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@#Objective 聽 聽 To explore the application value of failure mode and effect analysis (FMEA) in the risk management of unplanned extubation after esophageal cancer surgery. Methods 聽 聽 A total of 1 140 patients who underwent esophageal cancer surgery in our department from January 2015 to May 2017 were selected as a control group, including 948 males and 192 females with an average age of 64.45卤4.53 years. FMEA was used to analyze the risk management process of unplanned extubation. The potential risk factors in each process were found by calculating the risk priority number (RPN) value, and the improvement plan was formulated for the key process with RPN>125 points. Then 1 117 patients who underwent esophageal cancer surgery from June 2017 to December 2019 were selected as a trial group, including 972 males and 145 females with an average age of 64.60卤5.22 years, and the FMEA risk management mode was applied. Results 聽 聽 The corrective measures were taken to optimize the high-risk process, and the RPN values of 9 high-risk processes were reduced to below 125 points after using FMEA risk management mode. The rate of unplanned extubation in the trial group was lower than that in the control group (P<0.05). Conclusion 聽 聽 The application of FMEA in the risk management of unplanned extubation after esophageal cancer surgery can reduce the rate of unplanned extubation, improve the quality of nursing, and ensure the safety of patients.
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Objective:To promote the evidence application of the "Expert Consensus on Nursing Care for Prevention of Adult Oral Tracheal Intubation Unplanned Extubation" and verify its effectiveness.Methods:This was a quasi-experimental study. A total of 31 ICU nurses from Tianjin Teda Hospital were trained by workshops, in order to help promote the evidence transformation. With the evidence application model of the JBI Evidence-Based Health Care Center, we reviewed the measures for mechanically ventilated patients before and after intervention (51 cases at baseline and 77 cases at second review).Results:No unplanned extubation occurred during the period of two rounds of evidence review, the implementation rate of 9 review indicators had improved, and 6 of them showed statistically significant differences. indicator 1 increased from 3.92% (2/51) to 100.00% (77/77),indicator 3 increased from 86.27% (44/51) to 100.00% (77/77), indicator 5 increased from 27.45% (14/51) to 100.00% (77/77), indicator 7 increased from 45.10% (23/51) to 70.13% (54/ 77), indicator 8 increased from 50.98% (26/51) to 100.00% (77/77), indicator 9 increased from 45.10% (23/51) to 77.92 % (60/77), the difference was all statistically significant ( χ2 values were 8.02-119.87, all P<0.05). Conclusions:The "Expert Consensus on Nursing Care for Prevention of Adult Oral Tracheal Intubation Unplanned Extubation" can provide guidelines for clinical nursing practice. While preventing unplanned extubation, it can standardize nurses' behavior and promote medical-nursing cooperation.
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With the development of medical technology, the fixation method of the oral duct is constantly updated, and the selection of a relatively safe, effective, simple and fast fixation method of the oral duct has been widely concerned. However, the use of traditional 3M I-shaped tape fixation needs to be cut, which wastes time and easily leads to the outward displacement of the tracheal tube, and is easy to be soaked by oral secretions, resulting in facial skin damage. Therefore, the medical staffs of the department of critical care medicine of Hengshui People's Hospital designed a self-made tracheal catheter fixing band (composed of the main structure, the fixed band, the internal adjusting structure and the internal structure of the fixed block), and obtained the national utility model patent (ZL 2018 2 0508681.6). The inner side of the fixing band is fixed with a spongy body, which can absorb the secretions around the mouth to avoid the moist condition around the mouth and cheek skin. Meanwhile, the endotracheal catheter is fixed with the help of the card slot, hinge and other structures, which can fully ensure the fixation effect. A total of 80 patients undergoing airway intubation were admitted to the department of critical care medicine of our hospital from October 2020 to September 2021. They were divided into observation group and control group according to intubation time (single number and double number), with 40 patients in each group. The observation group was fixed with self-made tracheal catheter fixation band. Through evidence-based practice path, relevant literatures at home and abroad were searched for clinical practice basis, and the practice plan was formulated and implemented. The control group was fixed with 3M tape + inch tape according to the traditional method. The fixation of tracheal tube and the degree of facial skin injury were compared between the two groups. All patients were included in the final analysis without shedding cases. Severe catheter displacement occurred in 3 patients (7.5%) in the control group, and no severe catheter displacement occurred in the observation group. The incidence of facial skin injury in the observation group was significantly lower than that in the control group [25.0% (10/40) vs. 55.0% (22/40), P < 0.05]. Moreover, the fixation time of the observation group was significantly shorter than that of the control group (minute: 12.11±1.69 vs 17.59±1.27, P < 0.05). The application of self-made tracheal catheter fixation band can shorten the fixation time of tracheal catheter and reduce the incidence of unplanned endotracheal extubation (UEE) and facial skin injury, which is worthy of clinical promotion and application.
