目的 探讨神经外科危重患者经外周静脉置入中心静脉导管（PICC）的常见并发症发生原因，同时总结并发症有效预防措施及护理对策。 方法 纳入2009年9月－2012年9月期间行PICC的190例神经外科重症住院患者，统计并发症发生率，对其原因进行分析，并开展针对性预防和护理。 结果 本组患者PICC置管后有75例发生不同类型并发症，其中置管时并发症17例，包括导管异位8例，送管困难6例，穿刺失败3例，发生率为9%；导管留置期间并发症58例，包括穿刺点渗血、渗液16例，意外拔管12例，静脉炎10例，导管部分脱出9例，导管堵塞7例，导管相关性感染3例，导管相关性静脉血栓1例，发生率为30.5%。根据其发生的不同原因，采取积极的治疗和护理措施，并发症得以治愈，降低了并发症发生率。 结论 规范护理流程，加强临床培训，熟悉和掌握PICC并发症的预防和护理措施，可提高PICC置管、使用的安全性。
ObjectiveTo investigate the effectiveness of hydrocolloid dressing in preventing peripheral phlebitis due to intravenous infusions. MethodsFrom April 1st to October 30th, 2014, 320 patients admitted in the Biliary Department of West China Hospital for parenteral nutrition were collected along with their clinical data and were randomly divided into control group and intervention group. A total of 160 patients who were allocated in the control group accepted simple dressing with 3M adhesive tape (6 cm×7 cm) at the intravenous catheter site. In contrast, hydrocolloid dressing (5 cm×7 cm) was applied at the intravenous catheter site and then covered with 3M adhesive tape (6 cm×7 cm) for the patients in the intervention group. ResultsPhlebitis rate was significantly higher in the control group (115 patients) than that in the interventions group (64 patients) (χ2=32.978, P<0.001). In addition, the severity of phlebitis was higher in the control group than that in the intervention group (Z=-4.466, P<0.001). Statistically significant difference was noted. ConclusionHydrocolloid dressing is effective in preventing and delaying the occurrence of peripheral phlebitis due to intravenous infusions.
ObjectiveTo explore the value of portable ultrasound in assessing peripheral vein thrombosis of the injured in Lushan earthquake on April 20, 2013. MethodsFrom April 20th to May 5th in 2013, 321 earthquake victims were admitted into our hospital, and 203 fractured patients of them accepted peripheral venous two-dimensional and color doppler ultrasound examination beside the bed every three days. ResultsSixty-three patients (82 locations) suffered from venous thrombosis in the 203 earthquake victims, and the rate was 31.03% (63/203). Among them, one suffered from iliac vein thrombosis; 53 patients (71 limbs) were attacked by lower limb venous thrombosis; 9 patients (10 limbs) suffered from upper limb venous thrombosis. The time was from 2 to 15 days after trauma when the victims were diagnosed to have thrombus at the first time, averaging (6.1±3.8) days. On admission day, 45 victims were diagnosed with peripheral vein thrombosis. Among them, 19 patients increased the scope of thrombus after admission in hospital, while 26 victims reduced the scope. Eighteen victims suffered from newly developed peripheral venous thrombus after admission in hospital. None of the hospitalized patients died of pulmonary embolism. ConclusionsThe victims injured in the earthquake have a high incidence of peripheral vein thrombosis, and the calf is the main site of the disease. After trauma, peripheral venous thrombosis occurs within a short time. Bedside portable ultrasound is the first choice for peripheral vein thrombosis in the earthquake victims.
目的 了解成都市肿瘤科医护人员经外周静脉留置中心静脉导管术（PICC）认知现状，为今后开展PICC相关知识培训提供科学依据。 方法 2009年12月－2010年1月采用自行设计的问卷对成都市5家三甲医院的肿瘤科医护人员309名（医生134名，护士175名）进行PICC认知态度现状调查。 结果 成都市三甲医院肿瘤科医护人员PICC认知呈中等偏低的水平，护士PICC知识的掌握高于医生（P＜0.05），护士PICC态度得分优于医生（P＜0.05）。94.84%的医护人员知道PICC技术；只有8.38%的肿瘤科医护人员接受过PICC专业培训。不同文化程度、年龄、工龄、职业与PICC认知之间的差异存在统计学意义（P＜0.05）。 结论 三甲医院肿瘤科医护人员对PICC技术有一定的了解，但总体认知仍有待提高，需加强PICC相关知识培训，进一步提高医护人员PICC认知水平，以利于肿瘤专科开展PICC技术，促进肿瘤护理的专业化发展。