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RESUMEN Introducción. Actualmente la tasa de nacimientos a nivel mundial es de 18,8% y en el Perú es de 10%. Las principales causas de mortalidad neonatal son los partos pre termino, infecciones y defectos congénitos. La unidad de cuidados intensivos neonatales es el área que se encarga de la atención de los recién nacidos en estado crítico, siendo indispensable la obtención de una vía de acceso venoso central adecuada para su tratamiento. Objetivo. Describir la utilización del catéter percutáneo de inserción periférica en la Unidad de Cuidados Intensivos Neonatales del Instituto Nacional de Salud del Niño Breña, periodo junio 2017 - junio 2019. Métodos. Estudio descriptivo, observacional, retrospectivo, transversal. La muestra fue intencional conformada aproximadamente por 110 historias clínicas de recién nacidos que estuvieron hospitalizados en la unidad de cuidados intensivos neonatales. La técnica la observación y el instrumento la lista de chequeo. Resultados. El 51,8% fueron neonatos con patología quirúrgica. Asimismo, el 36,4% tuvieron una edad gestacional menor o igual de 32 semanas, la vena más usada fue la basílica con un 27,3%, el 37,3% de los catéteres fueron retirados por sospecha de sepsis y las puntas enviadas a cultivo. Conclusiones. El cuidado en el procedimiento y mantenimiento del catéter percutáneo fue el adecuado, presentándose un bajo número de complicaciones.
ABSTRACT Introduction. Currently the birth rate worldwide is 18.8% and in Peru it is 10%. The main causes of neonatal mortality are preterm births, infections and congenital defects. The neonatal intensive care unit is the area that is responsible for the care of newborns in critical condition, obtaining an adequate central venous access route for their treatment is essential. Objective. To describe the use of the percutaneous peripheral insertion catheter in the Neonatal Intensive Care Unit of the Instituto Nacional de Salud del Niño Breña, period June 2017 - June 2019. Methods. The study was descriptive, observational, retrospective, cross-sectional. The intentional sample was made up of approximately 110 medical records of newborns who were hospitalized in the neonatal intensive care unit. The technique the observation and the instrument the checklist. Results. 51.8% were neonates with surgical pathology. Likewise, 36.4% had a gestational age less than or equal to 32 weeks, the most used vein was the basilica with 27.3%, 37.3% of the catheters were removed due to suspected Sepsis and the tips were sent for culture. Conclusions. The care in the procedure and maintenance of the percutaneous catheter was adequate, presenting a low number of complications.
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BACKGROUND: Long-acting antimicrobial material Is a new polymer activator of organoslllcon quaternary ammonium salt and has obvious advantages In anti-Infection. OBJECTIVE: To investigate the effects of Jieyoushen, a long-acting antimicrobial material, on pathogenic distribution and serum inflammatory factors in patients with indwelling catheters. METHODS: A total of 200 male patients with indwelling catheter who received treatment during January 2014 to January 2018 in Hainan West Central Hospital, China were Included In this study. These patients were aged 35-55 years and were randomly divided Into two groups: A control group (n=100) and an observation group (n=100). Patients In the control group were given routine urethral orifice nursing. Patients in the observation group were sprayed with long-acting antimicrobial material “Jieyoushen” on the urethral orifice, catheter and catheter bag interface. Infection was detected at 1, 3, 5 and 7 days after catheterization. The changes of pathogenic bacteria and serum inflammatory factors in two groups were analyzed at 7 days after catheterization. This study was approved by the Medical Ethics Committee, Hainan West Central Hospital, China (approval No. 2013120602). RESULTS AND CONCLUSION: Compared with the control group, the Infection rates of the patients In the observation group decreased significantly at 1, 3, 5 and 7 days after catheterization (P < 0.05). Twenty pathogenic bacteria were Isolated In patients of the control group, Including 13 Gram-positive bacteria (65.0%) and 7 Gram-negative bacteria (35.0%). Seven pathogenic bacteria were Isolated In patients of the observation group, including 5 Gram-positive bacteria (71.4%) and 2 Gram-negative bacteria (28.6%). Compared with before indwelling catheter, serum levels of interleukin-1ß, interleukln-2, homocysteine, and procalcltonin Increased significantly in each group after catheterization (P < 0.05). After catheterization, serum levels of above-mentioned factors in the control group were significantly higher than those In the observation group (P < 0.05). These results suggest that long-acting antimicrobial material “Jieyoushen” can effectively reduce the Infection rate of pathogenic bacteria and lower serum levels of Inflammatory factors In patients with Indwelling catheter.