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Objective:To understand clinical effect of a homemade infants wrist hand thumb joint fixtures to prevent the unplanned extubation (UEX) in radial arterial puncture tube in children with congenital heart disease.Methods:From October 2016 to October 2019, 150 cases infants patients with simple congenital heart disease in cardiac surgery of the First Affiliated Hospital of University of Science and Technology of China were selected as the research objects, and the radial artery invasive manometric tube was routinely indwelling after operation. Subjects were randomly divided into observation group and control group, with 75 cases in each group. In the observation group, the wrist joint of children was fixed with homemade fixation device. The control group used conventional fixation methods to fix the wrist joint of infants. The incidence of pressure injury and unplanned extubation were compared between the two groups.Results:There was 1 case (1.33%) pressure injury in the observation group and 2 cases (2.67%) in the control group, and there was no statistical significance in the two groups ( P>0.05). The unplanned extubation rate of radial artery pressure tube occurred in 5 cases (6.67%) in the observation group, and lower than that in the control group (17/75, 22.67%) ( χ2=7.67, P<0.01). When children in the state of agitation and very agitation, the incidence of unplanned extubation rate in the observation group was 0 and 4.35%(1/23), lower than that in the control group 15.79%(6/38) and 35.00% (7/20), respectively ( χ2=6.19, 6.64, both P<0.05). With the extension of ICU time, the incidence of unplanned extubation rate was increased. The incidence of unplanned extubation rate was 4.76% (2/42) and 9.09% (3/33) in the observation group and 18.18%(8/44) and 29.03% (9/31) in the control group when ICU time was ≤24 h and>24 h, respectively. The difference was statistically significant ( χ2=5.51, 4.17, both P<0.05). Conclusions:The homemade wrist thumb joint fixtures device for infants does not increase the pressure injury of the fixed part, and can reduce the incidence of unplanned extubation of radial artery manometric tube in children with congenital heart disease.
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Objective:To acquire more scientific, accurate and efficient unplanned extubation (UEX) quality management data by using information technology to directly take the quality index data of unplanned extubation from the nursing medical record system.Methods:From June 2019 to August 2019, a knowledge base of pipeline management including the name of pipeline, pipeline evaluation, pipeline care measures, and reasons for unplanned extubation of pipeline was established in Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine. Through the analysis of each node of pipeline management, pipeline management system was established. And the non-planned pipeline management data set was directly collected to the nursing quality management system for statistics and analysis, which was verified.Results:In clinical application from September 2019 to september 2020, the direct collection of unplanned extubation quality index data saved 496 hours of nursing labor costs per month, and the accuracy of direct data collection increased from 95.8% (161/168) in trial operation to 100.0% (494/494). The underreporting rate of adverse events decreased to 0. Satisfaction with the application of the quality index management system for unplanned extubation was (4.35 ± 0.73) points.Conclusions:The direct collection of quality index data for unplanned extubation improves the accuracy of the data. Nurses no longer need to report unplanned extubation incidents. The clinical nursing information system and the nursing management system are interconnected to improve the management efficiency of unplanned extubation. It is worthy of application and promotion in clinic.
