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Study on the Risk Factors of Central Venous-Related Bloodstream Infection in Outpatients
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作者 Lu Yan Cuiyu Han +2 位作者 Xuerun Du Yujie Gu Rui Gao 《Journal of Clinical and Nursing Research》 2023年第4期120-125,共6页
Objective:To analyze the risk factors of catheter-related bloodstream infection in outpatients and propose feasible prevention and control measures.Methods:The medical records of outpatients with peripherally inserted... Objective:To analyze the risk factors of catheter-related bloodstream infection in outpatients and propose feasible prevention and control measures.Methods:The medical records of outpatients with peripherally inserted central catheter(PICC)from January 2020 to December 2021 were selected for retrospective analysis,and the factors that may be related to the occurrence of catheter-related bloodstream infection were analyzed by logistic multivariate analysis.Results:The incidence rate of catheter-related bloodstream infection among the enrolled patients was 4.78%.It was found that age,duration of catheterization,catheter site,number of punctures,and diabetes were all risk factors for catheter-associated bloodstream infection,and the differences were statistically significant.Conclusion:Age,duration of catheterization,catheterization site,and diabetes are all risk factors for catheter-related bloodstream infection,and medical personnel should fully understand and learn more about these risk factors and actively develop countermeasures to reduce the risk of catheter-related bloodstream infection. 展开更多
关键词 OUTPATIENT central venous catheter bloodstream infection
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Emphysematous thrombophlebitis caused by a misplaced central venous catheter: A case report
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作者 Ni Chen Hua-Jun Chen +3 位作者 Tao Chen Wen Zhang Xiao-Yun Fu Zhou-Xiong Xing 《World Journal of Clinical Cases》 SCIE 2023年第29期7207-7213,共7页
BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced... BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis,a rare but potentially lethal form of CRT and CVC-BSI characterized by both thrombosis and gas formation.CASE SUMMARY A 48-year-old male presented to the emergency room of a local hospital with sudden-onset headache and coma for 4 h.Computed tomography(CT)revealed right basal ganglia hemorrhage,so emergency decompressive craniotomy was performed and a CVC was inserted through the right subclavian vein for fluid resuscitation during anesthesia.Two days later,the patient was transferred to the intensive care unit of our hospital for further critical care.On day 9 after CVC insertion,the patient suddenly developed fever and hypotension.Point-of-care ultrasound(POCUS)demonstrated thrombosis and dilatation of the right internal jugular vein(IJV)filled with thrombosis.Ultrasonography also revealed that the CVC tip had been misplaced into the IJV and was surrounded by gas bubbles,which manifested as hyperechoic lines with dirty shadowing and comet-tail artifacts.Further CT scan confirmed air bubbles surrounding the CVC in the right neck.The final diagnosis was septic emphysematous thrombophlebitis induced by a misplaced CVC and ensuing septic shock.The responsible CVC was removed immediately.The patient received fluid resuscitation,intravenous noradrenaline,and a 10-d ultra-broad