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Objective: To evaluate the risk factors for postoperative indwelling catheter following enhanced recovery after primary unilateral total knee arthroplasty (TKA) under general anesthesia. Methods: Patients who underwent primary unilateral TKA under general anesthesia between January 2017 and August 2018 were enrolled in the study. Among them, 205 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, body mass index, preoperative range of motion, Hospital for Special Surgery (HSS) score, American Society of Anesthesiologists (ASA) score, disease type, comorbidity, hemoglobin, hematocrit, blood volume, length of operation and operation time, whether to keep drainage after surgery, intraoperative blood loss, total blood loss, and preoperative, intraoperative, postoperative fluid infusions, and total fluid infusion on the day of surgery, urine volume on the day of surgery. Univariate analysis and logistic regression analysis were used to screen the risk factors for postoperative indwelling catheter. Length of stay and incidences of complications (intermuscular vein thrombosis, deep vein thrombosis, pulmonary embolism, incision swelling and exudation, electrolyte disorder, nausea and vomiting, and urinary tract infection) were compared between the patients with or without indwelling catheter. Results: Indwelling catheter occurred in 41 (20%) of 205 patients. Single factor analysis showed that the influence factors were age, gender, keeping drainage after surgery, total fluid infusion and urine volume on the day of surgery ( P<0.05). The multiple factors analysis showed that the males and more urine volume on the day of surgery were the significant risk factors for indwelling catheter after primary TKA ( P<0.05). In addition, postoperative length of stay was shorter and the incidence of urinary tract infection was lower in non-indwelling catheter group than in indwelling catheter group, showing significant differences ( P<0.05). Conclusion: The male patients with more urine on the day of surgery have higher risk for indwelling catheter after primary unilateral TKA under general anesthesia with an enhanced recovery program.
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Objective@#To identify the anatomical positional relation of the internal jugular vein and the common carotid artery, and investigate the predictive factors associated with the stenosis rate of the internal jugular vein after catheterization in hemodialysis patients.@*Methods@#A single-center cross-sectional survey study of 235 patients from the Department of Nephrology, Guangdong Provincial People's Hospital between August 2017 and June 2018 was performed. According to whether received hemodialysis treatment, The patients were divided into dialysis group (n=187) and control group (chronic kidney disease non-dialysis patients, n=48). Clinical data such as age, primary disease, history of deep vein catheterization, catheter indwelling time and dialysis age were collected. The positional relationship between the internal jugular vein and the common carotid artery was examined by Doppler ultrasound. Measure the cross-sectional area of the internal jugular vein in different neck anatomical planes and analyse of the incidence of internal jugular vein stenosis in the dialysis group. Chi-square test was used to compare the differences in the incidence of internal jugular vein stenosis between subgroups of different ages, with or without catheter retention, catheter indwelling time, dialysis age and presence or absence of diabetic nephropathy.@*Results@#Doppler ultrasonography showed that in the 235 patients, there were four types of anatomical relationship between the internal jugular vein and the common carotid artery in the plane of the flat thyroid cartilage and the apex plane of the upper clavicle. The internal jugular vein was located on the lateral, anterolateral, anterior and medial sides of the common carotid artery, accounting for 16.23%, 36.52%, 41.11% and 3.14% respectively. There were significant differences in the anatomical relationship between the internal jugular vein and the common carotid artery between the left and right sides, different anatomical planes and patients of different ages (P<0.05). The rate of internal jugular vein stenosis in 187 hemodialysis patients was 47.1%. The right internal jugular vein stenosis rate was 66.4% and 44.1% in the age<65 years old group (n=128) and age≥65 years old group (n=59), respectively (P=0.004). The rate of internal jugular vein stenosis was 49.0% and 32.8% (P=0.018) in the catheter placement group (n=151) and the catheterless retention group (n=36), respectively. Two variables including age and history of catheterization were included in the logistic regression equation. The results showed that the history of catheterization was a risk factor for internal jugular vein stenosis (OR=1.668, 95% CI 1.083-2.568, P=0.020).@*Conclusions@#There is variability in the anatomical relationship between the internal jugular vein and the common carotid artery. Internal jugular vein stenosis is a common complication after indwelling catheters in hemodialysis patients. The history of internal jugular vein catheterization is a risk factor affecting internal jugular vein stenosis.
