Analysis of the Nursing Effect of Hierarchical Extended Nursing Based on The Guidance of Orem’s Theory in Patients with PICC Catheterization

Objective:To analyze the nursing effect of hierarchical extended nursing based on the guidance of Orem’s theory in patients with peripherally inserted central(PICC)catheterization.Methods:Ninety-one patients with PICC catheterization admitted to the hospital from May 2021 to May 2023 were selected and divided into a control group and an observation group,with 45 and 46 cases,respectively.The control group received routine nursing care,while the observation group received routine nursing care combined with hierarchical extended nursing based on the guidance of Orem’s theory for 3 months.Relevant indicators between the two groups were compared.Results:The improvement degree of various indicators in the observation group after nursing was better than that of the control group(P<0.05).Conclusion:Graded extended nursing based on the guidance of Orem’s theory improved the knowledge,belief,behavior,and self-efficacy of patients with PICC catheterization,and relieved their anxiety,depression,and other negative emotions.The nursing effect was deemed to be significant.

Anatomical variation in the internal jugular vein:potential risk factors for central venous catheterization-a case report

Central venous catheterization(CVC)is an invasive medical procedure used to measure central venous pressure and provides a stable route for continuous drug administration.CVC is widely used in the emergency department and intensive care units.It is typically performed by inserting a catheter through the internal jugular vein(IJV)into the superior vena cava near the right atrium.[1,2]While catheterization is a fundamental skill proficiently performed by healthcare professionals,lethal complications may occasionally occur because of undesirable positioning,depth and diameter.

How to manage the malposition of deep vein catheterization into the artery?

Central venous catheterization establishes temporary,efficient,and rapid use of deep venous access in patients,which provides high flow rate fluid perfusion,enables measurement of central venous pressure,and acts as an important reference for clinical decision-making.However,various complications such as pneumothorax,hemothorax,hematoma,and puncture failure can easily occur during the puncture and catheterization process.

超声联合影像学调整双腔耐高压PICC原发性异位的临床实践效果

目的:探讨双腔耐高压注射型经外周静脉穿刺中心静脉置管术(PICC)导管原发性异位借助超声引导+影像学资料复位的临床实践效果。方法:选取2020年3月—2023年3月我院724例双腔耐高压PICC置管病人,51例病人置管完成后24 h内通过胸部影像学检查确诊导管发生原发性异位,发生率为7.04%。异位后分析其原因,结合胸部影像学资料,通过实时B超影像、腔内心电图P波形态,多种手法及体位综合复位的处理措施。结果:41例病人成功复位,成功率为80.3%。10例病人多因病人血管因素或错过调管时机导致导管复位失败。结论:置管护士要有扎实的理论基础以及丰富的实践经验,在临床实际操作过程中,应该灵活应用,多方法结合,具体问题具体分析,尽可能保证PICC导管尖端处于最佳位置,减少并发症的发生。

多学科协作风险管控预防肿瘤病人PICC相关性静脉血栓的效果观察

目的:探讨多学科协作(MDT)风险管控预防肿瘤病人经外周静脉置入中心静脉导管(PICC)相关性静脉血栓的效果。方法:选取2020年6月—2022年6月在本院留置PICC的肿瘤病人190例,采用随机数字表法分为观察组和对照组,各95例。对照组给予常规护理,观察组在对照组基础上给予MDT风险管控护理,比较两组PICC穿刺、维护质量、相关性静脉血栓及腋下静脉最大血流速度(Vmax),平均血流速度(Vmean)情况。结果:观察组PICC一次穿刺成功率、维护质量优良率高于对照组(P<0.05);两组护理后腋下静脉Vmax、Vmean快于护理前,观察组护理后腋下静脉Vmax、Vmean快于对照组(P<0.05);观察组PICC相关性静脉血栓发生率为2.11%,低于对照组的11.58%(P<0.05)。结论:MDT风险管控可提高肿瘤病人PICC穿刺、维护质量,改善腋下静脉循环,有利于改善PICC相关性静脉血栓的预防效果。

成人PICC/上臂输液港原发性导管异位管理的最佳证据总结

目的评价、总结国内外成人PICC/上臂输液港原发性导管异位管理的最佳证据,为临床医护人员识别、预防和处理成人PICC/上臂输液港原发性导管异位提供参考。方法系统检索中英文数据库、指南相关网站和专业学会网站中有关成人PICC/上臂输液港原发性导管异位管理的证据,包括临床决策、最佳实践、临床实践指南、系统评价、证据总结和专家共识。检索时限为建库至2023年12月31日。2名研究者独立对纳入文献进行质量评价,并结合专业判断进行标准化的资料提取和证据分级。结果该研究共纳入13篇文献,包括6篇临床实践指南、2篇证据总结和5篇专家共识。最终从识别、预防及处理3个方面总结了39条最佳证据。结论该研究为临床医护人员管理成人PICC/上臂输液港原发性导管异位提供循证依据。在临床应用时,需要充分考虑临床情景,结合专业人士的判断及患者的意愿,遵循个体化原则,审慎地将证据应用于临床实践中。