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Objective:To retrieve, appraise and summarize the best evidence to prevent accidental extubation of peripheral venous catheters in adults.Methods:According to the "6S" evidence model, computer evidence retrieval was carried out. Search relevant domestic and foreign guideline networks and databases to collect relevant evidences, including clinical decision, guidelines, evidence summary, systematic reviews, etc. The retrieval time was from the establishment of the database to September 2021. Two researchers conducted independent literature search, quality evaluation, evidence extraction and summary. If there is a disagreement between the two, the third party shall be invited to make a ruling.Result:A total of 8 articles were included, including 1 clinical decision, 1 guideline, 2 evidence summaries, 3 RCTs and 1 expert consensus. The 35 best evidences were summarized from six aspects: education and training, catheter placement selection, dressing selection, catheter fixation, catheter maintenance and timing of extubation.Conclusion:This summary of evidence provided evidence-based evidence for the standardized management of clinical prevention of accidental extubation of peripheral venous catheters. However, some of evidence is lacking and of poor quality. In the future, the evidence should be used cautiously according to the clinical situation and patient conditions.
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Abstract Background: Unplanned extubations are safety events relatively frequent in the neonatal intensive care units (NICU). This study aimed to describe the frequency and characteristics of unplanned extubations in a NICU. Methods: We conducted a retrospective observational study of unplanned extubations in the NICU of a tertiary regional referral hospital. We reviewed medical records for data collection and performed the statistical analysis, comparing the cases of unplanned extubations with those in which it did not occur among all the cases that received intubation and invasive neonatal mechanical ventilation. Results: A total of 958 newborns were admitted to the NICU, of which 174 required assistance with invasive mechanical ventilation (18.1%) and 28 experienced unplanned extubations (16.1%): 25 patients with one episode, one with two episodes, and two with three episodes. The rate was 2.93 unplanned extubations for every 100 days of invasive mechanical ventilation in 5 years, with a significant decrease in the last three years (p = 0.0158). We found a statistically significant correlation between a weight < 1500 g and unplanned extubation in the multivariate analysis, although sedation appears to affect its interaction. Conclusions: Unplanned extubations are a relatively frequent problem, although with a tendency to decrease in recent years. The weight of the patients at birth and sedation during ventilation are important factors in this safety problem.
Resumen Introducción: La extubación no programada es un evento de seguridad relativamente frecuente en las unidades de cuidados intensivos neonatales (UCIN). El objetivo de este estudio fue conocer la frecuencia y las características de las extubaciones no programadas en una UCIN. Métodos: Se realizó un estudio observacional retrospectivo de las extubaciones no programadas en la UCIN de un hospital regional de referencia de tercer nivel. Se revisaron las historias clínicas y se realizó el análisis estadístico de los datos, comparando los casos de extubación no programada con aquellos en los que no sucedió entre todos los pacientes que recibieron intubación y ventilación mecánica invasiva neonatal. Resultados: Ingresaron en la UCIN 958 neonatos, de los cuales 174 precisaron asistencia con ventilación mecánica invasiva (18.1%) y 28 tuvieron una extubación no programada (16.1%). De estos, 25 presentaron un episodio, uno presentó dos episodios y dos presentaron tres episodios de extubación no programada. La tasa fue de 2.93 extubaciones no programadas por cada 100 días de ventilación mecánica invasiva en 5 años, con una importante disminución en los últimos 3 años (p = 0.0158). El peso < 1500 g se relacionó con las extubaciones no programadas de forma estadísticamente significativa en el análisis multivariante, aunque la sedación aparece como un factor modificador de efecto a través de su interacción. Conclusiones: Las extubaciones no programadas son un problema relativamente frecuente, aunque con tendencia a disminuir en los últimos años. El peso de los pacientes al nacimiento y la sedación son factores importantes en este problema de seguridad.