spectrum antibiotic treatment to combat septic shock.Both CVC and peripheral venous blood cultures yielded methicillin-resistant Staphylococcus cohnii.The patient was gradually weaned off vasopressors and the symptoms of redness and swelling in the right neck subsided within 7 d.CONCLUSION Emphysematous thrombophlebitis is a fulminant and life-threatening CVC-BSI associated with thrombosis and gas formation in the vein.A misplaced CVC may facilitate the development of emphysematous thrombophlebitis.POCUS can easily identify the artifacts produced by gas and thrombosis,facilitating rapid diagnosis at the bedside. 展开更多
关键词 Emphysematous thrombophlebitis Septic thrombophlebitis central venous catheter ULTRASOUND Catheter-related thrombosis central venous catheter-related bloodstream infection Case report
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Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation 被引量:2
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作者 Nicole D Triggs Stacey Beer +5 位作者 Sonam Mokha Kat Hosek Danielle Guffey Charles G Minard Flor M Munoz Ryan W Himes 《World Journal of Hepatology》 CAS 2019年第2期208-216,共9页
BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutriti... BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone,and parenteral nutrition(PN) may be indicated.While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation,less is known about the risks,particularly infectious,associated with this therapy among this specific group of patients.AIM To describe the incidence,microbiology,and risk factors of central line-associated bloodstream infection(CLABSI) among children with BA listed for liver transplantation.METHODS Retrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children's Hospital from 2008 through2015(n = 96).Patients with a central line for administration of PN(n = 63) were identified and details of each CLABSI event were abstracted.We compared the group of patients who experienced CLABSI to the group who did not,to determine whether demographic,clinical,or laboratory factors correlated with development of CLABSI.RESULTS Nineteen of 63 patients(30%,95%CI:19,43) experienced 29 episodes of CLABSI during 4800 line days(6.04 CLABSI per 1000 line days).CLABSI was predominantly associated with Gram-negative organisms(14/29 episodes,48%)including Klebsiella spp.,Enterobacter spp.,and Escherichia coli.The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae.Grampositive organisms(all Staphylococcus spp.) and fungus(all Candida spp.)comprised 9/29(31%) and 6/29(21%) episodes,respectively.No demographic,clinical,or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysis CONCLUSION There is substantial risk for CLABSI among children with BA listed for liver transplantation.No clinical,demographic,or laboratory factor we tested emerged as an independent predictor of CLABSI.While our data did not show an impact of CLABSI on the short-term clinical outcome,it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization,unnecessary healthcare dollar expenditures,and may exact an opportunity cost,in terms of missed allograft offers. 展开更多
关键词 PARENTERAL nutrition central line-associated bloodstream infection Pediatric Microbiology central venous catheter
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Central Line Associated Bloodstream Infection in Adult Intensive Care Unit Population—Changes in Epidemiology, Diagnosis, Prevention, and Addition of New Technologies 被引量:2
