Indwelling catheter and conservative measures in the treatment of abdominal compartment syndrome in fulminant acute pancreatitis

AIM： To study the effect of combined indwelling catheter, hemofiltration, respiration support and traditional Chinese medicine （e.g. Dahuang） in treating abdominal compartment syndrome of fulminant acute pancreatitis. METHODS： Patients with fulminant acute pancreatitis were divided randomly into 2 groups of combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring and routine conservative measures group （group 1） and control group （group 2）. Routine non-operative conservative treatments including hemofiltration, respiration support, gastrointestinal TCM ablution were also applied in control group patients. Effectiveness of the two groups was observed, and APACHE Ⅱ scores were applied for analysis. RESULTS： On the second and fifth days after treatment, APACHE Ⅱ scores of group 1 and 2 patients were significantly different. Comparison of effectiveness （abdominalgia and burbulence relief time, hospitalization time） between groups 1 and 2 showed significant difference, as well as incidence rates of cysts formation. Mortality rates of groups 1 and 2 were 10.0% and 20.7%, respectively. For patients in group 1, celiac drainage quantity and intra-abdominal pressure, and hospitalization time were positively correlated （r = 0.552, 0.748, 0.923, P 〈 0.01） with APACHE Ⅱ scores. CONCLUSION： Combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring, short veno-venous hemofiltration （SVVH）, gastrointestinal TCM ablution, respiration support have preventive and treatment effects on abdominal compartment syndrome of fulminant acute pancreatitis.

Management of recurrent malignant pleural effusions with a tunneled indwelling pleural catheter

In this review, we report on the use of indwelling pleural catheters in the treatment of malignant pleural effusions. We describe the most commonly used catheter. Also, treatment with indwelling pleuralcatheters as compared to talc pleurodesis is reviewed. A comparison of efficacy, costs, effects on quality of life, and complications is made. Only one randomized controlled trial comparing the two is available up to date, but several are underway. We conclude that treatment for malignant pleural effusions with indwelling pleural catheters is a save, cost-effective, and patientfriendly method, with low complication rates.

New cannulation method for pancreatic duct cannulationbile duct guidewire-indwelling method

The patient was a 58-year-old male with symptomatic alcoholic chronic pancreatitis.Since a 10 mm calculus was observed in the pancreatic body and abdominal pain occurred due to congestion of pancreatic juice,endoscopic retrograde cholangiopancreatography was conducted for assessment of the pancreatic duct and treatment of pancreatic calculus.Pancreatogram was slightly and insuff iciently obtained by injecting the contrast media via the common channel of the duodenal main papilla.We tried to cannulate selectively into the pancreatic duct for a clear image.However,the selective cannulation of the pancreatic duct was difficult because of instability of the papilla.On the other hand,selective cannulation of the bile duct was relatively easily achieved.Therefore,after the imaging of the bile duct,a guidewire was retained in the bile duct to immobilize the duodenal papilla and cannulation of the pancreatic duct was attempted.As a result,selective pancreatic duct cannulation became possible.It is considered that the bile duct guidewire-indwelling method may serve as one of the useful techniques for cases whose selective pancreatic duct cannulation is diff icult("selective pancreatic duct diff icult cannulation case").

Application of Modified Gastric Tube Placement in Patients with Indwelling Gastric Tube

Objective:To explore the effect of modified nasogastric tube placement and Rehabilitation New Liquid Spray in patients with indwelling gastric tube.Methods:Eighty-six cases with indwelling gastric tube in our hospital from January 2020 to May 2021 were randomly selected and divided into the reference group and the research group.The reference group was treated by modified gastric tube placement,and the research group was given the Rehabilitation New Liquid Spray intervention.The effect of the interventions on two groups was observed.Results:The incidence of nasal mucosal injury in the research group was lower than that in the reference group,and the incidence of pharyngeal mucosal injury in the research group was lower than that in the reference group(P<0.05).The pain score of the study group was lower than that of the reference group at 8 h,12 h and 24 h after replacement,and the incidence of hoarseness,swallowing discomfort and dry oropharynx was lower than that of the reference group(P<0.05).Conclusion:The application of modified gastric tube placement and Rehabilitation New Liquid Spray intervention in patients with indwelling gastric tube can effectively reduce the nasopharyngeal injury and improve the pain of catheterization.