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Objective@#To explore the effect of DMAIC(Define, Measure, Analyze, Improve, Control) in reducing catheter-related urinary tract infection.@*Methods@#A retrospective case control method was used to select 578 patients admitted and treated in comprehensive ICU of Tianjin First Central Hospital from January to December 2018 with catheters as research objects.The 283 patients from January to June 2018 were the control group, and 295 patients from July to December 2018 were the observation group.Routine methods were used in the control group, and DMAIC method with 6 sigma management was used in the observation group. The correct rate of implementation of each measure, the utilization rate of urinary catheter and the infection rate between the two groups were compared.@*Results@#Implementation rate of early extubation assessment, urine collection accuracy, urine tube fixed correctly, urine tube cleaning time, urine collection bags location accuracy were 60.42%(171/283), 69.61%(197/283), 79.86%(226/283), 89.40%(253/283), 92.58%(262/283)in the control group, 80.34%(237/295), 90.85%(268/295), 94.92%(280/295), 96.27%(284/295), 97.97%(289/295) in the observation group, the differences were statistically significant (χ2= 9.411-41.415, P < 0.01). The rate of urinary catheter usage was 75.31%(3 856/5 120) in the observation group and 82.60%(4 098/4 961) in the control group, the differences was statistically significant (χ2=80.475, P < 0.01). The rate of catheter associated urinary tract infection was 0.26‰ (1/3 856) in the observation group and 1.95 ‰ (8/4 098) in the control group, the differences was statistically significant (χ2=5.832, P< 0.05).@*Conclusions@#DMAIC can improve the accuracy of nursing measures, optimize the catheter care process, and reduce catheter-related urinary tract infections.
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Objective To identify the anatomical positional relation of the internal jugular vein and the common carotid artery, and investigate the predictive factors associated with the stenosis rate of the internal jugular vein after catheterization in hemodialysis patients. Methods A single-center cross-sectional survey study of 235 patients from the Department of Nephrology, Guangdong Provincial People's Hospital between August 2017 and June 2018 was performed. According to whether received hemodialysis treatment, The patients were divided into dialysis group (n=187) and control group (chronic kidney disease non-dialysis patients, n=48). Clinical data such as age, primary disease, history of deep vein catheterization, catheter indwelling time and dialysis age were collected. The positional relationship between the internal jugular vein and the common carotid artery was examined by Doppler ultrasound. Measure the cross-sectional area of the internal jugular vein in different neck anatomical planes and analyse of the incidence of internal jugular vein stenosis in the dialysis group. Chi-square test was used to compare the differences in the incidence of internal jugular vein stenosis between subgroups of different ages, with or without catheter retention, catheter indwelling time, dialysis age and presence or absence of diabetic nephropathy. Results Doppler ultrasonography showed that in the 235 patients, there were four types of anatomical relationship between the internal jugular vein and the common carotid artery in the plane of the flat thyroid cartilage and the apex plane of the upper clavicle. The internal jugular vein was located on the lateral, anterolateral, anterior and medial sides of the common carotid artery, accounting for 16.23％, 36.52％, 41.11％ and 3.14％respectively. There were significant differences in the anatomical relationship between the internal jugular vein and the common carotid artery between the left and right sides, different anatomical planes and patients of different ages (P﹤0.05). The rate of internal jugular vein stenosis in 187 hemodialysis patients was 47.1％. The right internal jugular vein stenosis rate was 66.4％and 44.1％in the age﹤65 years old group (n=128) and age≥65 years old group (n=59), respectively (P=0.004). The rate of internal jugular vein stenosis was 49.0％and 32.8％(P=0.018) in the catheter placement group (n=151) and the catheterless retention group (n=36), respectively. Two variables including age and history of catheterization were included in the logistic regression equation. The results showed that the history of catheterization was a risk factor for internal jugular vein stenosis (OR=1.668, 95％ CI 1.083-2.568, P=0.020). Conclusions There is variability in the anatomical relationship between the internal jugular vein and the common carotid artery. Internal jugular vein stenosis is a common complication after indwelling catheters in hemodialysis patients. The history of internal jugular vein catheterization is a risk factor affecting internal jugular vein stenosis.