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作者 Theresia Edgar Lutufyo Weidong Qin Xiaomei Chen 《Advances in Infectious Diseases》 2022年第2期252-280,共29页
Background: Intensive care units (ICUs) have an increased risk of Central line associated bloodstream infection (CLABSI) due to the prevalence of invasive procedures, devices, immunosuppression, comorbidity, frailty, ... Background: Intensive care units (ICUs) have an increased risk of Central line associated bloodstream infection (CLABSI) due to the prevalence of invasive procedures, devices, immunosuppression, comorbidity, frailty, and elderly patients. We have seen a successful reduction in Central line associated bloodstream infection related the past decade. In spite of this, Intensive care unit-Catheter related bloodstream infections remain high. The emergence of new pathogens further complicates treatment and threatens patient outcomes in this context. In addition, the SARS-CoV-2 (COVID-19) pandemic served as a reminder that an emerging pathogen poses a challenge for adjusting prevention measures regarding both the risk of exposure to caregivers and maintaining a high level of care. ICU nurses play an important role in the prevention and management of CLABSI as they are involved in basic hygienic care, quality improvement initiatives, microbiological sampling, and aspects of antimicrobial stewardship. Microbiological techniques that are more sensitive and our increased knowledge of the interactions between critically ill patients and their microbiota are forcing us to rethink how we define CLABSIs and how we can diagnose, treat, and prevent them in the ICU. The objective of this multidisciplinary expert review, focused on the ICU setting, is to summarize the recently observed occurrence of CLABSI in ICU, to consider the role of modern microbiological techniques in their diagnosis, to examine clinical and epidemiological definitions, and to redefine several controversial preventive measures including antimicrobial-impregnated catheters, chlorhexidine-gluconate impregnated sponge, and catheter dressings. 展开更多
关键词 central venous Catheter SARS-COV-2 ICU bloodstream infection Catheter Colonization Catheter Insertion
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Five-Year Surveillance of Central Line Associated Bloodstream Infection in an Intensive Care Unit Population—A Retrospective Analysis
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作者 Theresia Lutufyo Yuan Li +3 位作者 Hui Han Weidong Qin Geofrey Mahiki Mranda Xiaomei Chen 《Advances in Infectious Diseases》 2022年第2期281-297,共17页
Background: Central venous catheters (CVCs) are essential to current intensive care unit (ICU) practices as a tool for treating critically ill patients. However, the use of CVCs is associated with substantial risk of ... Background: Central venous catheters (CVCs) are essential to current intensive care unit (ICU) practices as a tool for treating critically ill patients. However, the use of CVCs is associated with substantial risk of infection. Central line associated bloodstream infection (CLABSI) is increasing in prevalence each year and is among the major causes of bloodstream infection in ICU patients. Therefore, investigating the epidemiology and risk factors of CLABSI in ICU patients is important. Objective: This study aimed to investigate the incidence rates, causative pathogens and risk factors of