Development and validation of a risk prediction model for repeated indwelling urinary catheterization in patients with cervical cancer after surgery

Objective:To study the factors influencing secondary indwelling catheterisation after cervical cancer surgery and to develop a predictive risk model.Methods:A total of 260 patients in a tertiary hospital in Chongqing were selected from January 2020 to December 2021 via convenience sampling.Relevant information of patients was recorded,including age;body mass index;history of hypertension and diabetes,bladder dysfunction,postoperative urinary retention,and postoperative urinary tract infection;Histology;staging;surgical approach;Operation time;Time of first remove of catheter;indwelling catheter days;Hospitalization days.Least absolute shrinkage and selection operator was used to reduce dimensionality and select patient characteristics,and multivariate analysis was performed based on the selected variables.Based on the outcome of analysis,a line chart model was developed for predicting the risk of secondary catheterization in patients with indwelling catheterization after radical cervical cancer surgery.The coefficient of conformity index(C-index)and calibration curves were used to evaluate the accuracy and fit.The model was internally validated via bootstrapping(1000 random samples),and the clinical utility of the model was assessed via decision curve analysis(DCA).Results:Four characteristic variables were selected,including preoperative bladder function,postoperative urinary tract infection,surgical approach,and Time of first remove of catheter.They are independent risk factors affecting urinary tract.The risk prediction model exhibited good discrimination performance with a C-index of 0.722(95%CI,0.661-0.783)and was well calibrated.The C-index was 0.708 in internal validation analysis.DCA showed that the risk model was clinically useful for predicting secondary catheterization,and clinical benefits were observed at the decision threshold of≥11%.Conclusion:A novel model was developed to predict the risk of secondary catheterization.The model was based on preoperative bladder dysfunction,postoperative urinary tract infection,surgical approach,and number of days since the removal of the primary catheter.

The Effect and Nursing of Indwelling Nasal Jejunal Feeding Tube for Enteral Nutrition in Acute Severe Pancreatitis

Objective:To analyze the effect of enteral nutrition and nursing intervention in patients with indwelling nasojejunal tube in acute severe pancreatitis.Methods:Sixty cases of patients with indwelt nasojejunal tubes treated in our hospital from August 2019 to August 2020 were divided into routine group and observation group as research subjects.Patients in both groups received enteral nutrition,patients in the routine group received routine care,and patients in the observation group received quality care.The recovery time of gastrointestinal function,length of hospital stay,hospitalization cost,nutritional indicators and incidence of complications in the two groups were compared.Results:The recovery time of gastrointestinal function in observation group was lower than that in routine group,P<0.05;The length and cost of hospitalization in observation group were lower than those in routine group,P<0.05;The nutritional indexes in observation group were higher than those in routine group,P<0.05;The incidence of complications in observation group was lower than that in routine group,P<0.05.Conclusion:Quality nursing service improve the effect of enteral nutrition,so as to ensure that patients get sufficient nutritional support.Its effect is remarkable and it is worthy of widespread clinical application.

Indwelling Pleural Catheter Insertion Following Inefficient Thoracoscopic Decortication in Postpneumonic Empyema: Beneficial or Contraindicated?

Video assisted thoracic surgery in advanced stage postpneumonic empyema aims for thorough debridement and washout of the pleural space followed by an attempt to release the entrapped lung (decortication). When the latter isn’t successful, and the patient is in a poor performance status, applying tube thoracostomy is the usual routine, to avoid conversion to thoracotomy and open decortication. Tube thoracostomy, however, is associated with complications necessitating further surgery, needs long term follow up and also entails quality of life distorting issues. To overcome these disadvantages, we instead inserted a PleurX&reg indwelling pleural catheter in four patients in the above situation. The method brought success (lung re-expansion and complete or partial pleurodesis) without the need for further surgery or quality of life problems in either patient. Although the use of the indwelling pleural catheter in infected pleural space is not recommended by manufacturers, we noted no complications.

Application of Intravenous Indwelling Needle in Undergraduate's Pharmacology Teaching Experiment

In this study,an intravenous indwelling needle was placed in the central artery of rabbit ear for collecting blood.The results show that this method greatly improves the success rate of blood sampling and well controls the experimental time.The students'unanimous feedback was that the method is simple and easy to operate,which is of great help to the stability of the experimental results.