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Objective:To compare the efficacy and complication in clinical application about the indwelling central venous transfusion port and peripheral venipuncture central vein indwelling catheter.Methods: 80 cases with indwelling central vein transfusion port were arranged to observation group and 80 cases with peripheral venipuncture central vein indwelling catheter were arranged to control group. All of patients were detected for blood routine, blood coagulation time and chest X-ray fluoroscopy routine examination before operation. And to take venipuncture by right subclavicle of patient skin under X-ray fluoroscopy guided, and then indwell catheter. To compare the clinical effect for the two kinds of indwelling catheter method.Results:In observation group, the successful rate was 97.5% (78/80), the average operation time was (51.23±10.21) min; while in control, the successful rate was 78.8% (63/80), the average operation time was (67.42±11.03)min, there were statistical significant difference in successful rate (x2=13.44,P<0.05) and average operation time (t=9.63,P<0.05) between observation and control group. In observation group, the rate of complications occurred was 13.75% (11/80), which was significant lower than 32.5% of control (26/80)(x2=7.91,P<0.05).Conclusion: It is safe and reliable to use the dwelling central venous transfusion port, and the complication of some patients mainly related with nursing skill of paramedic and the proficiency degree of pillbox puncture and using skill in this operation.
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Objective To evaluate the clinical effectiveness of venipuncture using the fluorescent intravenous indwelling catheter in dark environment in dog experiments. Methods Six dogs were randomly divided into three groups of two dogs each, and each dog was subjected to 40 times of venipuncture performed on a foreleg with normal intravenous indwelling catheter and fluorescent intravenous indwelling catheter, respectively, under high(101 -105 lux), moderate (10.2-100 lux)or low(5 -10 lux)brightness conditions. The success rates and time consumption of those two procedures were analyzed and compared statistically. Results The success rate and time consumption for venipuncture using fluorescent and normal intravenous indwelling catheter under low brightness were 82.5% and(204.36 ± 13.13)s vs. 40.0% and(249.35 ± 17.98)s, those performed under moderate(simulating morning and dawn)brightness were 90.0% and(194.86 ± 8.60)s vs. 67.5% and(206.37 ± 9.70)s, all showed a significantly higher efficiency of the venipuncture using fluorescent intravenous indwelling catheter(P < 0.05). Conclusions The use of fluorescent intravenous indwelling catheter has the advantages of higher success rate and shorter time consumption for venipuncture under low and moderate brightness conditions.
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Objective To compare the effects of two kinds of lidocaine gel indwelling catheter on male patients with general anesthesia during recovery period. Methods A total of 90 cases of male patients with general anesthesia were selected and divided into experimental group and control group by random digits table method,45 cases in each group. The experimental group was given lidocaine gel injection indwelling catheter urethral surface anesthesia, the control group will lidocaine gel evenly to the catheter indwelling catheter. The incidence of catheter related bladder irritation and restlessness were observed during the recovery period of general anesthesia. Results The incidence of catheter related bladder irritation in grade 0, I, II, III during the recovery period of general anesthesia were 28, 14, 3, 0 cases in the experimental group and 7, 23, 12, 3 cases in the control group, there was significant difference between 2 groups (Z=1500, P<0.01). The incidence of restlessness in grade 0, I, II and III during the recovery period of general anesthesia were 27, 18, 0 and 0 cases, respectively in the experimental group and 7, 20, 9, and 9 cases in the control group, respectively. The difference between the 2 groups was statistically significant (Z=1435.5, P<0.01). Conclusions Lidocaine gel injection into the urethra surface anesthesia can effectively improve the comfort of male patients during the recovery period of general anesthesia.