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Objective:To investigate the clinical application effect of self -made frenum fixator in the secondary fixation of drainage tube with full gauze coverage around the incision after limb fracture surgery. Methods:120 cases of patients with limb fracture treated by trauma surgery from October 2019 to June 2020 were selected and divided into control group (50 cases) and experimental group (70 cases) by drawing lots. The control group used the traditional 3M tape platform method to fix the drainage tube, and the experimental group used the homemade lace up fixator to fix the drainage tube. The difference of fixtion effect between the two groups was observed and compared.Results:The incidence of catheter-related risk events was 1.4% (1/70) in the experimental group, which was lower than 14% (7/50) in the control group (2 value was 7.408, P = 0.009); the change interval of fixation materials was (5.10±0.39) d, which was significantly higher than (1.68±0.23) d in the control group ( t value was 60.168, P<0.001); the fixed material reuse rate was 97.1% (68/70) and comfort 97.1% (68/70), which were higher than 0 and 48.% (24/50) in the control group, the differences were statistically significant (2 values were 112.00 and 39.37, P<0.001). Conclusion:The self -made lace up fixator has reliable fixation effect and can effectively reduce the occurrence of catheter -related risk events. It is feasibility and safety.
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Intubação endotraqueal é procedimento comum nas Unidades de Terapia Intensiva Neonatais e tem como evento adverso a extubação não planejada, um incidente grave, associado a morbidade neonatal. OBJETIVO: Verificar a prevalência de extubação não planejada e fatores associados em recém-nascidos submetidos à ventilação mecânica na unidade de terapia intensiva neonatal por condições respiratórias, cardíacas ou por pós-operatório. MATERIAIS E MÉTODOS: Estudo transversal, retrospectivo realizado entre março a dezembro de 2017. Os dados foram coletados da ficha de notificação do serviço e incluíram: sexo, peso no momento do evento, comorbidades do paciente, data e hora de ocorrência, condições associadas e conduta pós-extubação. RESULTADOS: Em 38 recém-nascidos em ventilação mecânica foram registrados 72 eventos, a prevalência da extubação não planejada de 4,6%. Entre os fatores identificados, peso inferior a 1.500g foi observado em 20 recém-nascidos (52,6%) e prematuridade em 25 (65,8%). Em 15 recém-nascidos (39,5%) houve mais de um evento/paciente. Peso inferior a 2.500g esteve associado a um risco 6 vezes maior de recorrência do incidente. As condições associadas aos eventos foram agitação motora do recém-nascido (50%), manuseio da cânula endotraqueal (28,3%) e durante procedimentos de rotina do recém-nascido (21,7%). Reintubação foi necessária em 58 casos (80,5%), sendo imediata em 20 (34,5%). CONCLUSÃO: A agitação motora e o manuseio da cânula endotraqueal, portanto, foram os fatores mais associados aos eventos, a recorrência foi mais frequente em recém-nascido com peso inferior a 2.500g. Medidas de prevenção devem incluir o manejo adequado da agitação motora do recém-nascido e implementação de protocolos de manuseio da cânula endotraqueal.
Endotracheal intubation is a common procedure in Neonatal Intensive Care Unit (NICU) and Unplanned Extubation (UE) is a severe related event, which increases neonatal morbidity. OBJECTIVE: To verify the prevalence of UE and associated factors in newborns submitted to mechanical ventilation (MV). MATERIALS AND METHODS: This is a cross-sectional retrospective study, including 38 newborns and 72 UE. The collected parameters were: gender, weight at the time of extubation, diagnosis, time of UE, associated conditions and conduct. The statistical analysis included the Fisher's exact test and odds ratio (Statistica®). RESULTS: A total of 72 UE were recorded in 38 newborns, with a rate of 1.561 intubated patients/day and UE prevalence of 4.6%. Weight less than 1,500g was observed in 20 newborns (52.6%) and prematurity in 25 (65.8%) and when it was less than 2500g it was associated with a 6-fold increased risk of recurrent UE. In 15 newborns (39.5%) there was more than one event per patient. The conditions associated with increased UE risk were motor agitation of the newborn (50%), endotracheal tube (ETT) manipulation (28.3%) and routine procedures (21.7%). Reintubation was necessary in 58 cases (80.5%), being immediate in 20 (34.5%). CONCLUSION: The prevalence of UE was high and strongly associated with motor agitation and manipulation of ETT. Its recurrence was more frequent in newborns weighing less than 2,500 g. Therefore, prevention measures should include adequate management of the motor agitation in newborns and implementation of protocols for handling the ETT.