隧道式置管方式在降低肿瘤病人PICC非计划性拔管率的效果研究

目的:观察肿瘤病人在经外周置入中心静脉导管(PICC)治疗期间应用隧道式置管方式对降低非计划性拔管率的效果。方法:选取2023年1月—11月南昌大学第二附属医院肿瘤科初次行PICC置管治疗的80例肿瘤病人为研究对象,随机分为对照组、试验组,每组40例。对照组行传统置管方式,试验组行隧道式置管方式,比较两组病人一次穿刺成功率、非计划性拔管率、并发症发生率及生活质量[生活质量评定量表(QOL)评分]。结果:试验组病人一次穿刺成功率为90.00%,高于对照组的72.50%(P<0.05);试验组病人置管后90、120 d非计划性拔管率低于对照组(P<0.05);试验组并发症总发生率为5.00%,低于对照组的25.00%(P<0.05);干预后试验组病人QOL评分高于对照组(P<0.05)。结论:隧道式置管方式可提高肿瘤病人PICC一次穿刺成功率,减少并发症,降低非计划性拔管率,改善生活质量。

植入式静脉输液港与PICC在血液肿瘤患者中的临床价值

目的 比较植入式静脉输液港(VPA)与经外周静脉穿刺置入中心静脉导管(PICC)在血液肿瘤患者护理中的临床应用价值,为临床血液肿瘤患者化疗期间选用合适的中心静脉给药方法提供参考。方法 选取河北工程大学附属医院2021年3月至2023年2月就诊的血液肿瘤患者80例,根据置管方法不同随机分为VPA组38例和PICC组42例,比较2组并发症、舒适度、生活质量评分。结果 VPA组并发症发生率5.26%,低于PICC组的26.19%,VPA组未发现导管阻塞、血流感染、皮肤过敏等并发症,2组差异有统计学意义(P<0.05);生活质量6个维度的比较中,1个社会关系功能无差异,其余5个VPA组均高于PICC组,2组生活质量评分比较差异有统计学意义(P<0.05);VPA组舒适度更高(P<0.05)。结论 相比于PICC静脉给药方法,VPA并发症少,舒适度好,更能提高患者生活质量,满足血液肿瘤患者长期治疗需求,值得临床推广。

PICC病人医用粘胶相关性皮肤损伤预防的最佳证据总结

目的:总结经外周静脉置入中心静脉导管(PICC)置管病人医用粘胶相关性皮肤损伤(MARSI)的相关证据,为临床循证实践提供依据。方法:应用循证的方法,根据金字塔“6S”证据模型系统检索关于预防PICC病人MARSI的相关文献。检索时限为2010年1月1日—2023年1月30日,由2名研究者对证据进行质量评价和推荐级别的评定。结果:共纳入12篇高质量文献,提取到19条最佳证据,包含对病人评估、操作方法、敷料的选择及使用、培训与教育4个方面的内容。结论:总结了预防PICC置管病人MARSI的最佳证据,为医护人员在临床工作中预防提供循证依据。

基于FOCUS-PDCA模式安全管理策略对早产儿PICC置管并发症及皮肤损伤的影响

目的探讨基于FOCUS-PDCA模式安全管理策略对早产儿PICC置管并发症及皮肤损伤的影响。方法选择2022年1月至2023年12月期间在扬州市妇幼保健院扬州大学附属医院接受PICC置管治疗的82例早产儿,采用随机数表法分为观察组与对照组。对照组采用标准护理,观察组在此基础上应用基于FOCUS-PDCA模式的安全管理策略。比较两组PICC置管并发症与皮肤损伤情况。结果观察组PICC置管并发症总发生率为7.14%,显著低于对照组19.05%,差异有统计学意义(P<0.05)。干预后第1 d、第7 d、第14 d,观察组皮肤损伤评分均较对照组低,差异有统计学意义(P<0.05)。结论基于FOCUS-PDCA模式的安全管理策略可有效减少早产儿PICC置管并发症,保护患儿置管部位皮肤健康。

