Clinical Application of Newborn Umbilical Vein Catheterization Combining with PICC

Purpose: Research on clinical application effect of combining very low birth weight newborn (VLBWN) umbilical vein catheterization (UVC) with peripherally inserted central catheter (PICC). Method: 60 cases of VLBWN checked in our hospital’s ICU are selected and divided into combination group (n = 30) and PICC group (n = 30) according to the random number table. Combination of UVC and PICC is applied on newborn of combination group while only PICC is applied on newborn of PICC group. These two groups’ newborn’s PICC catheterization operation time, PICC indwelling time, weight gain, hospital stays, hospital infection, planned extubation, successful single puncture, adverse events and other indexes are observed. Result: Newborns in combination group have less PICC catheterization operation time and less hospital stays than newborns in PICC group while newborns in combination group have longer PICC indwelling time and greater weight gain than newborns in PICC group. The difference here has statistical significance (p < 0.05). Combination group’s hospital infection ratio (3.33%) is lower than that of PICC group (23.33%). The difference here has statistical significance (p < 0.05). Newborns in combination group have a planned extubation rate of 93.33% and a successful single puncture rate of 93.33%, which are greater than those of newborn in PICC group (respectively 73.33% and 70.00%). The difference here has statistical significance (p < 0.05). Newborns in combination group have an adverse event occurrence rate of 43.33%, lower than that of PICC group (70.00%). The difference here has statistical significance (p < 0.05). Conclusion: Application of combination of UVC and PICC on VLBWN can greatly improve PICC catheterization efficiency and newborn patients’ nutriture and reduce rate of complications, thus, it is worthy of clinical application.

链条式综合性护理干预措施对肿瘤患者PICC置管的效果分析

目的探讨对肿瘤科患者施行经外周静脉穿刺中心静脉置管(PICC)链条式的综合性护理干预效果。方法选取2016年3月至2016年12月肿瘤科收治的PICC置管患者112例,随机分为对照组和观察组,每组56例。2组均进行常规护理,观察组在常规护理的基础上给予多媒体等综合性护理干预措施。采用Zung编制的焦虑自评量表(SAS)观察2组患者干预后焦虑状况的改善情况、PICC置管后并发症发生情况及患者的护理满意度比较。结果观察组综合性护理干预后、SAS评分(41. 35±1. 67)低于对照组(53. 98±1. 61),差异有统计学意义(t=5. 27,P <0. 05);并发症发生率(8. 93%)与对照组(17. 86%)比较,差异有统计学意义(χ2=21. 47,P <0. 05);护理满意度(96. 43%)高于对照组(89. 29%),差异有统计学意义(χ2=19. 54,P <0. 05)。结论对肿瘤科PICC置管患者施行综合性护理干预可明显减轻患者的焦虑情绪,降低患者并发症发生率,提高患者护理满意度,值得临床推广应用。

超声引导下PICC置管困难的原因分析及处理方法

目的分析超声引导下使用改良塞丁格技术进行上臂外周中心静脉置管困难的原因,并提出预防对策。方法对168例超声引导下PICC置管情况进行回顾性分析总结。结果 138例置管顺利,30例置管困难,其中导管尖端异位10例、送导管不畅8例、送导丝不畅7例、送微穿刺鞘不畅3例、穿刺针误入肱动脉2例。结论提高操作者置管技术水平及心理素质是减少PICC置管困难的关键,术前充分评估及健康教育到位是主要影响因素。

品管圈在PICC置管使用和维护过程中的应用

目的：探讨品管圈（QCC ）活动在提升化疗患者PICC置管使用和维护过程中的应用效果。方法将2012年10月～2014年1月联合化疗的恶性血液病患者63例随机分为两组，QCC活动前为对照组，QCC活动后为实验组。对照组实施常规护理。实验组提出QCC活动，采用成立QCC小组，运用QCC方法进行主题选定，拟定活动计划，分析主要原因，根据主要原因拟定对策并实施等方法。比较两组穿刺成功率和并发症的发生率。结果活动后PICC一次穿刺成功率明显提高，并发症的发生率明显降低（P＜0．05）。结论 QCC活动通过科学有效的方法，提升PICC护理品质，减少并发症，确保化疗药物安全输入。且圈员的工作热情、创造性思维、责任与荣誉及团队精神均有明显提高。

Exploring the Influences of Continuous Self-Management Education on the Self-Care Skills and Health Behavior of Patients with PICC Intubation