CLABSI in an ICU population. Methods: A retrospective observational study was performed in an ICU at Qilu Hospital of Shandong University in China from January 2016 to December 2020. Patients with at least one CVC were enrolled, and information relevant to CVC use was recorded. The prevalence was calculated, and related risk factors were analyzed. Results: A total of 1920 catheters were identified, 507 of which were eligible for analysis. For each of the years 2016-2020, the incidence rates of CLABSI were 1.91, 3.18, 1.69, 2.97 and 1.27 per 1000 catheter days, respectively. The yeast Candida albicans was the most prevalent pathogen (16 [(3.2%]), followed by Gram-positive methicillin-resistant Staphylococcus aureus (11 [2.2%]) and the Gram-negative multidrug-resistant pathogen Acinetobacter baumanii. Risk factors associated with CLABSI development were age, (p = 0.05), Charlson comorbidity index > 5 (p Conclusion: Candida albicans was the most common causative microorganism, which was followed by Gram positive methicillin resistant Staphylococcus, MDR K. pneumoniae and Acinetobacter baumanii. 展开更多
关键词 central venous Catheter Insertion Site bloodstream infection ICU Catheter Days
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Investigation and Analysis of the Status Quo of Prevention and Control Practices of Catheter-Line Associated Bloodstream Infections (CLABSI) in Guangxi, China 被引量:1
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作者 Caijiao Wu Huihan Zhao +3 位作者 Galal A. Al-Samhari Qingjuan Jiang Ying Ling Yanping Ying 《Advances in Infectious Diseases》 2021年第4期333-343,共11页
The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the pre... The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the prevention and control status of CLABSI in hospitals of different grades in Guangxi is not clear. In this study, we aim to investigate central venous catheter (CVC) placement and disinfectant use in second and third-level hospitals in Guangxi. This survey was conducted on the second and third-level hospitals in Guangxi, China from 13th April 2021 to 19th April 2021. The results show that a total of 283 questionnaires were collected, including 206 secondary hospitals and 77 tertiary hospitals. In terms of the CVC, tertiary hospitals were able to place CVC entirely under the guidance of B-ultrasound, which was 24 (31.6%) and secondary hospitals were 26 (20.6%). In secondary hospitals, Most CVC placements were performed in operating rooms 94 (74.6%) and 65 (85.5%) on the third level hospital, but 32.5% of secondary hospitals and 48.7% of tertiary hospitals were selected at the bedside of patients in general wards, and 27.8% of the second-level hospital, 43.4% of third-level hospitals was done in general ward treatment rooms, only 61.9% of secondary hospitals and 64.5% of tertiary hospitals could fully achieve the maximum sterile barrier. In terms of skin disinfectants, only 36.0% of tertiary hospitals and 16.4% of second-level CVC-operators chose > 0.5% chlorhexidine alcohol. In conclusion, the prevention and control of catheter line-associated bloodstream infections (CLABSI) in Guangxi are not ideal. The prevention and control department should increase training, implement guidelines and standardize management to reduce the incidence of CLABSI. 展开更多
关键词 central venous Catheter Catheter-Line Associated bloodstream infections PREVENTION Quality Control Survey
