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Objective To explore the influence of dressings( occlusive and semi-occlusive) on puncture site infection of patients with peritoneal dialysis. Methods The clinical data of 2458 patients who underwent peritoneal dialysis and dressings in our hospital from January 2006 to January 2015 were collected. According to the type of dressings( occlusive or semi-occlusive) ,the patients were respectively divided into occlusive dressing group(2031 cases) and semi-occlusive dressing group (427 cases). The relationship between the two variants was an-alyzed with χ2 and the difference between the two groups was analyzed with the Logistic regression model. Results Among the 2,458 patients who underwent catheter placement,1778 patients (72. 25％) were subjected to open operation, 598 patients(24. 32％) were subjected to special trocar,81 patients (3. 29％) were subjected to laparoscopy and 3 patients (0. 12％) were subjected to embedded catheter. Through univariate analysis, OR of occlusive dressing was 2. 17 with 95％CI (0. 8～5. 74). After variant adjustment,OR of occlusive dressing group was 2. 15 (95％CI 0. 81～5. 70). The incidence of infection at the puncture site was unaffected by the type of dressing used. The combined results of puncture site infection and tunnel infection showed no significant difference between the two groups ( OR 1. 46, 95％CI 0. 72 ～2. 97). For the independent predictive factor on the ppuncture site of patients over 65 years old,OR was 2. 04, 95％CI (1. 25～3. 30). Con-clusion The type of dressings( occlusive and semi-occlusive) used after insertion of catheter during peritoneal dialysis has no influence on the early infection of puncture site,but the occlusive dressing is more suitable for clinical application due to less adverse reaction,easy opera-tion,low material cost and less workload on the nurses.
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Objective: To explore the differences of physicochemical properties, antibacterial effect and clinically curative effect between nano silver combined activated carbon gel dressings and traditional dressings in change dressing at puncture site of ascites drainage. Methods: 94 patients with seroperitoneum who were implemented abdominocentesis were divided into observation group (50 cases, who were applied NSAC dressing) and control group (44 cases, who were traditional dressing) as random number table. The inhibition zone method was adopted to test the actual bacteriostasis of two dressings, and the permeability, isolation function of protective screen and adhesive force of the two dressings were compared, respectively. Besides, the maximum use time, infection rate, errhysis degree, changed dressing times in 1 week and the loose situation in changing dressing at puncture site of drainage about the two dressings were compared. Results: The permeability, adhesive force, anti-invading for outside world of dressing in observation group were 3.8 times, 2 times and 1.7 times of that of control group, respectively. At the aspect of inhibition zone, the result of observation was 1.82 times of that of control group. And the maximum usage time of observation group was (8.4±1.8)d, and it was significantly higher than that of control group (5.3±1.2)d, (t=9.683, P<0.05). The difference of times of changed dressing between observation group (1.2±0.3 times) and control group (2.7±0.8 times) was statistically significant (t=-12.318, P<0.05). The loose rate, infection rate and errhysis rate of III grade of observation group (11.2%,3.33% and 2.0%) were significantly better than that of control group (29.5%, 18.2% and 15.9%) (x2=4.468, x2=4.951, x2=6.616, P<0.05). Conclusion:Compared to traditional dressing, novel nano silver conbined activated carbon gel dressings has obvious superiority in physicochemical properties, antibacterial effect and clinically curative effect, and it is worth to be extensively popularized in changing dressing for ascites drainage at puncture site.
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Objective To investingate the possible predictory of radial artery occlusion(RAO) after transradial approach and its preventive measures.Methods We prospectively assessed the occurrence of RAO in 669 consecutive patients undergoing transradial approach and 63 patients were excluded from the final study (24of them did not meet the inclusion criterium,31 patients converted to other artery approaches,6 patients lost clinical follow-up and 2 patients died).Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention.The risk factors of RAO including sex,body mass index (BMI),smoking,hypertension,diabetes,dyslipidemia,puncture site,vessel spasm,and artery diameter/ sheath ratio were evaluated using a multivariate model analysis.Results Among the 606 patients,RAO occurred in 56 patients.There were no differences in sex,age,BMI,coronary lesions,rates of vessel spasm,vessel length,medication given and operation time between the 2 group of patients with vs without ROA (all P＞0.05).Univariate logistic analysis showed puncture site at 0 cm away from radial styloid and artery diameter/sheath ratio ≤ 1 were possible risk factory and puncture site ＞ 4 cm from radial styloid was possible protective factor.Further multivariate analysis showed the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P=0.033) and 8.90 (P=0.040),respectively.The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤ 1 (OR=2.45,P=0.004).Conclusions Distal puncture sites (0-1 cm away from the radius styloid process) can lead to a higher rate of RAO.
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Objective To analyze the correlative factors that affect the main complications caused by peripherally inserted central catheter puncture (PICC) on low birth weight infant with different puncture sites,in order to reduce the incidence of complications and achieve the purpose of indwelling safely.Methods A total of 431 infants with different PICC puncture sites were recruited in this study from January 2008 to January 2013,261 cases of them were punctured in the elbow upper extremity veins, 147 cases were in the elbows downward veins,5 cases were in the superficial temporal veins, 12 cases were in the axillary veins,and 6 cases were in the femoral veins.The complications occurring in the period of indwelling catheter were analyzed, and the effective treatments or preventive nursing measures were taken.Results 431 cases were punctured successfully.The sites of puncture were mainly in the veins of the upper arm,and the main complications were phlebitis,extremities swelling,jamming pipe and infection.The incidence of phlebitis, extremities swelling in the elbows downward veins were lower than those in the elbow upper extremity veins: 10.89％(16/147) vs.3.83％(10/261), 17.69％(26/147) vs.4.98％(13/261), and the differences were significant, x2=7.840, 17.561, P＜0.05.Conehusions The veins in the elbow and elbow downward are mainly selected.It is necessary to assess the complications promptly that may occur and to take effecdve measures,and good catheter maintenance consciousness also has important significance to the reduction of complications.
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Objective To investigate influencing factors of puncture site bleeding after trans-radial coronary intervention (TRI)in order to provide guidance for prevention of post-operative bleeding complications.Methods A total of 198 patients with TRI hospitalized at the department of interventional cardiology of our hospital from August,2011 to December,2011 were recruited in the study.In the prospective study,they were divided into two groups:bleeding group(n=62)and non-bleeding group(n=136).The general status,medication,position of radial compressor,time of immobilization of the wrist joint,duration of loosing tourniquet between the first time and second time and number of laps,time for depression,duration for total release of compression device and laboratory testing were recorded as data.Cox regression analysis was done to explore factors influencing bleeding.Results The factors for puncture site bleeding after trans-radial coronary intervention included pre-operative medications,location of compression device at the midline of operated forearm,distance between the compression device midpoint and the second wrist crease,and time for total release of compression device,with their RR=2.001,3.521,1.470 and 0.999,respectively.Conclusion Factors contributing to increased risk of local bleeding at puncture site following TRI included pre-operative medications,location of compression device at the midline of operated forearm,distance between the compression device midpoint and the second wrist crease;whereas the time for total release of compression device may be a protective factor.