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Pediatric kidney transplant recipients differ from adult counterparts in primary disease, physiology, psychology, organ function and immune status and their perioperative treatment and nursing management are different from those of adult kidney transplantation. To standardize holistic perioperative nursing regimens for pediatric kidney transplantation, Surgery Nursing Committee of Shanghai Nursing Association organized national medical and nursing experts in the fields of transplantation to jointly draft "expert consensus on perioperative nursing standards for pediatric kidney transplantation " (abbreviated as "consensus"). After three rounds of online expert inquiry, all revised opinions were jointly discussed combined with literature evidence, and the expert consensus was finally reached. The highlights of perioperative treatment and nursing care for pediatric kidney transplantation were summarized and stated, including preoperative evaluation, preoperative and postoperative nursing care, which were of scientific and practical value.
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Objective:To summarize literature of risk prediction models for catheter-related thrombosis in PICC at home and abroad, in order to provide reference for the development and improvement of risk prediction models for PICC catheter-related thrombosis (PICC-CRT) and the selection and use of medical staff.Methods:All studies on the risk prediction model of PICC-CRT were systematically searched in the Chinese and English literature database from June 2012 to June 2022. Two researchers independently screened the literature and extracted the data. The prediction model risk of bias assessment tool was used to evaluate the bias risk and applicability of the included literature.Results:A total of 13 articles were included, including 1 multicenter study and 12 single-center studies. Eight literatures were retrospective studies and five were prospective studies. Bias risk assessment showed that there was a bias risk in all the 6 studies. In terms of applicability evaluation, the 13 studies had good applicability in all fields and overall.Conclusions:There were various types of PICC catheter-related thrombosis risk assessment models, which had good predictive efficiency, but there was also a high risk of bias in these studies. The important contents of PICC catheter-related thrombosis risk prediction model are patient factors and treatment factors. In the future, the existing models need to be validated and improved, or a prediction model with low risk of bias should be constructed to effectively prevent PICC-CRT.
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Objective:To investigate the effect of power PICC with two different external lengths in patients with hematologic diseases.Methods:From August 2020 to August 2021, a retrospective analysis was conducted on 233 cases of hematologic diseases who received power PICC catheterization in Department of Hematology, the Nanfang Hospital of Southern Medical University, the patients were divided into 0-1 cm group (132 cases) and 2-4 cm group (101 cases) according to the external lengths after catheter insertion. The incidence of related complications and patient comfort at 24 hours, 72 hours, 7 days and 14 days after catheterization were compared between the two groups.Results:At 24 hours and 72 hours after catheterization, the incidence of bleeding at puncture point in 0-1 cm group was 14.39%(19/132) and 9.85%(13/132), in 2-4 cm group was 30.69%(31/101) and 32.67%(33/101), the difference was statistically significant ( χ2=9.02, 14.16, both P<0.05). The rate of redness and swelling of punture point at 7 days after catheterization was 9.09%(12/132) and 40.59%(41/101) in the two groups, with statistical significance ( χ2=32.32, P<0.05). The rates of slightly prolapse at 7 and 14 days after catheterization were 18.18% (24/132) and 18.94%(25/132) in 0-1 cm group, 59.41% (60/101) and 67.33%(68/101) in 2-4 cm group, the difference between the two groups was statistically significant ( χ2=42.18, 55.86, both P<0.05). In the observation of comfort at 14 days after catheterization, the comfort score of patients in the 0-1 cm group was significantly higher than that in the 2-4 cm group, and the difference between the two groups was statistically significant ( χ2=7.34, P<0.05). Conclusions:Patients with hematologic diseases can reduce the risk of bleeding and slightly prolapse, and improve the comfort of patients when the external lengths is 0-1 cm of power PICC, which is worthy of clinical application and promotion. The catheterizer should adopt accurate in appropriate measurement method to determine the best lengths of the catheters.
