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Objective@#To establish an evidence-based nursing bundle to prevent pressure injury related with operation and observe the clinical application of the bundle.@*Methods@#Clinical practice guidelines, systematic reviews/Meta-analysis, and randomized controlled trials (RCT) about prevention of pressure injuries related operation were acquired by searching databases, websites, manual retrieval and retrospective review. Two researchers independently screened and evaluated the literature, and experts′ advice were combined to form the prevention bundle of pressure injury related operation. A convenient sampling method was used to select 70 patients who underwent surgery in the Third Affiliated Hospital of Sun Yat-sen University. The pre-test for the clinical application of preventing the bundle was carried out to observe the incidence of pressure injury in patients and the implementation rate of each measure.@*Results@#This study included 22 RCTs, 6 systematic reviews/Meta analysis, and 6 clinical practice guidelines. The bundle for preventing pressure injury related operation included: preoperative pressure injury risk assessment, use of decompression flat car transporter, using a pressure reducing device to relieve local pressure, protection of dressing, placing the body position reasonably, adjusting intraoperative position, maintaining normal body temperature and skin cleansing. The frequency of implementation of the four measures of "use of decompression flat car transporter" , "protection of dressing" , "adjusting intraoperative position" , and "maintaining intraoperative skin cleansing" were 0, 17.1% (12/70) , 87.1% (61/70) , 5.7% (4/70) , respectively. The remaining measures were executed at a frequency of 100%. No pressure injury occurred from the beginning of operation to 6 days after operation among 70 patients.@*Conclusions@#The prevention bundle of pressure injury related operation can effectively prevent the occurrence of pressure injury related operation. Each of the measures included in the bundle is evidence-based and the interrelations of the various care measures are more focused, comprehensive, and systematic than the clinical practice guidelines.
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Objective To discuss the clinical effect of perioperative bundle of care for patients with advanced hepatocellular carcinoma (HCC) who are receiving CT-guided percutaneous minimally-invasive argon-helium knife cryoablation.Methods A total of 30 HCC patients,who underwent percutaneous argonhelium knife cryoablation,were enrolled in this study.Perioperative measures based on the concept of bundle of care were implemented,which included training of nursing team members,perfect preoperative psychological nursing,dietary guidance,preoperative routine preparations,effective intraoperative guidance and close observation of the patient's condition,postoperative activity guidance,prevention and observation of complications,etc.Results All 30 advanced HCC patients could actively cooperate with physicians for the performance of percutaneous argon helium cryoablation.After the treatment,two patients developed nausea and vomiting and one patient developed chills and fever,which were improved after symptomatic treatment.All the 30 patients recovered well during the perioperative period and were discharged from hospital smoothly.Conclusion Perioperative bundle of care can help patients restore the surgical damage as soon as possible,reduce the pain and improve the quality of life.
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objective To explore the effect of application of cluster-based strategies on preventing the complication of fibrosclerosis of patients with systemic scleroderma.Methods A total of 59 patients with systemic scleroderma were randomly assigned to the experimental group (34 cases) and the control group (25 cases) during the period of hospitalization in our department.The experimental group took the cluster-based strategies after admission,including a gymnastics,two kinds of respiratory breathing,three kinds of habits,four kinds of protection to prevent the complication of fibrosclerosis.The control group received the conventional care procedures of dermatology.The skin stiffness,joint function,Raynaud's phenomenon and swallowing function were evaluated when patients were admitted and before discharge in two groups.The length of stay between the two groups was also compared.Results The skin stiffness,joint function,Raynaud's phenomenon and swallowing function scored (14.74±1.33),(7.06±0.69),(0.88±0.33),(0.54±0.21) in the experimental group,significantly better than those of the control group,(24.08±1.12),(13.48±0.77),(1.24±0.60),(0.96±0.34),P ＜ 0.01.The length of stay in the experimental group and the control group was (23.65±5.45),(32.00±6.56) days,t=-5.340,P ＜ 0.01.Conclusions Application of cluster-based strategies can be effective against the fibrosclerosis damage of patients with systemic scleroderma and reduce the occurrence of complications.
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Objective To study the effects of bundles of care on complications and unplanned extubation rate of neonatal in PICC .Methods 116 cases of neonatal which didn′t accept the bundles of care ware group A ,the other 93 cases of neonatal which accepted the bundles of care ware group B .Two groups were observed and compared on the incidence of complications and un-planned extubation rate and so on .Results The complications in A group treatment were 70 cases(60 .3% ) ,while there were 25 ca-ses in group B(26 .9% ) ,the group B was significantly lower than the group A (P0.05),birthweightand catheter days had more impact on neonatal complications (P<0 .05) .Conclusion The cluster management can reduce the incidence of neonatal PICC complications ,reduce unplanned extubation rates ,better play the role of PICC ,try to arrange an experienced staff of medical operations for children of low birth weight newborns .
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Objective To evaluate the effect of the bundle of care interventions in preventing ventilator-associated pneumonia (VAP) in the mechanic ventilated patients.Methods The randomized controlled trials (RCT) on the bundle of care interventions in preventing ventilator-associated pneumonia (VAP) were collected using the databases of PubMed,Medline,Embase,Cochrane library,China National Knowledge Infrastructure (CNKI),Wanfang Periodical Databases and Chinese Science and Technology Periodical Databases (VIP),data were analyzed by RevMan5.0 software.Results Ten RCTs were included in the study.The results of Meta-analysis revealed that the incidence of ventilator associated pneumonia,mechanical ventilation time,ICU length of hospital stay and the mortality rate in the intervention group were different from the control group,the difference had statistical significance.Conclusions The bundle of care interventions can reduce the incidence of ventilator-associated pneumonia,mechanical ventilation time,ICU length of hospital stay and the mortality rate.