Objective: Our object is to study risk factors of tumor patients’ PICC catheter-related blood stream infection. Method: a retrospective analysis of data of 586 PICC catheterized patients was implemented, a univariate...Objective: Our object is to study risk factors of tumor patients’ PICC catheter-related blood stream infection. Method: a retrospective analysis of data of 586 PICC catheterized patients was implemented, a univariate analysis of general data and catheterizing data of tumor patients was then carried out, and data of single factors with statistical significance were incorporated into multi-factor Logistic regression model for analysis. Results: PICC catheter-related blood stream infection occurred to 16 patients, and occurrence rate was 2.73%. Multi-factor Logistic regression analysis results showed that number of puncturing times, positioning method and maintenance frequency were risk factors for tumor patients’ peripherally inserted central catheter catheter-related blood stream infection, and odds risk values were respectively 8.762, 9.253 and 10.324. Conclusion: for tumor patients implanted with peripherally inserted central catheters, using ECG positioning during strict sterile operation and catheterizing process to avoid repeated puncturing and increasing maintenance frequency could effectively reduce occurrence of PICC catheter-related blood stream infection.展开更多
Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for diff...Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.展开更多
Infection is a common complication and is the second leading cause of death in hemodialysis patients. The risk of bacteremia in hemodialysis patients is 26-fold higher than in the general population, and 1/2-3/4 of th...Infection is a common complication and is the second leading cause of death in hemodialysis patients. The risk of bacteremia in hemodialysis patients is 26-fold higher than in the general population, and 1/2-3/4 of the causative organisms of bacteremia in hemodialysis patients are Gram-positive bacteria. The ratio of resistant bacteria in hemodialysis patients compared to the general population is unclear. Several reports have indicated that hemodialysis patients have a higher risk of methicillin-resistant Staphylococcus aureus infection. The most common site of infection causing bacteremia is internal prostheses; the use of a hemodialysis catheter is the most important risk factor for bacteremia. Although antibiotic lock of hemodialysis catheters and topical antibiotic ointment can reduce catheter-related blood stream infection(CRBSI), their use should be limited to necessary cases because of the emergence of resistant organisms. Systemic antibiotic administration and catheter removal is recommended for treating CRBSI, although a study indicated the advantages of antibiotic lock and guidewire exchange of catheters over systemic antibiotic therapy. An infection control bundle recommended by the Center for Disease Control and Prevention succeeded in reducing bacteremia in hemodialysis patients with either a catheter or arteriovenous fistula. Appropriate infection control can reduce bacteremia in hemodialysis patients.展开更多
目的 系统评价血液透析患者导管相关性血流感染风险预测模型,为临床选择合适的预测模型或开发新模型提供参考依据。方法 检索CINAHL、PubMed、Web of Science、Cochrane Library、Embase、万方数据库、中国知网、维普网、中国生物医学...目的 系统评价血液透析患者导管相关性血流感染风险预测模型,为临床选择合适的预测模型或开发新模型提供参考依据。方法 检索CINAHL、PubMed、Web of Science、Cochrane Library、Embase、万方数据库、中国知网、维普网、中国生物医学文献数据库中有关血液透析患者导管相关性感染风险预测模型的文献,检索时限均为建库至2023年10月1日。由2名研究者独立筛选文献和提取数据,并采用预测模型研究的偏倚风险评估工具(prediction model risk of bias assessment tool,PROBAST)分析纳入文献的偏倚风险和适用性。结果 共纳入7篇文献。4篇关于血液透析患者长期导管相关性感染的风险预测模型,1篇血液透析患者临时导管相关性感染的风险预测模型,2篇关于血液透析患者中心静脉导管相关性感染的风险预测模型。共5篇文献将血清白蛋白水平、导管留滞时间和合并糖尿病都纳为血液透析患者导管相关性感染的主要预测因素,3篇文献将患者的年龄当做血液透析患者导管相关性感染的主要预测因子,置管部位和手卫生预测因素在2篇预测模型中被纳为预测因子。预测模型的受试者工作特征曲线下面积范围为0.734~0.889。7篇文献中共有4个模型进行了Hosmer-Lemeshow校准度分析,模型的呈现形式也大多采用风险评分公式。所有研究适用性较好,但存在方法学缺陷(如缺失数据处理不当、未采用恰当方法选择变量、未提及盲法等)导致较高的偏倚风险。结论 血液透析患者导管相关性血流感染风险预测模型预测性能较好,但存在较高的偏倚风险,不能直接应用于临床实践。未来应选择已有模型进行深入广泛的验证或开展大样本、多人群的前瞻性研究以开发预测性能优良、使用简便的预测模型。展开更多
目的探讨基于行为转变理论的培训对新生儿护士经外周置入中心静脉导管(peripherally inserted central catheter,PICC)相关血流感染防控行为的影响。方法采取随机抽样法,选取绵阳市某医院42名新生儿护士为研究对象,对其实施基于行为转...目的探讨基于行为转变理论的培训对新生儿护士经外周置入中心静脉导管(peripherally inserted central catheter,PICC)相关血流感染防控行为的影响。方法采取随机抽样法,选取绵阳市某医院42名新生儿护士为研究对象,对其实施基于行为转变理论的PICC相关血流感染防控培训,培训前、培训后分别采用PICC相关血流感染防控行为阶段调查表与PICC相关血流感染防控实践现状调查表对新生儿护士的PICC相关血流感染防控行为、感染防控认知与操作水平、导管相关性血流感染发生率进行评价。结果培训后,新生儿护士导管相关血流感染防控行为阶段优于培训前,差异有统计学意义(P<0.001),培训后导管相关血流感染防控认知与操作技能评分均高于培训前,差异有统计学意义(P<0.001),培训后导管相关性血流感染发生率1.06‰(2/1887)较培训前6.42‰(14/2180)明显下降,差异有统计学意义(P<0.001)。结论基于行为转变理论的培训有助于提升新生儿护士实施PICC相关血流感染防控措施的依从性,促进其防控行为发生正向转变,有助于PICC相关血流感染防控措施的落实,从而降低PICC相关血流感染发生率。展开更多
文摘Objective: Our object is to study risk factors of tumor patients’ PICC catheter-related blood stream infection. Method: a retrospective analysis of data of 586 PICC catheterized patients was implemented, a univariate analysis of general data and catheterizing data of tumor patients was then carried out, and data of single factors with statistical significance were incorporated into multi-factor Logistic regression model for analysis. Results: PICC catheter-related blood stream infection occurred to 16 patients, and occurrence rate was 2.73%. Multi-factor Logistic regression analysis results showed that number of puncturing times, positioning method and maintenance frequency were risk factors for tumor patients’ peripherally inserted central catheter catheter-related blood stream infection, and odds risk values were respectively 8.762, 9.253 and 10.324. Conclusion: for tumor patients implanted with peripherally inserted central catheters, using ECG positioning during strict sterile operation and catheterizing process to avoid repeated puncturing and increasing maintenance frequency could effectively reduce occurrence of PICC catheter-related blood stream infection.