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Objective:To investigate the application value of oral stimulation combined with maternal milk sucking in the pain caused by PICC in children with congenital digestive tract malformations.Methods:Using convenience sampling method, 80 children with congenital digestive tract malformations who were admitted to Hunan Children's Hospital from July 2018 to December 2019 were selected and divided into the experimental group and the control group of 40 cases in each group according to the random number table method. The control group was given routine nursing mode, while the experimental group was given oral stimulation combined with maternal milk sucking intervention on the basis of routine nursing. The intervention effects were evaluated by the Neonatal Infant Pain Scale (NIPS), the onset time of the first cry, the duration of crying, the onset time of the first painful face, the duration of the painful face, and indicators such as heart rate, respiratory rate and SpO 2. Results:The NIPS scores of children in the experimental group were (5.60 ± 1.24) and (4.10 ± 0.31) in the puncture period and the recovery period, which were significantly lower than those in the control group (6.10 ± 0.84), (4.93 ± 0.35), the differences were statistically significant (t = 2.12, 3.00, both P<0.05). The heart rate and respiratory rate of the children in the experimental group were (151.10 ± 12.37), (147.00 ± 12.16) times/min and (47.48 ± 7.59), (45.58 ± 6.51) times/min in the puncture period and the recovery period, which were significantly lower than those in the control group (159.75 ± 13.81), (156.05 ± 12.99) times/min and (52.38 ± 8.12), (49.75 ± 7.59) times/min, the differences were statistically significant (t values were 2.64-3.22, all P<0.05). The SpO 2 in the experimental group were 0.980 5 ± 0.009 0, 0.982 5 ± 0.010 8 in the puncture period and the recovery period, which were significantly higher than those in the control group 0.970 8 ± 0.014 2, 0.971 8 ± 0.018 1, the differences were statistically significant (t = 3.66, 3.23, both P<0.05). The onset time of the first cry, the duration of crying, the onset time of the first painful face, the duration of the painful face in the experimental group were (41.55 ± 6.38), (22.05 ± 4.47), (35.08 ± 5.94), (24.65 ± 5.46) s, significantly shorter than those in the control group (46.58 ± 5.26), (29.50 ± 6.48), (44.68 ± 13.31), (30.65 ± 9.42) s, the differences were statistically significant (t values were 2.63-5.98, all P<0.05). Conclusions:Oral stimulation combined with maternal milk sucking can effectively relieve the pain caused by PICC in children with congenital digestive tract malformation, and reduce the physiological stress response of children.
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OBJECTIVE@#To observe the clinical effect of moxibustion combined with plucking technique at Jiquan (HT 1) for preventing peripherally inserted central catheter (PICC)-related venous thrombosis in the upper limbs of malignant tumor patients.@*METHODS@#A total of 80 malignant tumor patients undergoing PICC were randomized into an observation group and a control group, 40 cases in each one. In the control group, the routine care for PICC was exerted. In the observation group, besides the routine care, moxibustion combined with plucking technique at Jiquan (HT 1) was added. Mild moxibustion was exerted along the venous distribution of PICC (avoiding the entry site) for 10 to 15 min, and then, the circling moxibustion was applied to Quchi (LI 11), Xuehai (SP 10) and Tianfu (LU 3), 3 to 5 min at each acupoint. Finally, plucking technique was given at Jiquan (HT 1) for 5 to 10 min. This combined therapy was intervened since the 2nd day of PICC placement, once daily, 5 times a week, for 3 weeks totally. The incidence of the PICC-related venous thrombosis in the upper limbs was compared between the two groups on day 42 of placement. On day 2, 7, 14, 21, 28, 35 and 42 of PICC placement, the peak systolic velocity (PSV) and the end-diastolic velocity (EDV) of the subclavicular vein on the placement side were observed separately in the two groups.@*RESULTS@#The incidence of the PICC-related venous thrombosis in the upper limbs in the observation group was lower than that in the control group (2.5% [1/40] vs 17.5% [7/40], P<0.05). From day 7 to 35 of PICC placement, PSV of the subclavicular vein on the placement side was higher than that on the day 2 of PICC placement in the observation group (P<0.05). On day 28 and 42 of PICC placement, PSV of the subclavicular vein on the placement side was lower than that on the day 2 of PICC placement in the control group (P<0.05). In the observation group, EDV of the subclavicular vein on the placement side was higher than that on the day 2 of PICC placement from day 7 to 28 of PICC placement (P<0.05). In the control group, EDV of the subclavicular vein on the placement side from day 28 to 42 of PICC placement was lower than that on the day 2 of PICC placement (P<0.05). From day 7 to 42 of PICC placement, PSV and EDV of the subclavicular vein on the placement side in the observation group were all higher than those in the control group (P<0.01, P<0.05).@*CONCLUSION@#The combined treatment of moxibustion with plucking technique at Jiquan (HT 1) can effectively prevent PICC-related venous thrombosis in the upper limbs and improve venous blood flow velocity in malignant tumor patients.