Clinical analysis on nosocomial pulmonary infection in patients with indwelling tracheal tube

Tracheal intubation by tracheotomy or by placing a tracheal tube through larynx into trachea,is not only one of important measures which are taken to rescue critically ill patients with respiratory failure etc.,but a commonly used method to prevent patients from airway obstruction in the postoperative period and facilitate mechanical ventilation.Meanwhile,the incidence rate of pulmonary infection,a complication caused by indwelling tracheal tubes,especially the incidence rate of hospital acquired pulmonary infection is apparently increasing.Particularly,pulmonary infection of this kind has characteristics of easily recurrent seizures,long treatment period and high drug-resistance.Hence,it is required for medical personnel to summarize,analyze and study not only general nursing,airway nursing and prevention of pulmonary infection,but also antibiotic selection as well as how and when to use those drugs after the incidence of pulmonary infection for the benefit of patients with indwelling tracheal tube.This article is based on a case collected from Comprehensive Surgery Department of the Third Affiliated Hospital of Inner Mongolia Medical University.The patient’s history is as follows:1.Pulmonary infection;2.Indwelling tracheal catheter after tracheotomy;3.Carbon monoxide toxic cerebrosis,mute state.By means of this case analysis,it is expected to make an early detection,and give an early and proper treatment to patients with pulmonary infection caused by indwelling tracheal tubes in clinical practice.

Role of Fine Management in Maintenance of Deep Venous Indwelling Catheter in Hemodialysis Patients

Objective:This paper mainly explores the effect of fine management application in maintenance of deep venous indwelling catheter in hemodialysis patients.Methods:150 hemodialysis patients with deep venous catheter indwelling in our hospital from December 2019 to September 2020 were divided into routine group and study group.The routine group was given routine nursing,and the study group was given fine management nursing.The nursing effect of the two groups was analyzed.Results:After nursing intervention,the incidence of complications in the study group was 14.66%,which was lower than that in the conventional group(53.33%),and the nursing compliance in the study group(98.66%)was higher than that in the conventional group(89.33%),all P<0.05.Conclusion:Fine management plays a significant role in the maintenance of deep venous indwelling catheter in hemodialysis patients,which can reduce the occurrence of complications.

Effect of Cluster Nursing in Preventing Urinary Tract Infection in Postoperative Patients with Indwelling Urinary Catheter

Objective:This paper expounds and analyzes the effect of cluster nursing in preventing urinary tract infection in postoperative patients with indwelling urinary catheter.Methods:A total of 400 postoperative patients with indwelling urinary catheter,treated in Yancheng No.1 People’s Hospital in recent two years,were recruited as research subjects.The patients were equally divided into group A and group B,with 200 patients in each group,and all received routine anti-infectives.The patients in group A(200 cases)received routine nursing.On the basis of group A,cluster nursing was implemented for patients in group B(200 cases).Results:The indwelling time of urinary catheter,the disappearance time of bladder irritation symptoms,and the probability of urinary tract infection were compared between both groups,which showed that the nursing effect of group B was better than that of group A(P<0.05).Conclusion:The implementation of cluster nursing in postoperative patients with indwelling urinary catheter can improve the deficiency of routine nursing,consolidate the treatment effect,and reduce the complication rate of urinary tract infection.

Port-A-Cath系统腹腔置入3例报告

1978年Dedcick等阐明了腹腔内化疗的药代动力学原理,接着又研制出对卵巢癌有较高敏感性的药物CODP。近年Port-A-Cath装置的问世,使腹腔化疗可在长时间内反复进行。

Complications from port-a-cath system implantation in adults with malignant tumors:A 10-year single-center retrospective study

Background:Port-A-Cath systems(PCS)are safe and convenient devices for long-term infusion in patients with malignant tumors.This study retrospectively analyzed the complications from PCS and their management.Methods:Data of 1695 adults(641 males and 1054 females)with malignant tumors who underwent PCS implantation in our center from January 1,2009 to December 31,2019 who had complete follow-up records were collected in this study.The early and late complications and corresponding treatments were studied.Results:A total of 1716 PCSs were implanted;21 patients underwent 2 implantations each.The success rate was100%and no severe complications occurred during implantation.The overall occurrence rate of post-implantation complications was 18.5%(318/1716);5.5%(94/1716)were early complications and 13.0%(224/1716)were late complications.A total of 451 PCSs were removed,of which 398 were removed due to the end of chemotherapy,while 53 were removed because of complications.A total of 4 deaths occurred from these complications.Conclusions:The incidence of intra-and post-operative complications is low.In most cases,complications can be effectively controlled without the removal of the PCS and regular follow-up and maintenance are critical.