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Airway Extubation , Infant, Premature , Patient SafetyABSTRACT
Objective To analyze the causes of unplanned tracheal extubation in mechanically ventilated patients in the pediatric intensive care unit using quality management practices and observe the changes of extubation rates before and after implementing these practices.Methods In the first place,we set up quality management group in June 2014.Second,the team formulated a risk factor checklist for unplanned tracheal extubation based on literature research, and analyzed the main causes requiring tracheal extubation. The last time,we developed some management measures for important reasons in 2014,and established and implemented a quality management strategy between 2015 and 2016.The incidence frequency of unplanned tracheal extubation,i. e. the number of extubation cases per 100 days with a tube in place(mechanical ventilation days),was used to evaluate the change of the extubation rates before and after implementing the new measures. The cases in 2014 were retrospectively analyzed,and cases from 2015 to 2016 were prospectively collected.The number of interval days for two continuity unplanned extubation was considered to be a means of quality control.Results Rick factors associated with unplanned extubation in the pediatric intensive care unit before implementing quality management were a delay of the replacing adhesive bandage, lack of sedation assessment,which were related to frequent physician replacement and insufficient training and supervision.In consideration of the identified risk factors,a standard operating procedure was formulated to prevent unplanned extubation,including standard operating procedure of tracheal catheter fixation and the sedation assessment. There were 484 mechanical ventilation in 2014,and the incidence of unplanned extubation was 0.8%,and the median number of days of separation was 8.0(4,20) d.Between 2015 and 2016,there were 1 379 mechanical ventilations,and the incidence of unplanned extubation was 0.2%,and the median number of days of separation was 34.0(19,61) d.The incidence of unplanned extubation in 2015 to 2016 was lower than that in 2014(χ2=5.936,P=0.018).Ramsay scoring usage increased from 28.6% in 2014 to 57.1% between 2015 and 2016,while Ramsay scored 3-4 points from 2015 to 2016 was higher than 2014(P< 0.05).Conclusion Establishing the quality management group according to the requirements of each hospital and implementing quality management strategies can reduce the incidence of unplanned extubation,thereby improving the quality of care in pediatric intensive care unit.
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Objective To evaluate the effects of"PICC fixed standard operation flow chart"in PICC fixed quality management. Methods Patients with PICC were admitted to the control group from January to June in 2014, given the routine PICC fixed method. PICC patients in the observation group who were enrolled from July to December 2014 were given new PICC fixed method that obey the"PICC fixed standard operation flow chart", which was established from relevant norms and guidelines and related literature. The incidence rate of medical adhesive related skin injury and unplanned extubation of PICC were compared with those of the two groups. Results The incidence rate of medical adhesive related skin injury was decreased from 35.20％(70034/198962) to 18.03％(37862/209955) (Z=-3.363, P<0.01) and PICC unplanned extubation decreased from 1.31‰(20/15384) to 0.37‰(7/18919) , the difference was statistically significant (χ2=6.940, P<0.05). Conclusions The PICC fixed standard operating flow chart can be used as a guide to implement the PICC fixation. Based on this, the quantitative management index is applied to the PICC fixed quality management, which can standardize the fixation of the PICC , reduce the related complications caused by the fixation of the catheter, prevent the occurrence of unplanned extubation of PICC , provide effective protection to ensure safe PICC long-term use and improve the patient's comfort.