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Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium's findings 被引量:24
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作者 Estuardo Salgado Yepez Maria M Bovera +13 位作者 Victor D Rosenthal Hugo A González Flores Leonardo Pazmino Francisco Valencia Nelly Alquinga Vanessa Ramirez Edgar Jara Miguel Lascano Veronica Delgado Cristian Cevallos Gasdali Santacruz Cristian Pelaéz Celso Zaruma Diego Barahona Pinto 《World Journal of Biological Chemistry》 CAS 2017年第1期95-101,共7页
AIM To report the results of the International Nosocomial Infection Control Consortium(INICC) study conducted in Quito, Ecuador.METHODS A device-associated healthcare-acquired infection(DAHAI) prospective surveillance... AIM To report the results of the International Nosocomial Infection Control Consortium(INICC) study conducted in Quito, Ecuador.METHODS A device-associated healthcare-acquired infection(DAHAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units(ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network(CDC/NHSN) definitions and INICC methods. RESULTS We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection(CLABSI) rate was 6.5 per 1000 central line(CL)-days, the ventilator-associated pneumonia(VAP) rate was 44.3 per 1000 mechanical ventilator(MV)-days, and the catheterassociated urinary tract infection(CAUTI) rate was 5.7 per 1000 urinary catheter(UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9(CLABSI) and 5.3(CAUTI)] and higher than NHSN rates [0.8(CLABSI) and 1.3(CAUTI)]- although device use ratios for CL and UC were higher than INICC and CDC/NSHN's ratios. By contrast, despite the VAP rate was higher than INICC(16.5) and NHSN's rates(1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI. CONCLUSION DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates. 展开更多
关键词 Ventilator-associated pneumonia catheter-associated urinary tract infection Healthcare-associated infection Antibiotic resistance Developing countries Intensive care unit SURVEILLANCE central line-associated bloodstream infections Hospital infection
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陕西省血液净化从业护士中心静脉导管相关血流感染预防知信行水平调查
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作者 刘小敏 刘彩飞 +3 位作者 龙卓 高菊林 辛霞 代雯晴 《中国卫生质量管理》 2024年第10期60-66,共7页
目的调查陕西省血液净化从业护士对中心静脉导管相关血流感染预防知信行现状,分析影响因素,为相关防控工作开展提供参考。方法采用便利抽样法,于2023年12月-2024年1月对陕西省二、三级医院血液净化从业护士进行问卷调查。利用逐步多元... 目的调查陕西省血液净化从业护士对中心静脉导管相关血流感染预防知信行现状,分析影响因素,为相关防控工作开展提供参考。方法采用便利抽样法,于2023年12月-2024年1月对陕西省二、三级医院血液净化从业护士进行问卷调查。利用逐步多元线性回归分析影响因素。结果共回收有效问卷832份。血液净化从业护士知信行总分、知识维度、信念维度、行为维度得分分别为(104.59±12.99)分、(15.47±1.97)分、(45.52±5.78)分、(43.61±10.23)分。医院等级是知识维度、信念维度和知信行总体的影响因素(P<0.05),所在科室、是否参加过相关防控培训是行为维度的影响因素(P<0.05),是否参加过相关防控培训、医院相关部门是否定期督导和检查是知信行总体的影响因素(P<0.05)。结论陕西省血液净化从业护士中心静脉导管相关血流感染预防的态度和行为积极,但知识水平有待提升。医院应加强培训,尤其是二级医院和ICU。 展开更多
关键词 血液净化 中心静脉导管 血流感染 知信行 护理质量
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血液净化用中心静脉导管相关血流感染防控管理的最佳证据总结 被引量:2
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作者 刘彩飞 刘小敏 +6 位作者 龙卓 辛霞 高菊林 王莉莹 代雯晴 陈思婕 杨聪 《中国卫生质量管理》 2024年第3期45-50,共6页
目的检索、评价并汇总血液净化用中心静脉导管相关血流感染防控管理的证据,为血液透析护理提供循证依据。方法根据“6S”证据模型,系统检索数据库及网站中血液净化用中心静脉导管相关血流感染防控的临床实践指南、专家共识、系统评价、... 目的检索、评价并汇总血液净化用中心静脉导管相关血流感染防控管理的证据,为血液透析护理提供循证依据。方法根据“6S”证据模型,系统检索数据库及网站中血液净化用中心静脉导管相关血流感染防控的临床实践指南、专家共识、系统评价、证据总结、最佳临床实践等。检索时限为建库至2023年7月25日。由两名研究人员进行文献质量评价,证据提取、分析与整合。结果共纳入16篇文献,其中指南8篇、专家共识5篇、系统评价3篇。最终形成包括危险因素、制度管理、无菌屏障、导管留置、导管评估、导管维护、冲封管7个类别共41条的最佳证据。结论医护人员在证据转化过程中应根据导管留置时间和患者个体差异应用证据,并及时更新相关证据,以降低血液净化用中心静脉导管相关血流感染发生率。 展开更多