Intravascular treatment for abnormal catheter positioning of port-a-cath system in the subclavian vein:A single-center study

Objective:This study aimed to explore the incidence of abnormal catheter positioning and the effectiveness and safety of intravascular adjustment or removal of abnormally positioned catheters through percutaneous punctures.Materials and methods:A retrospective analysis was conducted on 58 patients with abnormal catheter positioning,treated between January 2009 and June 2019.Intravascular adjustment of the migrated catheters and removal of the fractured catheters were performed through percutaneous puncture using a pigtail catheter,cobra catheter,and gooseneck snare.Results:Of the 58 cases,there were 23 cases of catheter migration and 35 cases of catheter fracture.The incidence of abnormal catheter positioning was 3.0%,corresponding to 1.2%migrations and 1.8%fractures.Among the 23cases of migration,1 case did not require adjustment and another underwent unsuccessful adjustment.The rate of successful adjustment of migrated catheters was 91.3%,whereas the rate of successful removal of fractured catheters was 100%.No surgery-related complications were observed either immediately or during the 1-month follow-up period.Conclusions:This study showed that the incidence of abnormal catheter positioning is low.Intravascular techniques used for the adjustment or removal of abnormally placed catheters are safe,efficient,and minimally invasive.

Extending the interval for port-a-cath maintenance

Objective: The objective of this study is to assess the outcome of port-a-cath (PAC) maintenance every three months in patients with gynecologic malignancies with the goal of standardizing a safe and appropriate interval that would maintain patency and minimize side effects. Methods: We performed a retrospective medical record review and evaluation of all patients with a Bard? PAC who were noted to have no evidence of disease (NED) during the years 2003 to 2010. The interval between accessions and any complications related to the presence of the PAC were recorded. Relevant complications included skin infections, bacteremia, thrombosis, and occlusions. Statistical analysis was done using the Fisher’s exact test. Results: A total of 201 patients had PAC placed and 43 patients underwent PAC accessions to maintain patency. The total number of accessions was 150 with a median number per patient of 2.0 (range 1 - 10). The mean time between flushes was 112 days (SD = 57). When comparing women in maintenance who had flushes within 90 days versus those who had flushes over 90 days apart, there was no difference in infection or occlusion rates between these groups (p = 0.515). In the Conclusion: Infections and occlusions are rare in women with gynecologic malignancies undergoing maintenance of their PAC. Longer intervals between PAC flushes do not appear to affect the outcome in our patients. Our ongoing data and follow-up confirm that extending the interval of PAC accession to every 3 months, rather than monthly, is safe, effective and convenient in the patient population with gynecologic malignancies.

Ultrasound Guided Port-A-Cath Implantation

Purpose: The use of port catheters is well accepted in the management of patients with malignancy. In this study, we compare the technical success and the complication rates of ultrasound guided Port-A-Cath implantation with doing this procedure by using the anatomical landmark method. Methods: In a retrospective study, from 2006 to 2009, medical files of 104 patients who had undergone Port-A-Cath implantation were reviewed. The indication for port catheter implantation was malignancy in all cases. Among our patients, Port-A-Cath implantation was done in 63 patients by using landmark method and in 41 patients by guidance of ultrasound. All patients had been observed for complications including pain, port infection, and port thrombus, thrombus of central veins, skin necrosis, and success in using of Port-A-Cath for at least one month following the procedure, in the vascular clinic. Results: in landmark method group, 2 catheters were non-functional just after placement (3.2%) while all Port-A-Caths in ultrasound-guided group were functional. Ten patients (15.9%) in land mark group and 1 patient (2.4%) in ultrasound-guided group were complicated. The difference between complication rate in anatomic landmarks method and ultrasound-guided method was statistically significant (p There was no significant difference in two groups in duration of port placement (p < 0.345), age (p < 0.444), site of port placement (p < 0.244) or type of malignancy (p < 0.18). Conclusion: Considering high rate of success and low complications in placement of Port-A-Cath with ultrasound guidance, this method is superior to the land mark method in patients with malignancy.

