ObjectiveTo systematically evaluate the efficacy and safety of local anesthesia for venipuncture in children, and to provide evidence for related nursing practice.MethodsWeb of Science, PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data, Chinese Biomedical Database and VIP databases were searched for randomized controlled trials (RCTs) about the application of local anesthesia in venipuncture in children till June 25th, 2021. Two reviewers independently reviewed the literature, extracted data, and assessed the risk of bias of included RCTs. RevMan 5.3 software was used for meta-analysis.ResultsA total of 19 RCTs were included, comprising 2 566 patients. All of them were high-quality English articles included in SCI or Medline. The results of meta-analysis showed that: the painless rate [odds ratio (OR)=3.80, 95% confidence interval (CI) (1.88, 7.66), P=0.000 2] and satisfaction rate of venipuncture [OR=2.12, 95%CI (1.27, 3.54), P=0.004] in the local anesthesia group were higher than those in the non-anesthesia group, and the pain score [mean difference=−0.62, 95%CI (−0.77, −0.48), P<0.000 01] in the local anesthesia group was lower than that in the non-anesthesia group. There was no statistically significant difference between the two groups in the success rate of the first puncture [OR=1.14, 95%CI (0.77, 1.68), P=0.52], the incidence of transient skin reactions [OR=1.15, 95%CI (0.67, 1.95), P=0.62], the incidence of paleness [OR=1.11, 95%CI (0.57, 2.15), P=0.76], or the incidence of edema at the puncture site [OR=0.64, 95%CI (0.21, 1.96), P=0.44].ConclusionsLocal anesthesia can effectively reduce pain and improve the satisfaction of children with venipuncture, and has good clinical safety. It can be used by nursing staff in clinical practice.
To report a case of a 1-year-old female child admitted to the hospital with recurrent convulsions and diagnosed as West syndrome, also known as infantile spasms (IS). The child had been experiencing convulsions for 4 months prior to admission, characterized by forward head tilt and flexion of the limbs, with 8 ~ 10 episodes per day. After admission, West syndrome was identified by EEG and imaging evaluation, and adrenocorticotropic hormone (ACTH) shock therapy was started on day 5 of admission, supplemented with peripherally inserted central catheter (PICC), gastric protection, calcium and potassium supplementation and other supportive measures. During the course of treatment, the nursing team implemented meticulous monitoring and assessment to ensure that the child's vital signs were stabilized, and potential side effects were detected and treated in a timely manner. After 14 days of treatment, the child had no further spasticity episodes during 3 ~ 14 days, and was discharged from the hospital with continued oral hormone intake and regular follow-up. During the nursing process, the nursing staff provided psychological support and education to the child and her family to help the family understand the disease and enhance their ability to manage it. In addition, personalized nutritional support and monitoring were provided to ensure the healthy growth of the child. The successful management of this case not only enhanced the quality of clinical care, but also provided useful reference and inspiration for similar cases.
ObjectiveTo systematically evaluate the efficacy and safety of anatomical landmark method (ALM) versus ultrasound (US)-guided internal jugular vein (IJV) catheterization in pediatric patients. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 10, 2016), CNKI, CBM, WanFang Data and CNKI were searched from inception to October 2016 to collect randomized controlled trials (RCTs) of landmark-guided versus ultrasound-guided IJV catheterization in pediatric patients who underwent elective surgery. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then RevMan 5.3 software was used to perform meta-analysis. ResultsA total of 13 RCTs involving 1 026 pediatric patients were included. The results of meta-analysis showed that, the overall success rate (RR=1.21, 95%CI 1.09 to 1.34, P=0.000 5) and arterial puncture rate (RR=0.19, 95%CI 0.07 to 0.50, P=0.000 7) of US-guided IJV catheterization were both significantly superior to the ALM group. Whereas there was no significant difference between two groups as for the incidence of hematoma formation (RR=0.35, 95%CI 0.09 to 1.31, P=0.12). ConclusionCurrent evidence shows that, for IJV catheterization of pediatric patients, both the effectiveness and safety of ultrasound-guided technique are better than the landmark-guided. Since the quantity and quality of included studies are limited, the conclusion of this study needs more high quality studies to verify.
ObjectiveTo systematically review the effectiveness and safety of anatomic landmarks positioning method (ALM) and real-time two-dimensional ultrasound (RTUS) guidance in the internal jugular vein cannulation. MethodsWe searched PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI for randomized controlled trials (RCTs) concerning the effectiveness and safety of ALM and RTUS in the internal jugular vein catheterization up to May 1st, 2014. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assess methodological quality of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 RCTs involving 1 973 cases were included in the metaanalysis. The results of meta-analysis showed that, compared with the ALM method, the RTUS method reduced puncture failure rate (OR=0.08, 95%CI 0.05 to 0.15, P<0.000 01). For safety, compared with the ALM method, the RTUS method was significantly lower in arterial injury rate (peto-OR=0.22, 95%CI 0.14 to 0.37, P<0.000 01), and the incidence of pneumothorax (peto-OR=0.13, 95%CI 0.04 to 0.40, P=0.000 3). ConclusionCompared to the ALM method, the RTUS method has characteristics such as causing fewer traumas, and having higher success rate and fewer complications. Due to limited quantity and quality of the included studies, the above conclusion still needs to be verified by conducting more studies.
ObjectiveTo observe the clinical efficacy of non-nutritional sucking and 10% glucose water plus non-nutritional sucking in relieving the venipuncture pain for premature infants. MethodA total of 167 premature infants between April and December 2014 were selected as our study subjects, and they were randomly divided into three groups:intervention group Ⅰ (n=53), intervention group Ⅱ (n=58), and the control group (without any intervention, n=56). Two minutes before venous indwelling needle puncture, blood oxygen saturation and heart rate of the infants were recorded during their quiet state. In the process of venipuncture, the intervention group Ⅰ was given non-nutritional sucking, intervention group Ⅱ was given 10% glucose water plus non-nutritional sucking, and the control group did not accept any intervention. Premature pain rating scale (PIPP) was used to compare the three groups of infants in terms of pain score, heart rate and blood oxygen saturation 1 minute and 5 minutes after intravenous indwelling needle puncture. SPSS 17.0 software was applied for statistical analysis. ResultsOf the 167 premature infants, one-time puncture was successful in 152 infants, with 46 in intervention group Ⅰ, 54 in intervention group Ⅱ, and 52 in control group. One minute after intravenous indwelling needle puncture, PIPP score of intervention group Ⅰ and Ⅱ was significantly lower than that of the control group (P<0.05). The PIPP score of intervention group Ⅱ was significantly lower than that of intervention group Ⅰ (P<0.05). One minute and 5 minutes after intravenous indwelling needle puncture, heart rate in the intervention groups was significantly lower than that in the control group (P<0.05), blood oxygen saturation in the intervention groups was signficantly higher than that in the control group (P<0.05), and they were significantly lower in intervention group Ⅱ than in intervention group Ⅰ (P<0.05). ConclusionsNon-nutritional sucking is effective in alleviating venipuncture pain for premature infants, especially when it is used together with 10% glucose water. The method is worthy of clinical promotion.
目的:探讨64层螺旋CT冠状动脉成像(64-slice CTA)检查中护理工作的重要性及获得最佳图像的影响因素。材料与方法:对462例行64-slice CTA检查的患者进行有效的护理措施和细致的前期准备工作。结果:462例检查者中96%的病例达到诊断标准。结论:经过细致准备和护理,可以提高图像质量和冠脉疾病的诊断率。