关键词 血液净化 中心静脉导管 导管相关血流感染 证据总结 循证护理
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基于倾向性评分匹配的ICU中心静脉导管相关血流感染危险因素
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作者 滕支梅 朱尚 +2 位作者 薛寒 黄劲华 孔旭辉 《中国感染控制杂志》 CAS CSCD 北大核心 2024年第11期1405-1412,共8页
目的探讨中心静脉导管相关血流感染(CLABSI)的独立危险因素,为制定感染防控的干预措施和开展针对性治疗提供依据。方法回顾性收集2019年1月—2023年12月某院诊断为CLABSI的患者,将其定义为感染组,并采用倾向性评分匹配(PSM)法1∶4匹配... 目的探讨中心静脉导管相关血流感染(CLABSI)的独立危险因素,为制定感染防控的干预措施和开展针对性治疗提供依据。方法回顾性收集2019年1月—2023年12月某院诊断为CLABSI的患者,将其定义为感染组,并采用倾向性评分匹配(PSM)法1∶4匹配置入中心静脉导管(CVC)且未发生感染的患者为对照组。以是否发生CLABSI为因变量,将匹配后两组的可能危险因素为自变量进行logistic回归分析,探索患者发生CLABSI的独立危险因素。结果共匹配CLABSI组患者42例,非CLABSI组患者168例。多因素logistic回归分析显示,急性生理学及慢性健康状况(APACHEⅡ)评分高[OR=1.217,95%CI(1.094~1.357),P<0.001]、中心静脉置管时间长[OR=1.273,95%CI(1.157~1.400),P<0.001]及股静脉置管[OR=6.846,95%CI(1.511~31.014),P=0.013]是CLABSI发生的独立危险因素。42例CLABSI患者共分离病原菌118株,以革兰阴性菌为主(56株)。结论高APACHEⅡ评分、中心静脉置管时间长及股静脉置管是CLABSI发生的独立危险因素,主要病原菌为革兰阴性杆菌,针对这些危险因素严格落实CLABSI相应的防控措施,减少感染风险。 展开更多
关键词 中心静脉导管相关血流感染 中心静脉导管 倾向性评分匹配 危险因素 CLABSI
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儿童专科医院护士中心静脉导管相关血流感染预防知信行调查
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作者 管萍 陈珺 +3 位作者 孙月 沈玲娣 孙霁雯 罗雯懿 《中国卫生质量管理》 2024年第6期50-56,共7页
目的调查儿童专科医院护士中心静脉导管相关血流感染(CLABSI)知信行现状,分析影响因素,为降低CLABSI发生率提供参考。方法便利选取3家三甲儿童专科医院1112名护士进行问卷调查。采用Kruskal-Wallis H检验进行单因素分析,使用多元线性回... 目的调查儿童专科医院护士中心静脉导管相关血流感染(CLABSI)知信行现状,分析影响因素,为降低CLABSI发生率提供参考。方法便利选取3家三甲儿童专科医院1112名护士进行问卷调查。采用Kruskal-Wallis H检验进行单因素分析,使用多元线性回归进行多因素分析。结果儿童专科医院护士CLABSI预防知信行总得分率为88.27%,知识、态度和行为维度得分率分别为82.71%、95.20%、90.05%。最高学历、医院是否有预防CLABSI的标准操作规程、是否接受过中心静脉导管留置和维护操作的规范化培训是知识维度的影响因素(均P<0.05);医院类别、医院对CLABSI预防的重视程度、是否接受过CLABSI预防相关知识培训是态度和行为维度的影响因素(均P<0.05)。结论儿童专科医院护士对CLABSI预防的态度和行为积极,但知识水平较低。医院应结合实际制订CLABSI防控策略,建立标准操作规程,加大对低学历护士培训力度。 展开更多
关键词 中心静脉导管 导管相关血流感染 儿童专科医院 护士 知识 信念 行为
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维持血液透析患者中心静脉导管相关血流感染影响因素及其交互作用研究
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作者 梁勋枢 李金梅 +1 位作者 江春锦 陆凤明 《系统医学》 2024年第5期98-101,共4页
目的探索维持血液透析患者中心静脉导管相关血流感染影响因素及其交互作用。方法回顾性选取2019年9月—2022年9月贵港市平南县人民医院行维持血液透析的299例患者的临床资料,按照是否感染分感染组(25例),未感染组(274例),通过多因素Logi... 目的探索维持血液透析患者中心静脉导管相关血流感染影响因素及其交互作用。方法回顾性选取2019年9月—2022年9月贵港市平南县人民医院行维持血液透析的299例患者的临床资料,按照是否感染分感染组(25例),未感染组(274例),通过多因素Logistic回归分析中心静脉导管相关性血流感染(Catheter Related Blood Stream Infection,CRBSI)的影响因素,并进一步探讨因素间的交互作用。结果多因素Logistic回归分析结果显示,年龄≥60岁、置管时间≥14 d、置管位置在股静脉、白蛋白(Albumin,ALB)<30 g/L是CRBSI发生的危险因素(OR=1.369、11.339、4.847、1.273,P均<0.05)。交互作用分析中,ALB<30 g/L与置管位置在股静脉存在相乘交互作用(P<0.05),不存在相加交互作用[超额相对危险度(Relative Excess Risk of Interaction,RERI)、归因比(Attributable Proportion of,AP)的95%CI包含0,交互作用指数(Synergy Index,S)的95%CI包含1]。结论维持血液透析患者CRBSI的影响因素为患者年龄、置留部位、置留时间、ALB。ALB<30 g/L与置管位置在股静脉之间存在相乘交互作用。 展开更多
关键词 维持血液透析 中心静脉导管 血流感染 影响因素 交互作用
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风险预警分级管理在ICU中心静脉导管相关性血流感染预防中的应用 被引量:1
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作者 梁钱钱 徐璐 周海燕 《临床护理杂志》 2024年第1期15-17,共3页
目的探讨风险预警分级管理在重症监护病房(ICU)中心静脉导管相关性血流感染(CLABSI)预防中的应用效果。方法选取2022年1月-2023年8月我院ICU行中心静脉置管治疗的患者82例为研究对象,采用抽签法分为对照组和观察组,各41例。对照组行常... 目的探讨风险预警分级管理在重症监护病房(ICU)中心静脉导管相关性血流感染(CLABSI)预防中的应用效果。方法选取2022年1月-2023年8月我院ICU行中心静脉置管治疗的患者82例为研究对象,采用抽签法分为对照组和观察组,各41例。对照组行常规管理,观察组在常规管理的基础上行风险预警分级管理。比较两组CLABSI发生率、导管留置时间、ICU住院时间及ICU护理人员感染控制能力。结果观察组CLABSI总发生率低于对照组,导管留置时间、ICU住院时间短于对照组(P<0.05);观察组管理后护理人员感染控制能力评分高于对照组(P<0.05)。结论风险预警分级管理在ICU中心静脉置管患者的应用可降低CLABSI发生率,缩短导管留置时间及ICU住院时间,提高护理人员感染控制能力。 展开更多