文摘Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.
文摘Infection is a common complication and is the second leading cause of death in hemodialysis patients. The risk of bacteremia in hemodialysis patients is 26-fold higher than in the general population, and 1/2-3/4 of the causative organisms of bacteremia in hemodialysis patients are Gram-positive bacteria. The ratio of resistant bacteria in hemodialysis patients compared to the general population is unclear. Several reports have indicated that hemodialysis patients have a higher risk of methicillin-resistant Staphylococcus aureus infection. The most common site of infection causing bacteremia is internal prostheses; the use of a hemodialysis catheter is the most important risk factor for bacteremia. Although antibiotic lock of hemodialysis catheters and topical antibiotic ointment can reduce catheter-related blood stream infection(CRBSI), their use should be limited to necessary cases because of the emergence of resistant organisms. Systemic antibiotic administration and catheter removal is recommended for treating CRBSI, although a study indicated the advantages of antibiotic lock and guidewire exchange of catheters over systemic antibiotic therapy. An infection control bundle recommended by the Center for Disease Control and Prevention succeeded in reducing bacteremia in hemodialysis patients with either a catheter or arteriovenous fistula. Appropriate infection control can reduce bacteremia in hemodialysis patients.
文摘目的 系统评价血液透析患者导管相关性血流感染风险预测模型,为临床选择合适的预测模型或开发新模型提供参考依据。方法 检索CINAHL、PubMed、Web of Science、Cochrane Library、Embase、万方数据库、中国知网、维普网、中国生物医学文献数据库中有关血液透析患者导管相关性感染风险预测模型的文献,检索时限均为建库至2023年10月1日。由2名研究者独立筛选文献和提取数据,并采用预测模型研究的偏倚风险评估工具(prediction model risk of bias assessment tool,PROBAST)分析纳入文献的偏倚风险和适用性。结果 共纳入7篇文献。4篇关于血液透析患者长期导管相关性感染的风险预测模型,1篇血液透析患者临时导管相关性感染的风险预测模型,2篇关于血液透析患者中心静脉导管相关性感染的风险预测模型。共5篇文献将血清白蛋白水平、导管留滞时间和合并糖尿病都纳为血液透析患者导管相关性感染的主要预测因素,3篇文献将患者的年龄当做血液透析患者导管相关性感染的主要预测因子,置管部位和手卫生预测因素在2篇预测模型中被纳为预测因子。预测模型的受试者工作特征曲线下面积范围为0.734~0.889。7篇文献中共有4个模型进行了Hosmer-Lemeshow校准度分析,模型的呈现形式也大多采用风险评分公式。所有研究适用性较好,但存在方法学缺陷(如缺失数据处理不当、未采用恰当方法选择变量、未提及盲法等)导致较高的偏倚风险。结论 血液透析患者导管相关性血流感染风险预测模型预测性能较好,但存在较高的偏倚风险,不能直接应用于临床实践。未来应选择已有模型进行深入广泛的验证或开展大样本、多人群的前瞻性研究以开发预测性能优良、使用简便的预测模型。
文摘目的探讨基于行为转变理论的培训对新生儿护士经外周置入中心静脉导管(peripherally inserted central catheter,PICC)相关血流感染防控行为的影响。方法采取随机抽样法,选取绵阳市某医院42名新生儿护士为研究对象,对其实施基于行为转变理论的PICC相关血流感染防控培训,培训前、培训后分别采用PICC相关血流感染防控行为阶段调查表与PICC相关血流感染防控实践现状调查表对新生儿护士的PICC相关血流感染防控行为、感染防控认知与操作水平、导管相关性血流感染发生率进行评价。结果培训后,新生儿护士导管相关血流感染防控行为阶段优于培训前,差异有统计学意义(P<0.001),培训后导管相关血流感染防控认知与操作技能评分均高于培训前,差异有统计学意义(P<0.001),培训后导管相关性血流感染发生率1.06‰(2/1887)较培训前6.42‰(14/2180)明显下降,差异有统计学意义(P<0.001)。结论基于行为转变理论的培训有助于提升新生儿护士实施PICC相关血流感染防控措施的依从性,促进其防控行为发生正向转变,有助于PICC相关血流感染防控措施的落实,从而降低PICC相关血流感染发生率。