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Objective To observe the effects of finger-holding force ball on prevention of unplanned extubation in ICU patients.Methods A convenient sampling method was used to select 70 patients from January to June 2017 who received tracheal intubation,femoral vein catheterization or bladder catheter.From April to June 2017,35 patients were selected as the experimental group,and hand restraint was strengthened by means of finger-holding force ball.Thirty-five patients recruited from January to March 2017 were selected as the control group,and wrist restraint was performed by routine method.The risk rate of extubation and the skin injury of the wrist in two groups were compared.Results The risk rate of extubation in the experimental group for femoral vein catheterization,bladder catheter and tracheal intubation was 6.37 cases/1000 catheter days,0 and 5.68 cases/1000 catheter days,lower than 200.00 cases/1000 catheter days,177.60 cases/1000 catheter days,and 230.34 cases/1000 catheter days in the control group,with statistically significant differences(P＜0.001);redness and skin injury at wrist restraint site in the experimental group was 5.71％ and 0,lower than 22.86％ and 17.14％ in the control group,and the differences were statistically significant (P＜0.05).Conclusion The finger-holding force ball is easy to use,the effects are good,and it is much more comfortable to use the finger-holding force ball than traditional restraint tools.
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Objective To observe the effect of FOCUS-PDCA on the unplanned extubation (UEX) in ICU patients. Methods About 237 ICU patients during Jan. to Dec. 2014 were assigned as the control group, where the FOCUS-PDCA program was not used. Another 235 patients during Jan. to Dec. 2015 were assigned as the study group, where the the FOCUS-PDCA program was used. The two groups were compared in view of unplanned extubation rate and nurse's comprehensive ability. Result Compared with the control group, hospitalization time was comprehensively shortened in the observation group and the nurses comprehensive abibity increased (all P<0.05). Conclusion The FOCUS-PDCA program can prevent UEX in ICU patients, reduce the rate of UEX, improve the comprehensive ability of nurses and the quality of nursing.
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Objective To explore the effect of risk assessment tracking management in reducing unplanned extubation in patients with tracheal intubation.Methods From January to December 2015,120 patients with tracheal intubation in ICU were selected as the control group with routine nursing care of indwelling endotracheal intubation.From January to November 2016,120 patients with tracheal intubation were selected as the observation group,where the risk assessment and risk management were done on the basis of routine nursing as in the control group.The two groups were compared in terms of tracheal intubation and unplanned extubation related knowledge,the implementation of the risk assessment,the accuracy in risk assessment and the incidence of unplanned extubation.Result The tracheal intubation and unplanned extubation related knowledge in the observation group was lower than that of the control group (P＜0.001),The implementation rate of the risk assessment and the accuracy in risk assessment in the observation group were significantly higher than the control group,and the rate of unplanned extubation in the observation group was significantly lower than in the control group (all P＜0.01).Conclusion The implementation on risk assessment and extubation-preventing nursing quality tracing management can enhance the awareness and knowledge of preventing trachea cannula exodus,improve the quality of nursing and reduce the rate of unplanned extubation.
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Objective To explore the effect of failure mode and effect analysis (FMEA) on reducing the unplanned extubation rates for patients with severe craniocerebral injury. Methods FMEA model was used to analyze the main reasons of unplanned extubation patients with severe craniocerebral injury, 7 failure modes with higher RPN scores was selected. The nursing intervention for the fixation of the catheter were improved. The control group with 181 cases of patients without FMEA application were given routine care. FMEA group owning 196 cases were given the optimization process. The incidence rate of unplanned extubation of two groups was compared. Results After improvement of the nursing process of patients with severe craniocerebral injury for fixing the catheter, the RPN of 7 failure modes was lowered. Compared with the control group, the total rate of unplanned extubation in FMEA group decreased to 1.1% (9/832), less than 5.1% (40/779) of the control group. The statistical difference was significant (χ2=22.410, P 0.05). Conclusions The FMEA model can be effective in reducing the rate of unplanned extubation .