新生儿PICC相关性血栓预防与管理的证据总结

目的:总结新生儿经外周静脉置入中心静脉导管(PICC)相关性血栓预防与管理的证据,为临床医护人员提供循证依据。方法:系统检索国内外临床决策网站、指南网站、专业协会网站、循证文献资源库及原始文献数据库,检索时限为建库至2023年2月。对纳入的文献进行方法学质量评价,结合专业判断、临床情境提取证据并进行汇总。结果:共纳入14篇文献,其中临床决策2篇,指南6篇,系统评价4篇,队列研究2篇。从风险评估、导管置入、导管维护、血栓诊断、血栓治疗、拔管等6个方面共汇总了31条证据。结论:本研究总结了新生儿PICC相关性血栓预防及管理的证据。医护人员可结合文化背景、临床情境选择证据,制定科学的血栓预防及管理方案,提升护理质量。

基于肿瘤病人PICC导管相关血栓形成影响因素的预见性护理应用效果

目的:观察以肿瘤病人PICC导管相关血栓形成影响因素的Logistic回归模型为基础的预见性护理对预防肿瘤科病人经外周静脉穿刺中心静脉置管(PICC)导管相关血栓形成的效果。方法:随机选择2021年7月—2022年6月和2022年7月—2023年6月于我院肿瘤科进行PICC置管的化疗病人分别为对照组和预见性护理组,对对照组病人给予常规护理并行Logistic多因素回归分析,总结PICC导管相关血栓形成的风险因素,对照组病人予以常规护理,预见性护理组采用以对照组Logistic多因素回归模型为基础的预见性护理。比较两组病人血栓发生率和护理满意度。结果:肿瘤分期、血栓史、是否合并糖尿病、导管末端位置以及D-二聚体水平是肿瘤科病人PICC导管相关血栓形成的危险因素,抗凝药物的使用是保护性因素。预见性护理组4.17%发生PICC置管相关血栓,明显低于对照组(30.83%);预见性护理组病人护理满意度(98.33%)高于对照组(90.83%),差异均有统计学意义(P<0.05)。结论:肿瘤分期、血栓史、是否合并糖尿病、导管末端位置以及D-二聚体水平是肿瘤科病人PICC导管相关血栓形成的危险因素,使用抗凝药物是保护性因素。以Logistic回归分析结果为基础的预见性护理不仅能够降低病人血栓的发病率,同时能够提升病人对护理工作的满意度。

早产儿经大隐静脉行PICC置管最佳置管深度的临床研究

目的分析早产儿经大隐静脉(great saphenous vein,GSV)行经外周静脉穿刺的中心静脉导管(peripherally inserted central venous catheter,PICC)置管最佳置管深度(optimal placement depth,OPD)与体格测量参数之间的相关性,以期建立经GSV PICC置管OPD的预测公式。方法回顾性选取2022年12月—2024年2月在中南大学湘雅三医院新生儿重症监护室经GSV PICC置管的早产儿为研究对象。按穿刺部位不同[膝关节(knee joint,KJ)或踝关节(ankle joint,AJ)GSV],分为GSV-KJ置管组(38例)和GSV-AJ置管组(33例)。测量置管时体重(body weight,BW)、身长、上部量、下部量、头围、腹围,应用Pearson相关分析评估上述变量与OPD的相关性,构建早产儿经GSV PICC置管OPD的预测公式,比较传统预估公式和新预测公式的预测深度与理想的OPD之间的预测残差。结果Pearson相关分析显示,GSV-KJ置管组和GSV-AJ置管组PICC OPD与BW、身长、上部量、下部量、头围、腹围呈显著正相关(均P<0.05),两组中其与BW的相关性均最高;一元线性回归分析显示,GSV-KJ置管组和GSV-AJ置管组PICC置管OPD与BW呈线性关系。OPD预测方程分别为:GSV-KJ PICC置管OPD(cm)=13.1+2.7×BW(kg),GSV-AJ PICC置管OPD(cm)=13.4+6.0×BW(kg);新预测公式的预测残差显著小于传统预估公式(P<0.05)。结论早产儿经GSV PICC置管OPD与BW呈正相关,依据BW构建的新预测公式的预测结果更接近理想的OPD。

Lower extremity peripherally inserted central catheter placement ectopic to the ascending lumbar vein:A case report

BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.

纵膈异常肿瘤患者PICC置管方法研究

总结43例纵膈异常肿瘤患者行经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)的实践经验。针对纵膈异常肿瘤患者PICC置管过程中易出现导管置入长度测量不准确以及送管困难等问题,通过多学科团队合作,构建科学的临床操作方案:置管前增加胸部增强CT评估,胸部CT结合体表测量确定导管预置入长度,置管中注意送管技巧及运用心电定位技术减少送管困难,及时发现导管异位,置管后特殊案例资料填写并加强延续性管理。43位患者成功留置PICC导管,将导管置入理想位置为34例,置入理想位置准确率为79.1%,上腔静脉下段位置7例,右心房2例,2例患者经导管外拔处理后导管尖端位于理想位置。

Central venous catheterization-related complications in a cohort of 100 hospitalized patients:An observational study

Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.