Pneumothorax Complicating Port-a-Cath and Groshong Catheter Positioning in Children: Our Experience before Routine Ultrasound-Guided Puncture

Objective: To study incidence and management of long term central venous catheter (CVC) placement related pneumothorax (PNX) in children. Aim: To construct a baseline value before the introduction of systematic use of ultrasound guidance, which requires specific training and equipment. Background: Anesthesia Service and Pediatric Oncology of the Italian National Cancer Center;patients were children (age ≤ 18 years) with solid tumors, needing long-term central venous catheters (Groshong or Port-a-Cath). Materials/Methods: Catheter placement was performed, mostly under general anesthesia, utilizing a micropuncture 5-7 Fr needle and fluoroscopy. In the study period ultrasound was used only in case of previously failed attempts. Relevant data were collected retrospectively. Results: From August 2008 to December 2011, 452 catheters were implanted to our patients. The prevalent approach was from subclavian vein (left 85.7%, right 9.7%);in few cases internal jugular vein was chosen (right 2.4%, left 2.2%). Pneumothorax occurred in 14 patients (3.1%;95%CI 1.9-5.1). In 4/14 children the PNX was considered minimal and not treated. In 10 patients the PNX was drained. In 7 cases a traditional, surgical thoracostomy was performed, while in 3 children a 14-Ga polyurethane catheter (Arrow International&#174) was inserted over a wire guide in the pleural space by anaesthetists. Conclusions: In our centre rates of PNX are the same as those described in literature and are expected to lower when ultrasound guidance of the puncture will be routinely applied. Percutaneous drainage of PNX seems as effective as surgically placed thoracostomy catheter, but less invasive.

导向注药套管经鼻悬吊留置伴或不伴锚定治疗肺部霉菌病的操作流程

全身使用有效抗霉菌药物是治疗肺部霉菌病的基础治疗方法,同时,经过内镜注药是气管、支气管和肺部霉菌病最重要的治疗方式之一。相比内镜注药,导向注药套管经鼻悬吊留置伴或不伴锚定治疗肺部霉菌病具有较多优势,包括可接驳注射泵持续缓慢地注入药物,可避免反复进行呼吸内镜等。该文介绍了导向注药套管经鼻悬吊留置伴或不伴锚定治疗肺部霉菌病的操作流程。

水胶体敷料Y型固定在外周静脉留置针中的应用效果

目的探讨外周静脉留置针中采用水胶体敷料Y型固定的效果。方法选取2022年6月至2024年3月江西省肿瘤医院住院的98例肺癌化疗间歇期患者作为研究对象,按照随机数字表法分为研究组和对照组,每组49例。所有患者均使用外周静脉留置针,对照组使用3M透明贴常规固定,研究组在对照组基础上使用水胶体敷料Y型固定,比较两组患者的穿刺点渗血、渗液、静脉炎发生率,穿刺部位症状评分,留置针固定情况评分,留置时间,留置针脱出发生情况。结果研究组的穿刺点渗血、渗液、静脉炎发生率低于对照组,差异有统计学意义(P<0.05)。研究组的穿刺部位症状评分、留置针固定情况评分低于对照组,留置时间长于对照组,差异有统计学意义(P<0.05)。研究组的留置针脱出总发生率低于对照组,差异有统计学意义(P<0.05)。结论外周静脉留置针中应用水胶体敷料Y型固定的效果较好,能够有效降低穿刺点渗血、渗液、静脉炎发生率,改善穿刺部位症状及留置针固定情况,延长留置时间,避免留置针脱出。

转头前倾法在脑卒中吞咽功能障碍患者留置胃管中的效果观察

目的研究转头前倾法在脑卒中吞咽功能障碍患者留置胃管中的作用。方法临床纳入2022年1月至2023年2月期间我院收治的84例脑卒中吞咽功能障碍患者作为研究对象,将患者分为两组各42例(随机数字表法),所有患者均需留置胃管。其中42例患者采用常规方法进行留置胃管作为对照组;另42例患者采用转头前倾法进行留置胃管作为观察组。观察两组患者置管成功率、不良反应发生率、生活质量以及护理人员对吞咽功能障碍摄食训练相关知识的知晓率情况。结果观察组一次置管成功率和再次置管成功率分别为92.86%、100.00%,均高于对照组的76.19%、30.00%,均有差异(P<0.05)。观察组不良反应发生率明显低于对照组的不良反应发生率(4.76%vs 19.05%),有差异(P<0.05)。干预前两组患者生活质量各评分对比无差异(P>0.05);干预后观察组生活质量各评分均优于对照组,均有差异(P<0.05)。培训后护理人员对吞咽功能障碍摄食训练相关知识的知晓率为96.67%,明显高于培训前的53.33%,有差异(P<0.05)。结论转头前倾法能使护理人员更好掌握吞咽功能障碍摄食训练的相关知识,有效提高脑卒中吞咽功能障碍患者留置胃管的成功率,降低不良反应发生率,进一步提高患者生活质量,值得临床应用及推广。