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Humans , Catheterization, Central Venous/methods , Catheterization, Peripheral/adverse effects , Moxibustion/adverse effects , Neoplasms/complications , Upper Extremity , Venous Thrombosis/etiologyABSTRACT
The peripherally inserted central catheter (PICC) is widely used as a central venous catheter for both pediatric and adult patients. Fewer procedure-related complications have been reported than for conventional methods using the internal jugular, femoral, or subclavian veins for access. On the other hand, thrombosis and phlebitis are more common than in conventional methods, and sometimes the catheter cannot be removed by manual traction. In this study, a 13-year-old girl had received long-term sedation from a PICC due to neurodegenerative disease. The patient was referred to our department because of difficulty in manual drawing for removal of the PICC. A CT scan showed that the PICC was bent at the right axillary vein and there was a high-density area around it. Surgical treatment was chosen after a joint conference between the department of pediatrics and us to discuss the reliability and invasiveness of the several treatments. Under general anesthesia, an incision was made under the right subclavian bone, and her axillary vein was exposed. The lumen of the vein was filled with a white plaster-like compound, and the catheter itself was buried inside it. The compound was removed, and the bent PICC was straightened and removed from the puncture site. There is no other case for difficult removal of PICC in this form without calcification. We believe that surgical removal was effective in this case because of her vascular structure.
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Objective:To explore the application effect of CDIO (Conceire, Design, Implement, Operate) teaching mode in the training of PICC nurse trainees.Methods:A total of 80 PICC nurses trained in Xinjiang Uygur Autonomous Region People ′s Hospital from March to August 2021 were divided into the control group (40 patients) and the intervention group (40 patients) according to the baseline comparison principle. The control group participated in the first training using the traditional teaching mode, and the intervention group participated in the second training using the CDIO teaching mode. The scores of core competence and teaching satisfaction of PICC specialist nurses in the two groups were compared at the 8th week after training, and the theoretical and operational scores of the two groups were compared at the 4th and 8th week after training. Results:After training, the scores of professional theoretical knowledge, professional operation skills and related abilities in the core competence of PICC specialist nurses in the intervention group were (27.76 ± 2.07), (40.42 ± 4.12) and (11.42 ± 1.86), respectively. The control group was (22.21 ± 3.71), (34.84 ± 6.86) and (10.15 ± 2.10) points, respectively, and the differences between the two groups were statistically significant ( t=-8.25, -4.42, -2.85, all P<0.01). After 4 and 8 weeks of training, the theoretical scores of the intervention group were (82.00 ± 7.51), (86.25 ± 3.53) points, and the operational scores of PICC laying and maintenance were (93.68 ± 3.25), (91.13 ± 4.75) points, respectively. The control group was (76.48 ± 9.38), (83.28 ± 4.05), (91.48 ± 3.72), (88.58 ± 6.28) points, respectively, and the differences between the two groups were statistically significant ( t values were -3.50 - -2.05, all P<0.05). In the teaching satisfaction of the intervention group, the teaching level, teaching method and teaching effect were 97.5% (39/40), 95.0% (38/40), 100.0% (40/40), while that of control group were 77.5% (31/40), 80.0% (32/40), 85.0% (34/40). There were statistically significant differences between the two groups ( χ2=7.31, 4.11, 4.51, all P<0.05). Conclusions:CDIO teaching mode is superior to traditional teaching mode. It can improve students′ core competence and achievement of theoretical and operational knowledge, and improve teaching satisfaction. It is worth promoting.