精细化护理在乳腺癌PICC置管化疗患者中的应用对导管相关性上肢深静脉血栓预防效果的价值探讨

目的探讨精细化护理在乳腺癌经外周静脉置中心静脉导管(Peripherally Inserted Central Venous Catheter,PICC)置管化疗患者中的应用及对导管相关性上肢深静脉血栓(Catheter Related Deep Venous Thrombosis of Upper Extremity,UEDVT)的预防效果。方法单纯随机选取2021年10月—2023年7月福建省三明市第二医院行PICC置管化疗的90例乳腺癌患者为研究对象,以随机数表法为依据分为两组,对照组(45例)实施常规护理,观察组(45例)基于对照组实施精细化护理,比较两组的UEDVT及其他置管事件发生情况、干预前后的腋下血液流速、血栓弹力图(Thromboelastography,TEG)参数以及生活质量。结果观察组UEDVT及其他置管事件的发生率(2.22%和4.44%)均低于对照组(17.78%和17.78%),差异有统计学意义(χ^(2)=4.444、4.050,P均<0.05)。干预后,观察组两项腋下血液流速指标(最大血液流速与静脉平均血液流速)均快于对照组,差异有统计学意义(P均<0.05)。干预后,观察组TEG参数中的R值高于对照组,MA值低于对照组,差异有统计学意义(P均<0.05)。干预后,观察组生活质量评分量表中的环境、社会、生理及心理得分均高于对照组,差异有统计学意义(P均<0.05)。结论精细化护理能够有效改善乳腺癌PICC置管化疗患者的腋下血液流速,预防UEDVT及其他置管事件发生,提升患者置管期间的生活质量。

PICC相关新生儿胸腔积液2例并文献复习

目的探讨新生儿经外周静脉置入中心静脉导管(PICC)并发胸腔积液的临床特点、病因及防治措施,为临床诊治PICC相关新生儿胸腔积液提供依据。方法回顾2例新生儿PICC置管并发胸腔积液的临床资料,并以关键词“经外周静脉置入中心静脉导管”“胸腔积液”“PICC并发症”“peripherally inserted central catheter”“neonatal”“pleural effusion”“PICC complications”搜索中国知网(CNKI)、中华医学期刊全文数据库、PubMed、Web of science、Embase等数据库,检索2010年1月至2023年6月收录的文献。总结新生儿PICC相关胸腔积液的临床特点、治疗及预后。结果2例患儿均在PICC置管情况下突发呼吸困难,影像学检查及胸腔穿刺证实为PICC导管渗出性胸腔积液发生,通过立即拔除PICC导管以及行胸腔穿刺,胸腔积液吸收,经积极治疗后均治愈出院,预后良好。纳入文献16篇,总计53例患儿进行分析。53例患儿均为早产儿,除1例出生体重不详外,其余52例患儿均为低出生体重儿,其中极低出生体重儿44例,比例约80.2%,超低出生体重儿占比约11.3%。除1例未具体说明置管穿刺点外,其余52例患儿中,选择经上肢静脉置比例94.2%,下肢为3.8%。除8例未具体说明导管尖端位置外,其余病例中80%发生异位,以远心端方向异位居多,占比77.8%。结论新生儿PICC可并发胸腔积液,临床需引起重视并及时防范,正确处理,一般预后良好。

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.

节奏化弹力训练对居家病人PICC置管相关性血栓及运动疲乏感的影响

目的:探讨节奏化弹力训练对居家病人经外周静脉置入中心静脉导管(PICC)置管相关性血栓及运动疲乏感的影响。方法:选取启东市人民医院2021年3月—2023年2月收治的108例PICC置管居家病人为研究对象,按随机数字表法分为对照组和观察组,每组54例。对照组实施常规护理,观察组在对照组基础上实施节奏化弹力训练,比较两组病人PICC相关性血栓发生率及运动疲乏感。结果:观察组病人PICC相关性血栓发生率(3.70%)低于对照组(16.67%),两组比较差异有统计学意义(P<0.05);观察组多维度疲乏症状简表各维度评分均低于对照组,两组比较差异有统计学意义(P<0.05)。结论:节奏化弹力训练在PICC置管居家病人中的应用,有助于改善肢体血液循环,降低相关性血栓风险,缓解运动疲乏感。