Objective:To analyze the effects of continuous self-management education on the selfcare ability and health behavior of patients with tumor through peripherally inserted central venous catheters(PICC).Methods:The period from August 2018 to August 2020 was used as the research time range,and the random number table method was used as the basis for grouping.80 patients with malignant tumors who regularly performed fixed catheter maintenance care in the PICC clinic of our hospital were admitted in the experimental group(given PICC specialist nursing,and implemented continuous self-management education),and 80 patients with PICC tube malignant tumors discharged from the superior hospital during this time range served as the control group(return to the original catheterization hospital from time to time or perform catheter maintenance care in the nursing clinic of our hospital).The self-care ability scores,health behavior scores,and complications during intubation between both groups were analyzed.Results:(1)There was no significant difference in self-care ability score and healthy behavior score between groups before the intervention,P>0.05;the self-care ability score and health behavior score of the research group were better than the control group after intervention,P<0.05;(2)After investigation,the incidence of complications in the research group(2.50%)was lower than that of the control group(10.00%),but there was no difference between the groups,P>0.05.Conclusion:Continuous self-management education has good effects on improving the self-care ability of tumor patients with PICC intubation.It can urge patients to maintain good health behaviors and reduce complications.It is worthy of promotion.

Appropriate posture of cancer patients treated with PICC to prevent internal jugular vein ectopic

We aimed to study the appropriate posture of peripherally inserted central catheter （PICC） patients, to reduce the incidence of internal jugular vein heterotopia. Methods： From 2009 to 2013, a total of 290 cases with PICC were enrolled in our study. They were divided into two groups. The patients in control group took regular position, which mean pros- tration, upper limb of tube side was abduction 90°, head moved to puncture side in order to block the internal jugular vein. On the basis of conventional body position putting, posture of patients in observation group was improved, the head remain neutral, and had 180° angle with trunk longitudinal axis, not favor any side. After ensuring the upper limb abduction, had 90° angle with the trunk, then catheter was inserted slowly. The jugular venous catheter heterotopia rate was judged by X.ray results. Results： The jugular venous catheter heterotopia rate of control group and observation was 12.8% and 0.68%, respectively. The difference between two groups was statistically significant （P 〈 0.01）. Conclusion： The body posture improvement can prevent discomfort of patients and reduce the jugular venous catheter heterotopia rate of PICC.

Venous thromboembolism in patients with liver cancer:a retrospective study

Background:Little is known about the association between venous thromboembolism(VTE)and tumors.In this study,we identified the clinical features of patients with liver cancer who presented with at least 1 VTE episode.Methods:This was a retrospective case-control study of a single-institution database with univariate and multivariate analyses usingχ^(2)and Fisher exact tests.Statistical significance was set at P<0.05.Results:The overall incidence of VTE in the patients with liver cancer was 1.2%.More than half(53.8%)of the 13 patients with liver cancer and venous thrombosis died within 2 months.The thrombus in 12 patients(92.3%)was located within the deep veins,whereas the other patient(7.7%)was diagnosed with a pulmonary embolism.Of the 11 patients,9(69.2%)had swelling and/or pain symptoms.All 6 patients with peripherally inserted central catheters(PICCs)had thrombosis,accounting for 46.2%of all patients with liver cancer and venous thrombosis.Compared with the controls,liver cancer patients with PICC tubes,thrombosis-related symptoms such as swelling and pain,traumatic stimulation such as fracture,acute respiratory distress syndrome,and interventional therapy or hemostasis drugs were prone to be diagnosed with VTE(P<0.05).Conclusions:Liver cancer and thrombosis are rare and have poor prognoses.Liver cancer with thrombosis may be associated with PICC catheterization,traumatic stimulation,or hemostatic drugs.Patients with liver cancer and thrombosis often present with swelling and pain.

经外周穿刺中心静脉导管置管、维护及拔管操作的成本核算

目的对经外周置入中心静脉导管(peripherally inserted central catheter,PICC)置管、维护及拔管的单项操作成本进行核算,为制定合理的操作收费价格提供依据。方法通过横断面调查,采用项目成本阶梯分摊法,于2019年1—5月在复旦大学附属肿瘤医院血管通路门诊测算PICC各单项操作人力成本、设备折旧费及未单独计价材料费,测算直接成本,并通过分摊测算间接成本,最后测算PICC置管、维护及拔管的单项操作成本。结果PICC置管、维护及拔管的各单项操作实际成本分别为(157.03±4.73)元、(33.66±3.04)元、(32.38±3.11)元,与上海市医疗机构对PICC各项操作的收费标准(分别为150元、30元、30元)基本相符。结论建议将PICC维护及拔管的操作收费纳入收费标准中,促进PICC输液技术的可持续发展并确保护理服务的持续供给。

5F鞘组在经外周静脉穿刺置入中心静脉导管中的应用效果

目的探讨5F鞘组在经外周静脉穿刺置入中心静脉导管(peripherally inserted central catheter,PICC)中临床应用的效果。方法回顾性分析并总结2012年12月至2013年2月哈尔滨医科大学附属第一医院收治的应用5F鞘组10例行PICC患者的临床资料。结果 10例患者均顺利完成PICC,有2例患者术后出现静脉炎,其余患者均未发生严重的并发症。结论静脉穿刺条件差的患者应用5F鞘组行PICC导管有利于提高置管成功率。