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Objective:To explore the practical effect of PICC catheterization in breast cancer patients by a multidisciplinary team led by specialist nurses.Methods:Choose Affiliated Tumor Hospital, Xinjiang Medical University in March 2018 to January 2020, 120 cases of breast cancer patients undergoing chemotherapy, according to the random number method, 60 cases were divided into control group and test group, control group given routine nursing care, experimental group on the basis of conventional nursing to the specialist nurses as the leading multidisciplinary team management mode to compare two groups of patients with a success rate of puncture complications patients satisfaction and unscheduled decannulation rate before and after the implementation of the multidisciplinary model nurse satisfaction.Results:The one-time puncture success rate, unplanned extubation rate, incidence of mechanical phlebitis, medical adhesion-related skin injury, puncture point infection, and catheter blockage rate were 98.3% (59/60), 10.0% (6/60), 8.3% (5/60), 1.7% (1/60), 10.0% (6/60), and 10.0% (6/60), respectively. The control group was 88.3% (53/60), 20.0% (12/60), 20.0% (12/60), 13.3% (8/60), 18.3% (11/60) and 21.7% (13/60), respectively. The difference was statistically significant ( χ 2 values were 4.821-14.911, P<0.05). The satisfaction scores of patients in the experimental group were (17.05±1.43), (17.13±1.28) and (4.38±0.56) points respectively in the three dimensions of nurse skill level, nursing service experience and health education guidance, while those in the control group were (14.53±2.10), (15.03±1.38) and (3.10±0.75) points respectively, the difference was statistically significant ( t values were 0.576, 0.623, 0.699, P<0.001). Nurse satisfaction after the implementation of the multidisciplinary model on the professional ability, job security, teamwork, self-assessment score four dimensions, respectively (12.73±1.02), (24.00±3.52), (16.42±2.06), (13.00±1.83) points, not the implementation of the multidisciplinary model its satisfaction each dimension score (9.69±1.49), (7.88±2.07), (11.92±1.32), (8.88±1.18) points, improved from the previous implementation, the difference was statistically significant ( t values were 0.576-0.798, P<0.001). Conclusions:The multidisciplinary team management model led by specialist nurses is applied to the PICC management of breast cancer patients, which not only reduces the incidence of catheter complications, but also improves the quality control level of PICC and the satisfaction of patients and nurses, in order to further promote intravenous treatment. Specialized development provides guidance.
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Objective:To explore the effects of video teaching combined with scenario simulation teaching on the maintenance skills of peripherally inserted central venous catheter (PICC) in nursing interns.Methods:A total of 70 nursing interns from June 2019 to March 2020 in our hospital were selected and randomly divided into study group and control group, with 35 cases in each group. The control group was given scenario simulation teaching, and the research group was given scenario simulation combined with video teaching. The evaluation of interns in the two groups on the teaching mode (expanding learning ideas, and improving learning initiative, communication ability, learning efficiency and operation ability), PICC catheter maintenance assessment results (theoretical scores, operational scores and comprehensive scores) and teaching satisfaction were compared between the two groups. SPSS 19.0 was used for t test and chi-square test. Results:The evaluation of the teaching mode in the research group was significantly better than that in the control group in terms of expanding learning ideas and improving learning initiative, communication ability, learning efficiency and operation ability ( P<0.05); the theoretical scores, operational scores and comprehensive scores were significantly higher than those in the control group ( P<0.05); teaching satisfaction of the research group (91.43%) was significantly higher than that (68.57%) of the control group ( P<0.05). Conclusion:Video teaching combined with scenario simulation teaching in PICC maintenance skills training of nursing interns can effectively expand learning ideas and improve learning initiative, communication ability, learning efficiency, operation ability, examination results and teaching satisfaction.
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【Objective】 To investigate the role of thromboelastography (TEG) in the diagnosis and treatment of PICC related venous thrombosis in tumor patients, and provide basis for predicting PIC related venous thrombosis. 【Methods】 148 tumor patients who underwent PICC catheterization in our hospital from January to July 2019 were enrolled. The patients were subjected to TEG examination and ultrasound examination of limb blood vessels on catheterization side regularly one day before catheterization and 4 successive weeks after catheterization(once a week), respectively. The patients with venous thrombosis were subjected to TEG examination and vascular ultrasound regularly for 3 successive weeks(once a week) after anticoagulant therapy. The relationship between the occurrence and time of venous thrombosis and the changes of TEG parameters was analyzed. 【Results】 The pre-/post-catheterization TEG parameter of 81 patients without venous thrombosis indicated that coagulation state was normal (R value F=0.198, K value F=0.047, α value F=0.442, MAvalue F=0.079, CIvalue F=0.026, P>0.05). The TEG parameter of 67 patients, who developed asymptomatic venous thrombosis 1 to 3 weeks after catheterization(38 cases in 1 week, 16 in 2 weeks and 13 in 3 weeks), indicated the blood was hypercoagulable and the TEG parameter was statistically different from the pre-catheterization value(P0.05). 【Conclusion】 TEG can reflect the status of PICC related venous thrombosis in tumor patients.Strengthening TEG monitor in tumor patients 1 to 3 weeks after PICC catheterization is conducive to early detection, diagnosis and treatment for PICCrelated thrombosis, thus reducing the harm of venous thrombosis to patients.
