=0.001), especially in the patients with male(P=0.016), ≥60 years old(P=0.008), low rectal cancer(P=0.019), laparoscopic surgery(P=0.013), and Miles(P=0.037).④Compared with the TUC, the point of catheter-related pain was significantly lower in the SPC by using CVC(P=0.001), no matter males(P=0.005) or females(P=0.010), aged 60 years and older(P=0.023) or younger(P=0.034), middle rectal cancer(P=0.017) or low rectal cancer(P=0.046), open surgery(P=0.033) or laparoscopic surgery(P=0.021), Dixon(P=0.019) or Miles(P=0.035).⑤The duration of catheterization was similar between the SPC by using CVC and the TUC(P=0.597). ConclusionSPC by using CVC is a safer, more effective and more acceptable method of bladder drainage in middle and low rectal cancer surgery as compared with routine TUC.