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Objective:To explore the application value of central venous indwelling catheter guided by ultrasound in temporary hemodialysis patients.Methods:Seven hundred and eight cases of hemodialysis patients were choosed as the respondents who were divided into control group(n=386) and ultrasound group(n=322), sex ratio, average age, disease distribution, platelet count(Plt), prothrombin time(PT), systolic blood pressure (SBP), neck circumference was no statistical difference in two groups. In control group, indwelling catheter of the right internal jugular vein were implemented in the triangle area formed by sternocleidomastoid clavicular head, sternum, clavicle by using surface anatomic mapping. In ultrasound group, position, the diameter and blood flow filling situation of the right internal jugular vein by using ultrasound scan, the veins were punctured and indwelled catheter under the guided by ultrasound. The success rates and times of indwelling catheter, as well as complications were compared between two groups.Results: One-time success rate of indwelling catheter guided by ultrasound group was obviously higher than that of control group, the rates were statistically significant difference (x2=118.82,P<0.01), and the indwelling time was significantly shorter than that of control group, The difference was statistically significant (t=7.03,P<0.01). The puncture comfort score of ultrasound group was significantly higher than that of control group, The difference was statistically significant (t=6.29,P<0.01). The complication rate of ultrasound group was lower than that of control group, the difference was statistically significant (x2=28.24,P<0.01).Conclusion: Ultrasound help to understand the position, diameter and blood flow filling situation of the right internal jugular vein, improve the success rate of indwelling catheter and reduce the occurrence of complications.
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Objective To investigate the application effect of quality control management in the prevention of indwelling catheter associated urinary tract infection in intensive care unit (ICU) patients. Methods Cases of patients stayed in the department of ICU undergoing indwelling catheter over 10 d were selected by using time stage sampling method. Totally 136 cases of patients were selected from January 1, 2012 to December 31, 2012, as the control group. A total of 145 cases of patients were selected from January 1, 2013 to December 31, 2013, as the performance group. Cases in performance group were taken standardized training and quantify the performance appraisal on the basis of measures in the control group. The urine routine was tested and bacterial was cultured at indwelling catheter 3 d, 7 d and 10 d, respectively. The indwelling catheter associated urinary tract infections of the two groups were compared. Results After the implementation of the performance appraisal management, the incidences of indwelling catheter associated urinary tract infection at 3 d, 7 d and 10 d were 4.8%(7/145), 19.3% (28/145) and 32.4% (47/145), respectively. Within each quarter, the incidence of indwelling catheter associated urinary tract infection was rising with indwelling catheter time prolonged. And the incidences of the first and second quarter were higher than three and four quarter. The incidences of indwelling catheter associated urinary tract infections at 3 d, 7 d and 10 d in the performance group were lower than the control group, the differences were statistically significant (χ2=4.494, 30.660 and 49.307, P < 0.05). Conclusions Standardized training of nursing staff in ICU and implementation of performance appraisal management could effectively improve the enthusiasm and sense of responsibility of the nurses, and effectively reduce the incidence of indwelling catheter associated urinary tract infection.
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Objective To observe the impact of three different concentration heparin tube -sealing solution on the jugular vein integrated catheter in hemodialysis(HD)patients.Methods 96 HD patients were selected and divided into three groups according to different treatments.Each group had 32 cases.Patients in A,B and C group received heparin sodium 30mg,40mg,60mg respectively.The degree of symptoms improvement and the complications in the three groups were evaluated.Results For bleeding,catheter position adverse,arrhythmia,air embolism, A group had 10 cases,11 cases,8 cases,5 cases;B group had 9 cases,8 cases,9 cases,4 cases;C group had 2 cases, 1 case,1 case,0 case.Compared with B group and A group,C group had lower complication,the difference was statis-tically significant(χ2 =6.667,10.42,4.706 and 5.450,4.706,7.680,all P 0.05);For the infection and throm-bosis,A group had 10 cases,8 cases;B group had 9 cases,8 cases;C group had 1 case,1 case.Compared with B group and A group,C group had lower complication,the difference was statistically significant (χ2 =7.680,4.706,all P 0.05 ). Conclusion Treatment with 60mg heparin saline solution for HD patients will help to improve symptoms in patients, and decrease complications,thus it is worth for further promotion in clinical practice.