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The best tip position of PICC is located in the inferior 1/3 of superior vena cava to the junction between superior vena cava and right atrium. Ensuring the best tip position of PICC is very important for the treatment of patients. In this paper, the applications of X-ray positioning, electrocardiograph, ultrasound, electrocardiograph Doppler ultrasound guidance, and electromagnetic navigation system in PICC tip positioning technology are reviewed. The future development of PICC tip positioning technology is prospected.
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Humans , Catheterization, Central Venous , Central Venous Catheters , Electrocardiography , Heart Atria , Ultrasonography, Doppler , Vena Cava, Superior , X-RaysABSTRACT
background and Aim: Central venous catheters can be considered as important pillars in the practice of modern-day intensivecare including oncological and onco-hematological units. However, like all medical interventions, central venous catheters tooare linked with a number of complications. The objective of the particular study had been aimed to assess the complicationslinked with peripherally inserted central catheters (PICCs) in a group of oncology patients.Materials and Methods: In this retrospective study, we included all patients carrying PICCs (n = 201) inserted at SMH cancerCentre during June 2015–May 2018 (i.e., 36 months). The major variables that were collected and analyzed have been medicalinvestigation, catheter care, placement, time span of catheterization, rationale of catheter removal, obstacles, and nursing care.Complications/obstacles were enumerated as infection, phlebitis, edema, thrombosis, ecchymosis, and/or migration.Results: The same nursing care protocol was used to treat all the patients. The rate of incidence of complications was notedto be two cases per 1000 days of catheter time span. The most pertinent complications warranting the removal of PICCs werefound to be infection and thrombosis, with an incidence of 0.17 cases per 1000 days of total catheterization duration. The averagetime period of catheterization was 170 days. In addition to common causes such as “treatment completion” (48.42%) and “death”(22.53%), the other most talked cause of catheter removal was its migration (displacement toward the exterior) of 5.90%.Conclusions: The central venous catheter (PICC) is quite a safe device that allows the administration of long-term treatment inaddition to preserving the integrity of the venous system of the patient. Adequate care of the catheter is quite crucial to preventthe occurrence of complications and improve the quality of life of the patients having oncological and hematological conditions.Thus, proper training with the latest recommendations for nursing staff as well as patients is particularly required.
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Objective@#To explore the use of supporting guide wire to exclude the PICC catheter refolding malposition,and reduce the number of the catheter resetting and the average time of catheter resetting,while reducing the mechanicalness phlebitis and the incidence of symptomatic thrombosis.@*Methods@#A total of 3 513 patients who received PICC from September 2016 to August 2018 were enrolled. The patients were divided into control group (1 757 cases) and observation group (1 756 cases) by random number table method.The control group was treated with conventional B-ultrasound guided modified Sadinger technique PICC. After the observation group was finished on the basis of the control group, the support guide wire was partially withdrawn and re-sent, according to whether the guide wire was re-supplied or not, to determine whether the catheter has a partial fold in the body. The incidence of catheter refolding malposition, the number of reductions, the time of reduction, and the incidence of mechanicalness phlebitis and symptomatic thrombosis were compared between the two groups.@*Results@#The refolding malposition rate of the observation group and the control group were 0 and 3.47%(61/1 757), respectively. The difference was statistically significant (χ2=59.943, P<0.01). Among the 74 patients in the observation group who underwent catheter resetting, 63 patients were reset ≤1 times, 9 patients were reset twice, 2 patients were reset≥third; among the 61 patients in the control group who underwent catheter resetting, 24 patients were reset≤1 times, 6 patients were reset twice, 31 patients were reset≥third, the number of the resetting in two groups were compared,the difference was statistically significant(χ2=42.712, P<0.05). The average reset time of the observation group was (49.66±25.45) s, and the average reset time of the control group was (610.41±206.23) s, the difference was statistically significant (t=18.636, P<0.01).The incidence of mechanical phlebitis in the observation group and the control group were 1.31%(23/1 756) and 3.76%(66/1 757), respectively. The incidence of mechanical phlebitis in the two groups was statistically significant (χ2=20.241, P<0.01). The incidence of symptomatic thrombosis in the observation group and the control group were 0.34%(6/1 756), 1.20%(21/1 757), respectively. The incidence of symptomatic thrombosis in the two groups was statistically significant (χ2=8.261, P<0.05).@*Conclusions@#The use of the supportting guide wire to withdraw and re-feed during the catheterization process can effectively eliminate the PICC catheter refolding malposition, reduce the number of catheter reposition and the average reposition time, and reduce the incidence of mechanicalness phlebitis and symptomatic thrombosis. This method is simple and easy to use, it is worthy of clinical application.
