Analysis of the reason and handling measures of catheter fracture of the implantable vascular access device / 中国实用护理杂志

Objective To analyze the reasons of catheter fracture of implantable vascular access devices and to explore the prevention and handling measures. Methods A retrospective analysis was carried in 3 887 adult patients with implantable vascular access devices and 13 had catheter fracture. The clinical features and causes were analyzed and the successful handling measures were summarized. Results Of 3 887 cases, a total of 13 (0.33%) catheter fracture occurred. The incidence rate of catheter fracture via subclavian jugular venipuncture was 3.70%,(6/162) , via internal jugular venipuncture was 0.18% (7/3 725), via internal jugular venipuncture was significantly lower than that via the subclavian venipuncture (χ2=47.505,P=0.000). There had no statistical differences between the left and right of the two puncture ways(P=0.707,0.682). Conclusions Catheter fracture is one of the serious complications in the process of use and maintenance of implantable vascular access device. Choosing appropriate surgical method, strengthen maintenance education, specificating the operation procedure, closing observation and other measures can not only reduce the occurrence of the catheter fracture, but also can dealt with catheter fracture in time, which could ensure the safety of patients' life.

Application of the standardization management form of the totally implanted vascular access devices / 中国实用护理杂志

Objective To strengthen the standardized management of totally implanted vascular access devices (TIVAD) in order to prevent and reduce the complications.Methods The unified TIVAD maintenance record form was adopted.The form contained the embedded and maintenance information.The maintenance and propaganda handbooks were handed out to the patients.The incidence of complications between before and after the application of the maintenance record form was analyzed statistically.Results The incidence of infection and obstruction fell from 2.1％(20/942) and 8.3％(78/942) to 1.0％(13/1 258) and 2.8％(35/1 258),the difference was statistically significant.Conclusions The application of TIVAD maintenance record form can reduce the occurrence of complications and prolong the service life of TIVAD.

Clinical application of totally implantable central venous port / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the disposal methods and the reasons of complications in operation of totally implantable central venous port (TICVP).</p><p><b>METHODS</b>A total of 2 007 patients were enrolled in this observational, single-center study between December 2008 and March 2013. TICVP implantation was performed with one small skin incision and subcutaneous puncture of subclavian or jugular vein. Patient's profiles, indications of port system, early and delayed complications, and disposal methods were evaluated. There were 38 male and 1 969 female patients, aged from 21 to 85 years, with a mean of 47.6 years.</p><p><b>RESULTS</b>The mean duration of the TICVP system was (242 ± 12) days, ranging from 9 to 1 243 days. The achievement rate of puncture in the right jugular vein (99.76%) was the highest. Sonographic approach using the internal jugular vein were better than the external landmark-guided technique (99.80% vs. 96.34%, χ² = 29.905, P = 0.000). The rate of immediate complication was 0.80%, which included pneumothorax, hemothorax, lymphatic fistula and thrombosis. Early complications rate was 0.10%, which included pocket hematoma, catheter migration, venous thrombosis, port pocket infection, fibrin sheath formation. Late complications rate was 7.87%, which included catheter fracture, pinch-off syndrome, catheter-related bloodstream infection, fibrin sheath formation, catheter migration, extravasation, port inversion and port reveal. The rate of removal due to complications was 1.34% (27/2 007), and the early complication was higher (χ² = 8.053, P = 0.011).</p><p><b>CONCLUSIONS</b>The low incidence of complications suggests that TICVP is safe and reliable for long term intermittent venous access. The results support the use of TICVP in the oncology patients and patients requiring long-term intravenous therapy.</p>

Time to Start Rehabilitation after Mastectomy for Affected Limb Function / 中国康复理论与实践

Objective To explore the effect of rehabilitation training start time after mastectomy on the recovery of the affected limb function. Methods 90 patients who received modified radical mastectomy were divided into groups A, B and C randomly. All the patients ac-cepted the unified rehabilitation program, but started 1, 3 and 10 d after the operation respectively. They were evaluated with the Japanese Orthopaedics Association (JOA) assessment for affected shoulder 1, 3 and 6 months after operation. Results The score of JOA was the least in the group C (P0.05). Conclusion The rehabilitation training can be started as early as possible.