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In the light of nurses' questions regarding the handling of the totally-implanted venous access device, this study aimed to evaluate these professionals' knowledge. This is a descriptive study with a qualitative approach, whose sample was made up of 28 nurses working on the Internal Medicine ward and in the Emergency Room. The study was undertaken in two stages: interviewing, to evaluate knowledge regarding the handling of the implanted port; and an integrative review to clarify the doubts identified. The results indicated that the nurses' knowledge was inadequate regarding when to use the implanted port, its purpose, the puncture technique, maintenance and handling. It is concluded that the knowledge of the subjects evaluated is inadequate, and that it is necessary for these professionals' clinical skills to be standardized and for them to receive theoretical-practical training.
Frente a consultas de enfermería sobre el manejo del catéter en pleno funcionamiento, se evaluaron los conocimientos de estos profesionales. Se trata de un estudio descriptivo con un enfoque cualitativo, cuya muestra estuvo conformada por 32 enfermeras que trabajan en la sala de Medicina Interna y el Centro de Atención de Emergencias. El estudio se realizó en dos etapas: entrevista para evaluar su conocimiento sobre el manejo del catéter totalmente implantado; e revisión integrativa para aclarar las dudas identificadas. Los resultados mostraron un déficit de conocimiento de las enfermeras sobre la indicación y el propósito de la sonda, técnica de punción, mantenimiento y manejo. Llegamos a la conclusión de que el conocimiento de los sujetos evaluados es deficitario, lo que requiere la estandarización de conductas y formación teórico-práctico de estos profesionales.
Frente aos questionamentos de enfermeiros acerca do manuseio do cateter totalmente implantado, teve-se como objetivo avaliar o conhecimento destes profissionais. Trata-se de estudo descritivo com abordagem qualitativa, cuja amostra foi composta por 28 enfermeiros atuantes na enfermaria de clínica médica e no Centro de Pronto Atendimento. O estudo foi desenvolvido em duas etapas: entrevista para avaliação do conhecimento sobre o manuseio do cateter totalmente implantado; e revisão integrativa para esclarecer as dúvidas identificadas. Os resultados apontaram déficit de conhecimento dos enfermeiros sobre indicação e finalidade do cateter, técnica de punção, manutenção e manuseio. Conclui-se que o conhecimento dos sujeitos avaliados é deficitário, havendo necessidade de padronização das condutas e capacitação teórico-prática destes profissionais. .
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Humans , Oncology Nursing , Catheterization, Central Venous , Catheters, Indwelling , Catheters , Nursing CareABSTRACT
Objective To explore effect of two methods for treating extravasation of venous indwelling needles.Methods A total of 96 patients with extravasation at transfusion were randomly divided into experiment and control groups with 48 cases in each group. Magnesium sulfate wet packing was used in the control group and external application of potato chips in the experiment group.The two groups were compared in terms of time for curative effect to occur and time for recovery.Result The time for curative effect to occur and time for recovery in the experiment group were both significantly shorter than those of the control group.Conclusion External application of potato chips is effective in reducing extravasation during venous transfusion.It is simple and free from side effects.
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BACKGROUND:Catheter-related infection (CRI) of the central vein is a common cause of nosocomial infection. This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit (EICU) in order to provide the beneficial reference.METHODS:From January 2008 to December 2010, a total of 1363 patients were subjected to catheterization. In these patients, the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1363 patients using the central venous catheter. The peak rate of CRI was 10.79％, with an incidence of 3.05 episodes per 1000 catheter days. Of the 147 patients, 46.94％ had gram-negative bacilli, 40.14％ had gram-positive cocci, and 12.92％ had fungi. Unconditional logistic regression analysis suggests that multiple catheterization, femoral vein catheterization, the application of multicavity catheter, and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.