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Objective@#To explore the correlation between PICC optimal prediction length and height, body mass index, and provide a more accurate prediction method for PICC depth management.@*Methods@#A total of 100 patients with PICC catheterization in January 2018 were selected for self-controlled study, and two different in vitro measurement methods were used for the same patient at the same time.Traditionally, the Rountree method is used to obtain the predicted length from the puncture point to the right sternoclavicular joint and back down to the third intercostal space (A). This group of methods is used only for measurement and data recording as A control.The experimental measurement method adopted the modified method, that is, the length from the puncture point to the right sternoclavicular joint, plus the predicted length based on the pre-addition of 6-10cm according to the height and body mass index (B). This group of methods was applied to the actual catheterization.The ideal length of the catheter was determined by chest radiograph after catheterization (C).The length of the catheter is predicted by traditional Rountree methods (A) 42.0 ± 2.867cm, experimentally measured (B) 40.30± 2.435cm, and idealized (C)39.81± 2.411cm.Kruskal-wallis H test and analysis of three lengths of data A, B and C were performed, and the correlation between height, body mass index and PICC catheter length was compared through multiple linear regression analysis.@*Results@#the length predicted by the experimental method was closer to the ideal length (P=0.657), and the regression model had statistical significance, F(2,97) =36.931, P<0.01, and adjusted, R2=0.421. The included height and body mass index (BMI) were statistically significant in predicting ideal catheter length (P<0.05).@*Conclusions@#The length of the catheter was predicted from the puncture point to the right sternoclavicular joint plus 6-10cm according to the height and body mass index, which was closer to the ideal length.
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Objective To explore the use of supporting guide wire to exclude the PICC catheter refolding malposition,and reduce the number of the catheter resetting and the average time of catheter resetting,while reducing the mechanicalness phlebitis and the incidence of symptomatic thrombosis. Methods A total of 3 513 patients who received PICC from September 2016 to August 2018 were enrolled. The patients were divided into control group (1 757 cases) and observation group (1 756 cases) by random number table method.The control group was treated with conventional B-ultrasound guided modified Sadinger technique PICC. After the observation group was finished on the basis of the control group, the support guide wire was partially withdrawn and re-sent, according to whether the guide wire was re-supplied or not, to determine whether the catheter has a partial fold in the body. The incidence of catheter refolding malposition, the number of reductions, the time of reduction, and the incidence of mechanicalness phlebitis and symptomatic thrombosis were compared between the two groups. Results The refolding malposition rate of the observation group and the control group were 0 and 3.47%(61/1 757), respectively. The difference was statistically significant (χ2=59.943, P＜0.01). Among the 74 patients in the observation group who underwent catheter resetting, 63 patients were reset≤1 times, 9 patients were reset twice, 2 patients were reset≥third;among the 61 patients in the control group who underwent catheter resetting, 24 patients were reset≤1 times, 6 patients were reset twice,31 patients were reset≥third,the number of the resetting in two groups were compared,the difference was statistically significant (χ2=42.712, P＜0.05). The average reset time of the observation group was (49.66 ± 25.45) s, and the average reset time of the control group was (610.41±206.23) s, the difference was statistically significant (t=18.636, P＜0.01).The incidence of mechanical phlebitis in the observation group and the control group were 1.31%(23/1 756) and 3.76%(66/1 757), respectively. The incidence of mechanical phlebitis in the two groups was statistically significant (χ2=20.241, P＜0.01). The incidence of symptomatic thrombosis in the observation group and the control group were 0.34% (6/1 756), 1.20% (21/1 757), respectively. The incidence of symptomatic thrombosis in the two groups was statistically significant (χ2=8.261, P＜0.05). Conclusions The use of the supportting guide wire to withdraw and re-feed during the catheterization process can effectively eliminate the PICC catheter refolding malposition, reduce the number of catheter reposition and the average reposition time, and reduce the incidence of mechanicalness phlebitis and symptomatic thrombosis. This method is simple and easy to use, it is worthy of clinical application.