关键词 风险预警 重症监护病房 中心静脉导管相关性血流感染
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中心静脉导管相关性血流感染风险预测模型的系统评价
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作者 赵顺莹 沈斌 +1 位作者 邢韦韦 高艳秋 《中国护理管理》 CSCD 北大核心 2024年第8期1239-1245,共7页
目的:系统检索并评价中心静脉导管相关性血流感染的风险预测模型,以期为临床选择及应用中心静脉导管相关性血流感染的风险预测模型提供参考。方法:检索中、英文数据库中关于中心静脉导管相关性血流感染的有关文献,检索时限为建库至2023... 目的:系统检索并评价中心静脉导管相关性血流感染的风险预测模型,以期为临床选择及应用中心静脉导管相关性血流感染的风险预测模型提供参考。方法:检索中、英文数据库中关于中心静脉导管相关性血流感染的有关文献,检索时限为建库至2023年12月11日。2名研究员独立进行文献筛选和资料提取,使用预测模型研究的偏倚风险评价工具对纳入的研究进行偏倚风险和适用性评价。结果:共纳入16篇文献,涉及15个中心静脉导管相关性血流感染风险预测模型。15个模型的AUC或C指数为0.67~0.930;5个模型进行了内部验证,8个模型进行了外部验证。16篇文献质量评价结果均为高偏倚风险、低适用性风险。出现频次较高的预测因子包括:肠外营养、糖尿病、中心静脉导管留置时间、重症监护室患者或住院史、管腔数、使用抗生素、股静脉置入、恶性肿瘤。结论:现有的中心静脉导管相关性血流感染风险预测模型的预测性能较好,预测因子对临床具有一定的指导意义,但偏倚风险高,未来应对模型进行进一步验证,为制订有效的预防策略提供依据。 展开更多
关键词 中心静脉导管 导管相关性血流感染 预测模型 系统评价
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人中性粒细胞载脂蛋白、降钙素原、白介素-6对危重患者发生导管相关性血流感染的早期诊断价值
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作者 高菲 赵敏敏 +2 位作者 李长秀 韩笑 刘蓓蓓 《中国当代医药》 CAS 2024年第23期22-27,共6页
目的探讨人中性粒细胞载脂蛋白(HNL)、降钙素原(PCT)、白介素-6(IL-6)对长期留置中心静脉导管的危重患者发生导管相关性血流感染(CRBSI)的早期诊断价值。方法选取2022年1月至2023年9月山东第一医科大学第二附属医院重症医学科收治的189... 目的探讨人中性粒细胞载脂蛋白(HNL)、降钙素原(PCT)、白介素-6(IL-6)对长期留置中心静脉导管的危重患者发生导管相关性血流感染(CRBSI)的早期诊断价值。方法选取2022年1月至2023年9月山东第一医科大学第二附属医院重症医学科收治的189例留置中心静脉导管患者为研究对象,按照是否发生CRBSI分为CRBSI组(n=63)和非CRBSI组(n=126)。收集患者临床特征资料及留取血培养当天的HNL、PCT、IL-6结果。采用logistic回归分析建立HNL、PCT和IL-6的联合检测模型。采用受试者工作特征(ROC)曲线评价各项指标对危重患者发生CRBSI的早期诊断价值。结果CRBSI组HNL、PCT、IL-6水平均高于非CRBSI组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,HNL、PCT、IL-6及联合检测模型诊断CRBSI的ROC曲线下面积(AUC)分别为0.950、0.901、0.828、0.964,差异有统计学意义(P<0.05)。HNL、PCT、IL-6诊断CRBSI的最佳临界值分别为248.51 ng/ml、0.62 ng/ml、32.68 pg/ml,灵敏度分别为81.0%、79.4%、84.1%,特异度分别为99.2%、86.4%、69.6%。一致性检测结果显示,联合检测模型结果与预测诊断CRBSI存在较好的一致性(Kappa=0.810,P<0.05),HNL≥248.51 ng/ml与预测诊断CRBSI存在较好的一致性(Kappa=0.804,P<0.05)。结论相比于PCT、IL-6,HNL对危重患者发生导管相关性血流感染有较好的早期诊断价值。 展开更多
关键词 人中性粒细胞载脂蛋白 降钙素原 白介素-6 血流感染 导管相关性血流感染
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基于倾向值匹配法探讨白血病PICC病人并发导管相关性血流感染的因素及预防建议
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作者 瞿春霞 龙志国 《全科护理》 2024年第13期2513-2516,共4页
目的:基于倾向值匹配法探讨白血病经外周静脉置入中心静脉导管(PICC)病人并发血流相关性感染(CRBSI)的因素,并根据分析结果提出预防建议。方法:回顾性选取416例白血病PICC病人,根据有无并发CRBSI分为并发组和未并发组,按照1∶1比例倾向... 目的:基于倾向值匹配法探讨白血病经外周静脉置入中心静脉导管(PICC)病人并发血流相关性感染(CRBSI)的因素,并根据分析结果提出预防建议。方法:回顾性选取416例白血病PICC病人,根据有无并发CRBSI分为并发组和未并发组,按照1∶1比例倾向值匹配两组混杂因素,采用Logistic回归分析探讨匹配后并发CRBSI的因素,并提出CRBSI预防建议。结果:CRBSI发生率为14.66%;倾向性匹配前后并发组合并糖尿病、高渗性输注液、贫血、带管出院占比均高于未并发组(P<0.05),白细胞、血红蛋白、一次穿刺成功占比均低于未并发组(P<0.05),导管留置时间均长于未并发组(P<0.05)。Logistic回归分析显示合并糖尿病、高渗性输注液、贫血、带管出院、导管留置时间均是并发CRBSI的危险因素(P<0.05),白细胞、血红蛋白、一次穿刺成功均是并发CRBSI的保护因素(P<0.05)。结论:合并糖尿病、白细胞、血红蛋白、一次穿刺成功、高渗性输注液、贫血、带管出院、导管留置时间均是白血病PICC病人并发CRBSI的影响因素,应针对上述危险因素加强管理。 展开更多
关键词 倾向值匹配法 白血病 中心静脉置管 导管相关性血流感染 因素
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中心静脉导管相关血流感染的危险因素及风险预测列线图模型构建
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作者 王素娟 海云婷 +2 位作者 陆雪耕 王雪 曲琳 《国际医药卫生导报》 2024年第12期1982-1987,共6页
目的分析重症监护病房(ICU)患者发生导管相关血流感染(CRBSI)的危险因素,构建风险预测列线图模型并验证。方法收集2020年1月1日至2023年4月30日在内蒙古自治区人民医院ICU住院期间留置中心静脉导管患者的病例资料,按照EPV法建立建模组(... 目的分析重症监护病房(ICU)患者发生导管相关血流感染(CRBSI)的危险因素,构建风险预测列线图模型并验证。方法收集2020年1月1日至2023年4月30日在内蒙古自治区人民医院ICU住院期间留置中心静脉导管患者的病例资料,按照EPV法建立建模组(660例)和验证组(179例)。建模组男408例,女252例,年龄66.5(54.0,76.0)岁,导管留置天数10(5,17)d,住ICU天数12(6,22)d;验证组男114例,女65例,年龄66.0(55.0,75.0)岁,导管留置天数10(5,16)d,住ICU天数10(5,22)d。对建模组ICU患者采用多因素logistic回归分析其发生CRBSI的危险因素,采用R4.3.0软件绘制风险预测列线图模型。对模型进行内部验证和外部验证,采用受试者操作特征曲线(ROC)、Calibration校准曲线和Hosmer-Lemeshow拟合优度检验评价模型的区分度、校准度和拟合程度。采用非参数Wilcoxon检验、χ^(2)检验。结果糖尿病、低蛋白血症、插管次数≥2次、导管留置天数与抗菌药物使用天数均是ICU患者发生CRBSI的独立危险因素(均P<0.05)。Hosmer-Lemeshow拟合优度检验结果显示,建模组(χ^(2)=3.466,P=0.902)和验证组(χ^(2)=1.723,P=0.988)中该列线图模型的拟合程度较好;校准曲线分析结果显示,该列线图模型预测建模组与验证组的CRBSI发生率与实际发生率基本吻合;ROC分析结果显示,该列线图模型预测建模组与验证组发生CRBSI的曲线下面积(AUC)分别为0.872[95%CI(0.824~0.920)]、0.937[95%CI(0.890~0.984)]。结论建立的风险预测列线图模型具有较好的预测价值和应用价值,可有效识别ICU患者中发生CRBSI的高危人群。 展开更多