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Objective To investigate the characteristics of pathogens and risk factors of the catheterassociated infection (CAI) in emergency ICU (EICU) in order to design an appropriately therapeutic strategy for the future.Methods From January 2008 to December 2010,a total of 1363 patients were enrolled for this retrospective study.Blood sample taken from the vein with indwelling catheterization and the tips of catheters cut in 5 cm after withdrawn from the veins in 1363 patients were collected for bacterial culture.Results Of 1363 catheters,pathogens were found in 147 (10.79％) after venous catheterization.The daily occurrences of CAI were 3.05 ones per 1000 catheters.Of 147 cases of infection,46.94％ pathogens were gram-negative bacilli,40.14％ gram-positive cocci,and 12.92％ fungi.Unconditional Logistic regression analysis suggested that repeated catheterization,femoral vein catheterization,the application of multi-lumen catheter and long-term indwelling catheterization were the independent risk factors responsible for CAI.Conclusions The risk factors responsible for catheter related infections should be controlled to prevent the occurrence of nosocomial infection.
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Intrathecal drug administration system (ITDAS) can reduce the side effects while increasing the effectiveness of opioids compared to systemic opioid administration. Therefore, the use of ITDAS has increased in the management of cancer pain and chronic intractable pain. Catheter obstruction is a serious complication of ITDAS. Here, we present a case of catheter obstruction by a mass formed at the side hole and in the lumen. A 37-year-old man suffering from failed back surgery syndrome received an ITDAS implantation, and the ITDAS was refilled with morphine every 3 months. When the patient visited the hospital 18 months after ITDAS implantation for a refill, the amount of delivered morphine sulfate was much less than expected. Movement of the pump rotor was examined with fluoroscopy; however, it was normal. CSF aspiration through the catheter access port was impossible. When the intrathecal catheter was removed, we observed that the side hole and lumen of the catheter was plugged.
Subject(s)
Adult , Humans , Analgesics, Opioid , Catheter Obstruction , Catheters , Catheters, Indwelling , Failed Back Surgery Syndrome , Infusion Pumps, Implantable , Injections, Spinal , Morphine , Pain, Intractable , Stress, PsychologicalABSTRACT
ObjectiveTo explore the factors related to infections of intravenous catheter as well as preventive measures.MethodsIn 598 cases of patients with central venous catheterization,indwelling time,location,bacteriology were monitored among 130 patients with suspected venous catheter infection.ResultsIndwelling catheter lasts for 3 days at least,70 days at most.For 77 out of toual cases,microbiology culture of catheter tip and blood culture were positive,accounting for 12.88％.Detected pathogens were 151 in total.Gram-negative bacteria were 48(31.79％),gram-positive bacteria were 78(50.65％),fungal were 25 (16.56％).Among these,the most common pathogens were Staphylococcus epidermidis,Staphylococcus aureus,Candida and Acinetobacter,most of the bacteria had a high degree of drug resistance.The choice of position:infection rate of subclavian vein and basilic vein was lower than that of the superclavian vein and internal jugular vein,infection rate of catheterization time ≤ 13d was lower than that of ≥ 14d.ConclusionsThe choice of subclavian vein and basilic vein,standardization of puncture technical,strict catheter care,shortening of catheterization time and improvement of the general condition of patients can reduce catheter-reiated infections.The rational use of antibiotics is a critical measure to reduce vascular catheter infections of patients.
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A utilização de um cateter venoso central (CVC) torna-se necessária para manter um acesso venoso prolongado, sendo amplamente utilizado nos transplantes de medula óssea. A implantação de um CVC torna-se necessária para manter umacesso venoso seguro, por período prolongado, para que se receba periodicamente manuseios para aspiração sanguínea e administração de medicamentos e hemocomponentes. Contudo, a utilização das diferentes coberturas para o curativo do sítio de inserção do cateter é controversa quanto ao custo e à prevenção de infecção. Objetivou-se, com este estudo, analisar a utilização e o custo de diferentes tipos de coberturas de CVC em relação à periodicidade de sua troca e, também, a frequência de infecções relacionadas ao dispositivo em um serviço de transplante de medula óssea. Foi realizada uma pesquisa retrospectiva com caráter exploratório e descritivo, mediante coleta de dados de prontuários de 68 pacientes. Foi possível observar que o período de permanência do filme transparente como cobertura variou de quatro a sete dias, enquanto para o de gaze estéril foi de uma dois dias. A utilização da gaze estéril para cobertura apresentou custo mais elevado em comparação como uso de filme, dada a necessidade de trocas repetidas durante a semana. Não foi encontrada diferença estatística entre as diferentes coberturas utilizadas e a ocorrência de infecção. Conclui-se que há necessidade de constante avaliação do processo do cuidado em enfermagem, associada à assistência, à pesquisa e à gerência, uma vez que estudos sobre o impacto de procedimentos padronizados podem levar ao aprimoramento do serviço da enfermagem e da instituição.