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Objective To explore the correlation between PICC optimal prediction length and height, body mass index, and provide a more accurate prediction method for PICC depth management. Methods A total of 100 patients with PICC catheterization in January 2018 were selected for self_controlled study, and two different in vitro measurement methods were used for the same patient at the same time.Traditionally, the Rountree method is used to obtain the predicted length from the puncture point to the right sternoclavicular joint and back down to the third intercostal space (A). This group of methods is used only for measurement and data recording as A control.The experimental measurement method adopted the modified method, that is, the length from the puncture point to the right sternoclavicular joint, plus the predicted length based on the pre_addition of 6-10cm according to the height and body mass index (B). This group of methods was applied to the actual catheterization.The ideal length of the catheter was determined by chest radiograph after catheterization (C).The length of the catheter is predicted by traditional Rountree methods (A) 42.0 ± 2.867cm, experimentally measured (B) 40.30± 2.435cm, and idealized (C)39.81± 2.411cm.Kruskal_wallis H test and analysis of three lengths of data A, B and C were performed, and the correlation between height, body mass index and PICC catheter length was compared through multiple linear regression analysis. Results the length predicted by the experimental method was closer to the ideal length (P=0.657), and the regression model had statistical significance, F(2,97)=36.931, P<0.01, and adjusted, R2=0.421. The included height and body mass index (BMI) were statistically significant in predicting ideal catheter length (P<0.05). Conclusions The length of the catheter was predicted from the puncture point to the right sternoclavicular joint plus 6-10cm according to the height and body mass index, which was closer to the ideal length.
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Objective To determine the accuracy of intracavitary electrocardiogram bimodal P-wave and characteristic P-wave in the position of PICC tip. Methods In the process of ECG guided catheterization, the morphological changes of P-wave in the intracavitary electrocardiogram were observed, and the bimodal P-wave and characteristic P-wave were recorded. The corresponding catheter length of the bimodal P-wave and characteristic P-wave were recorded. CT three-dimensional reconstruction was performed on 416 patients who underwent CT examination before and after catheterization. The distance between carina of trachea to superior vena cava and the right atrium junction was measured as best position of PICC and the standard distance. After catheterization, the distance from the tip of catheter to the corresponding catheter length of the bimodal P-wave and characteristic P-wave was measured as actual distance, and compared with the standard distance. Results In 416 cases, 168 patients (40.38％) were bimodal P-wave, and the accurate rate of bimodal P-wave was 86.31％(145/416), and the accurate rate of the characteristic P-wave was 13.69％(23/416). The standard distance was (41.96 ± 9.16) mm, the actual distance of corresponding characteristic P-wave was (48.00±15.18) mm and bimodal P-wave was (45.10± 11.16) mm. The distance of bimodal P-wave to control was (1.31±0.33) mm and characteristic P-wave was (6.00 ± 2.88) mm, which was significant statistical difference (t =5.197, P < 0.05), and the standard deviation of the distance of bimodal P-wave to control was smaller (0.33 < 2.88). Conclusions The intracavitary electrocardiogram bimodal P-wave is more accurate than characteristic P-wave in the position of PICC tip and it supplements and improves thePICC's tip position.