关键词 重症监护病房 中心静脉导管 导管相关血流感染 危险因素 风险预测
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ICU信息化平台支持下基于FMEA护理管理预防CLABSI的实证研究
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作者 冯灿 丁根 +1 位作者 杨咏梅 梅俊杰 《循证护理》 2024年第11期2039-2042,共4页
目的:探讨重症监护室(ICU)信息化平台支持下基于失效模式与效应分析(FMEA)护理管理预防中心静脉导管相关血流感染(CLABSI)的效果。方法:回顾性选取2020年7月1日—2021年6月1日我院急诊重症监护室(EICU)住院的219例行中心静脉置管(CVC)... 目的:探讨重症监护室(ICU)信息化平台支持下基于失效模式与效应分析(FMEA)护理管理预防中心静脉导管相关血流感染(CLABSI)的效果。方法:回顾性选取2020年7月1日—2021年6月1日我院急诊重症监护室(EICU)住院的219例行中心静脉置管(CVC)的病人为对照组,采用常规护理管理,选取2021年7月1日—2022年6月1日我院EICU住院的209例行CVC的病人为观察组,采用ICU信息化平台下基于FMEA护理管理,观察两组护士CVC知识掌握情况、CVC相关情况以及环境、物体表面样本监测合格率。结果:观察组护士知识、行为评分均高于对照组(P<0.05);观察组置管使用总日数少于对照组,CLABSI发生率低于对照组,CLABSI发生次数少于对照组(P<0.05),两组导管留置时间比较,差异无统计学意义(P>0.05);观察组环境、物体表面样本监测合格率均高于对照组(P<0.05)。结论:ICU信息化平台支持下实施基于FMEA护理管理效果明显,其用于CVC管理中可提高护士CVC相关知识掌握情况,提高环境、物体表面样本监测合格率,有效预防病人CLABSI的发生。 展开更多
关键词 ICU信息化平台 失效模式与效应分析法 中心静脉导管相关血流感染 环境监测
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经隧道式中心静脉导管行血液透析导管相关血流感染发病率及危险因素的系统评价与Meta分析 被引量:9
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作者 豆欣蔓 谢琪 +2 位作者 张丽红 钟娟平 王兴蕾 《中国血液净化》 CSCD 2023年第3期215-221,共7页
目的系统评价经隧道式中心静脉导管行血液透析导管相关血流感染(catheter-related blood stream infection,CRBSI)发病率及危险因素。方法检索从建库到2022年9月PubMed、Web of science、Embase、Cochrane Library、中国知网、维普、万... 目的系统评价经隧道式中心静脉导管行血液透析导管相关血流感染(catheter-related blood stream infection,CRBSI)发病率及危险因素。方法检索从建库到2022年9月PubMed、Web of science、Embase、Cochrane Library、中国知网、维普、万方和中国生物医学文献数据库,搜集报道了CRBSI发病率和/或危险因素的临床研究。采用R语言(version 4.1.2)进行单组率和危险因素的Meta分析。结果共纳入21篇文献,6758例经隧道式中心静脉导管行血液透析的患者。Meta分析结果显示:CRBSI总发病率为14.5%,欧洲人群发病率为28.9%(95%CI:16.2%~43.5%),病例对照研究的发病率为26.3%(95%CI:14.1%~40.7%),年龄≥60岁人群发病率为22.2%(95%CI:14.5%~31.0%),导管使用时间>24个月的发病率为28.2%(95%CI:2.5%~67.2%)。年龄≥60岁(OR=1.85,95%CI:1.29~2.64)、白蛋白<30g/L(OR=2.12,95%CI:1.40~3.22)、股静脉置管(OR=2.17,95%CI:1.24~3.80)、合并糖尿病(OR=1.82,95%CI:1.37~2.40)、置管时间≥4周(OR=2.04,95%CI:1.22~3.41)是经隧道式中心静脉导管行血液透析患者发生CRBSI的重要危险因素。结论经隧道式中心静脉导管行血液透析CRBSI发生率较高,年龄≥60岁、白蛋白<30g/L、股静脉置管、合并糖尿病、置管时间≥4周是CRBSI的重要危险因素。 展开更多
关键词 血液透析 隧道式中心静脉导管 导管相关血流感染 发病率 危险因素
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预充式导管冲洗器对中心静脉导管封管的效果 被引量:2
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作者 祝喜鹰 刘金凤 +4 位作者 牛洪艳 赵秀明 胡璐璐 李青枝 蒋培慧 《中国感染控制杂志》 CAS CSCD 北大核心 2023年第3期328-333,共6页
目的 探讨预充式导管冲洗器对中心静脉导管封管的效果。方法 选取2020年1月—2021年6月在某三级甲等医院血液净化中心采用颈静脉置管行血液透析治疗的患者,将符合入选标准的患者按照随机数字表法分为观察组和对照组。观察组患者采用预... 目的 探讨预充式导管冲洗器对中心静脉导管封管的效果。方法 选取2020年1月—2021年6月在某三级甲等医院血液净化中心采用颈静脉置管行血液透析治疗的患者,将符合入选标准的患者按照随机数字表法分为观察组和对照组。观察组患者采用预充式导管冲洗器对中心静脉导管封管,对照组患者采用肝素钠封管液封管,分析两组患者导管相关血流感染(CRBSI)发生及导管通畅情况、导管封管费用、冲管时间及封管时针刺伤发生情况。结果 共纳入患者85例,其中观察组42例,对照组43例。观察组患者CRBSI发生率(0.79‰,1/1 260)低于对照组(5.43‰,7/1 290),观察组患者导管冲管时间[(6.44±1.11)s]短于对照组[(220.04±5.98)s],两组比较差异均有统计学意义(均P<0.05)。观察组患者导管堵塞3例,对照组导管堵塞4例,两组比较差异无统计学意义(P=0.728)。观察组封管时未发生针刺伤,对照组发生针刺伤5例,两组比较差异有统计学意义(P<0.05)。观察组患者封管费用人均11.40元,对照组患者封管费用人均15.14元。结论 预充式导管冲洗器能有效降低采用颈静脉置管行血液透析治疗的患者CRBSI发生率,节约成本,减少针刺伤,提高工作效率。 展开更多
关键词 预充式导管冲洗器 中心静脉导管 封管 导管相关血流感染 护理
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