A central venous catheter is indispensable to maintain a prolonged venous access, and is widely used in bone marrow transplants. The implementation of a central venous catheter (CVC) is necessary to keep a safer venous access for long periods of time. It is necessary as well to maintain blood aspiration, administration of medication and blood products. However, the choosing of different dressing covers for the catheter insertion site is controversial given the difference in its costandabilityt o prevent infections. This study aimed to analyze the use and cost of different types of Central Venous Catheter covers, how often it is changed, and the appearance of infections related to that device in a Bone Marrow Transplantation Unit. A retrospective research with an exploratory and descriptive approach was carried out. Data was collected from 68 patientsmedical records. It was observed that a transparent film dressing lasted from 4 to 7 days, whilst sterile gauze pads were inplace from24 hours to 48 hours. The use of sterile gauze pads had a higher cost when compared to transparent film as the former needed to be changed more frequently during the week. There was no connection between the use of the different dressing covers and the appearance of infection. In conclusion a constant evaluation of the nursing care procedure is needed, along with an appropriate care, research and sensible management. Further studies on the importance of standardized procedures could lead to the improvement of the nursing care service and of the hospital in general.
Para mantener un acceso venoso prolongado y seguro se necesita el Catéter Venoso Central (CVC), ampliamente utilizado en los trasplantes de médula ósea, debiendo ser manipulado periódicamente para aspirar la sangre e inyectar medicamentos y hemocomponentes. No obstante, la utilización de las diferentes coberturas para el sitio de inserción del catéter es discutible, tomando en cuenta los costos y la prevención de infecciones. El presente estudio tuvo como objetivo analizar la situación yel costo de diferentes tipos de coberturas del Catéter Venoso Central en relación a los reemplazos rutinarios y a la frecuenciade casos de infección vinculados al dispositivo en un Servicio deTrasplante de Médula Ósea. Fue realizada una investigación retrospectiva con carácter descriptivo exploratorio y recogida de datos de historias clínicas de 68 pacientes. Fue posible observar que el período de permanencia del apósito transparente como cobertura varió de 4 a 7 días, mientras que para gasa IV fue de 1 a 2 días. El uso de gasa estéril para cobertura presentó un costo mas elevado en comparación conel uso de los apósitos transparentes, debido a la necesidad de efectuar cambios repetidos durante la semana. No se encontró ninguna diferencia estadística entre las dos coberturas utilizadas ni tampoco que haya habido infección. En conclusión, es necesaria la evaluación constante en el proceso de cuidados en enfermería asociada a la atención, investigación y gerencia, una vez que estudios sobre el impacto de procedimientos estandarizados pueden llevar a la excelencia del servicio de enfermería y de la institución.
Subject(s)
Humans , Male , Female , Catheterization, Central Venous/economics , Catheterization, Central Venous/nursing , Nursing Care , Catheter-Related Infections/nursing , Catheter-Related Infections/prevention & controlABSTRACT
Objective To investigate the effect of nursing intervention on preventing leakage of urine in patients with indwelling catheter in neurology department.Methods A total of 76 patients with indwelling catheter in neurology department were randomly assigned into the observation group and the control group with 38 cases in each group.The control group received routine care,the observation group received systemic nursing intervention on the basis of routine care.The incidence of leakage of urine and patients satisfaction degree with nursing service was observed between two groups.Results The incidence of leakage of urine in the control group was 21.1％,higher than 2.6％ of the observation group.he score of satisfaction degree of the observation group was (4.66±0.62),higher than(3.26±0.42) of the control group.Conclusions Nursing intervention can effectively reduce the incidence of leakage of urine and improve the satisfaction degree of patients with indwelling catheter in neurology department,it is worthy of clinical application.