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Objective To explore the application of limbs and fingers movement combined with moxibustion in patients with PICC catheterization. Methods A total of 346 PICC catheterized patients treated from August 2014 to July 2017 were randomly divided into control group (173 cases) and observation group (173 cases) according to random number table method. The control group was given local hot-wet compression at 3-4 cm of puncture point after 24 h of catheterization, and the observation group was given preventive moxibustion with the direction of the punctured vein at the same site in the control group, and then was given limbs and fingers movement. The levels of serum monocyte chemoattractant protein- 1 (MCP- 1), tumor necrosis factor- α (TNF- α) and interleukin- 8 (IL- 8), hemorheological parameters [rate of high and low shear whole blood viscosity (RBV), rate of plasma specific viscosity (RPV), hematocrit (HCT)] and the incidence rates of mechanical phlebitis and venous thrombosis were compared between the two groups after intervention. Results The levels of MCP-1, TNF-αand IL-8 were (53.03±7.86), (85.93±10.72), (54.65±9.23) ng/L in the observation group, (60.27± 8.45), (94.74±11.36), (63.08±10.07) ng/L in the control group, and there were significant differences (t=8.252, 7.419, 8.117, all P<0.05). The levels of high shear RBV, low shear RBV, RPV and HCT were (3.94 ± 0.85) mPa · s, (6.55 ± 1.22) mPa · s, (1.70 ± 0.54) mPa · s and (43.71 ± 4.82)％ respectively in the observation group, (4.18±0.74) mPa·s, (6.97±1.25) mPa·s, (1.92±0.59) mPa·s and (45.13±4.65)％in the control group, and there were significant differences (t=2.789-3.618, P<0.05). The incidence rates of venous thrombosis and phlebitis were 1.16％(2/173) and 5.78％(10/173) respectively in the observation group, 5.78％(10/173) and 13.29％(23/173) in the control group, there were significant differences (χ2=4.230, 5.661, P<0.05). Conclusions Limbs and fingers movement combined with moxibustion can effectively improve the blood flow status, and reduce the occurrence of mechanical phlebitis and venous thrombosis in patients with PICC catheterization.
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Objective: To investigate the application effect of location technique of endocaridal ECG at catheter tip of patient with catheter of peripherally inserted central catheter (PICC) during the period of wearing catheter. Methods:116 patients with peripherally inserted central catheter(PICC) were enrolled into the research. And the location of endocaridal ECG were guided through saline water column under the condition without guiding wire. In these ECG, the results of 110 cases showed P wave was high, and results of 4 cases showed incisura of M shape, and results of 2 cases showed P wave was flatness. As the confirmed results of X-ray, the catheters of 2 patients with flat P wave were ectopic. Results: After endocaridal ECG was guided by using saline water column, the change of P wave could locate the tip location of patients with catheter of PICC, and its specificity was 98.2%. And the difference of P wave between guided endocaridal ECG and ECG of body surface was significant (t=22.194, P<0.05). Conclusion: The catheter of PICC that observes the change of P wave by guiding endocaridal ECG can judge the location of the tip of catheter. And this operation is convenient, non-damage, and high specificity. Besides, it can decrease examination cost of patients, and enhance the safety of patient with catheter of endocaridal ECG. Therefore, its clinical application value is well.
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Objective@#To observe the effect of the application of the "3Y" shape Multipore tape combined with transparent dressing in the maintenance of double lumen PowerPICC.@*Methods@#Totally150 patients inserted double lumen powerPICC were randomly assigned to experimental group and control group, each group included 75 patients. when maintaining PICC, the "3Y" shape Multipore tape combined with transparent dressing were used for experimental group, while traditional method were used for control group. The endpoints were: the time for dressing change,the incidence of catheter migration,the incidence of dressing rolling or loosing,the incidence of PICC related complications.@*Results@#The time for dressing change of experimental group (13.14±0.23) min was significant longer than control group (12.99±0.24) min (t=4.025, P<0.05) ; incidence of catheter migration of experimental group (5.3%,4/75) was significant lower than control group (18.7%, 14/75) (χ2=6.424, P=0.04). Incidence of dressing rolling or loosing of experimental group (9.3%,7/75) was significant lower than control group (22.7%,17/75)(χ2=7.028, P=0.03). Incidence of complication of experimental (1.3%, 1/75) was significant lower than control group (9.3%, 7/75) (χ2=4.754, P=0.03) .@*Conclusions@#Application of the "3Y" shape Multipore tape combined with transparent dressing in the maintenance of double lumen PowerPICC cost a little bite more time,while reduce the incidence of catheter migration and related complications, improve patients′degree of comfort, worth to be widely used.