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Objective To investigate current status of knowledge-attitude-behavior about unplanned extubation (UEX) of central venous catheter among infusion nurses in Guangdong Province.Methods The nurses who attended the 2015 intravenous therapy nursing training provided by Guangdong Nursing Association were selected as participants.A self-designed questionnaire about nurses' knowledge-attitude-behavior about UEX of central venous catheter was used to investigate 450 nurses.Results The proportion of nurses who reached good level in knowledge were 41.1％,nurses who had positive attitude were 71.0％,nurses who had positive behaviors were 30.0％.There were significant differences among nurses with different educational background,different titles and different hospital ranks(P＜0.05).Conclusion The knowledge-attitude-behavior of nurses are not satisfactory,especially those who are junior or have lower education or work in non-tertiary hospital.
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Objective To evaluate the effect of a new type of fixation tape for tracheal catheter in intensive care patients.Methods A purposive sampling study was conducted. Ninety patients experienced oral tracheal intubation for mechanical ventilation, and admitted to respiratory intensive care unit (ICU) of the Second Affiliated Hospital of Nantong University from November 2015 to February 2017 were enrolled. All the patients were randomly (random number) divided into the control group and the observation group with 45 patients in each group. The patients in control group was treated with the traditional medical adhesive tape and fixation belt to fix endotracheal tube, while the patients in observation group was treated with a new type of tracheal catheter fixation tape. The fixation effect, skin complication rate, patient's comfort level, nursing workload and satisfaction were evaluated in both groups.Results There were 6 patients with mild displacement, 2 patients with moderate displacement and 1 patient with severe displacement in the control group, while there was no catheter displacement or detachment occurred in the observation group, and the difference between the two groups was statistically significant (χ2 = 2.944,P = 0.003). In the control group, there were 39 patients with facial skin redness,6 patients with facial skin damage, 36 patients with neck skin redness, and 2 patients with neck skin damage. In the observation group, there were no facial skin complications and only 2 patients with neck skin redness, and the skin complication rate was significantly higher than that of the control group (facial skin:Z = 9.173,P = 0.000; neck skin:Z = 7.549,P = 0.000). Compared with the control group, the patients' comfort levels were significantly elevated in the observation group (the intolerance patients: 9 vs. 24, the extreme discomfort patients: 4 vs. 8,Z = 3.695,P = 0.000). The total changing times of the fixation belt and operating time for each change in the observation group were significantly decreased as compared with those of control group [changing times of the fixation belt (times): 1.89±0.77 vs. 3.86±1.18, operating time for each change (minutes): 10.31±1.47 vs. 15.78±1.89, bothP < 0.01]. Nursing satisfaction in the observation group was significantly higher than that of the control group (100% vs. 33.3%,P < 0.01).Conclusions The new fixation tape for tracheal catheter could significantly reduce the catheter displacement and detachment rate, and decreasethe incidence of facial skin injury. It is easy to learn and worth to generalize clinically.
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Unplanned extubation (UEX) is defined as premature removal of the indwelling catheter tube by a patient (deliberate unplanned extubations) or by staff during nursing and medical care (accidental extubations). UEX, either deliberate or accidental, can cause severe damage of patients, with the increasing of hospital costs and medical disputes. Identifying high-risk patients is the key point of reducing UEX. This review conclude risk assessment tools reported for UEX.
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Objective To evaluate the efficacy of 3+x mode for the reduction of unplanned extubation in the patients with stomach cancer. Methods 107 patients with the indwelling gastric tube of gastric cancer perioperative from June 2014 to September 2014 were collected as the observation group, and 101 patients with the indwelling gastric tube of gastric cancer perioperative from June 2013 to September 2013 were collected as the control group. Once preoperative education on stomach tube was performed in the control group, and 3+x education mode was used in the observation group, so as to compare unplanned extubation rate of two groups. Results The tube unscheduled decannulation rate in postoperative patients with gastric cancer in the control group was significantly higher than that in the observation group [4.95 %(5/101) vs 0 (0/107)], and there was significant difference (χ2= 5.168, P= 0.029). Conclusion 3+x mode education can significantly reduce unplanned extubation rate in operation patients with gastric cancer.
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BACKGROUND: Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU. METHODS: Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE. RESULTS: The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE. CONCLUSIONS: To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.