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小儿静脉留置针的护理进展

【摘要】小儿静脉留置针以操作简单、使用方便、套管柔软、套管在静脉内留置时间长且不宜穿破血管，可随时进行输液治疗，不仅有利于危重患儿的抢救和提高护理工作效率，还可以减轻患儿痛苦，已被广泛应用于临床。为了充分发挥留置针的临床应用效果，进一步提高护理质量，护理人员应重视留置针置管过程中每一环节的护理。置管前根据患儿的年龄及病情选择合适的留置针及穿刺部位，掌握正确的置管方法，妥善固定，置管后严密观察局部反应，做好穿刺部位局部护理，正确封管，同时加强患儿及家长的健康教育和心理护理，可有效预防并发症的发生，减轻患儿痛苦，促进患儿尽早康复。

新生儿不同部位留置针留置效果对比

目的　评价留置针在新生儿治疗中不同穿刺部位的留置效果。 方法　采用随机对照方法将2009年1月－2011年10月收治的265例新生儿分为两组，A组139例经头皮静脉穿刺，B组126例经四肢静脉穿刺。观察比较两组留置针使用时间、局部有无红肿、脱针、液体外渗和不滴情况以及停止使用留置针的原因。 结果　B组留置时间明显长于A组、外渗率与局部红肿率则低于A组，两组比较差异有统计学意义（P＜0.01）。 结论　在妥善固定的情况下，新生儿四肢静脉留置效果优于头皮静脉。

Quality Control Circle Application in Reducing Patients' Adverse Events Caused by Needle Indwelling

ObjectiveTo reduce patients' adverse events caused by needle indwelling through quality control circle (QCC) activities, in order to ensure the effectiveness and safety of intravenous fluids. MethodsGuided by the QCC theory, we set up QCC, selected the topic related to reduction of patients' adverse events caused by needle indwelling, and worked out the plans from September 2012 to April 2013. Then, we adopted Plan-Do-Check-Act (PDCA) cycle method to set up goals, formulate measures, and inspect and improve the results. ResultsThe incidence of needle-related adverse events reduced from 44.8% to 9.8% by implementation of quality circle activities. There was a significant statistical difference between the two groups (χ2=148.16, P<0.05). ConclusionQCC activity can not only reduce the adverse events incidence of needle indwelling, but also improve the nurses' working enthusiasm and responsibility, problem-solving skills and accomplishment, and promote team cohesion.

静脉留置针输液致右贵要静脉血栓形成的护理一例

Comparison of Two Catheter Implantation Methods in Administering Amphotericin B in Patients with Hematological Malignancies with Fungal Infections

目的：通过经外周静脉穿刺中心静脉置管（PICC）或锁骨下静脉置管与前臂静脉留置针在血液病患者并发深部真菌感染时应用两性霉素B中的比较，探讨如何减少患者静脉炎及并发症发生率和再次静脉穿刺的发生率，从而提高患者生活质量。方法：80例血液病患者分为两组，40例PICC置管或锁骨下静脉置管组为A组，40例前臂静脉留置针为B组，记录静脉炎、疼痛发生情况、留置时间。结果：A组留置时间30～68天，B组留置时间1～5天；A组静脉炎率5%，B组静脉炎率45%；A组疼痛率5%，B组疼痛率35%；结论：在血液病患者并发深部真菌感染时应用两性霉素B治疗中，选用PICC置管或锁骨下静脉置管效果明显优于前臂静脉留置针，值得临床推广。

Continuous Quality Administrations of the Safety of Vein Detained Needles for Inpatients in the Department of Neurology

目的　探讨神经科住院患者留置针安全的持续质量管理。 方法　选择2011年8月－10月100例神经科住院患者，按入院时间先后排序分为对照组和试验组，每组50例。对照组运用静脉留置针的常规护理方法进行护理，试验组在给予常规护理方法的同时实施一系列持续质量管理的措施，包括安排护理业务查房、组织操作示范、应用留置安全健康宣传小卡片对患者进行宣教、定期不定期的留置质量检查、将留置针安全作为一项交班内容、强调优质护理指针。留置针留置第3天对两组患者使用同一自制量表调查留置期间的安全问题及患者对护理的评价，并对两组调查结果进行统计分析。 结果　试验组留置期间不良事件发生率为6.0%，对照组为34.0%，两组差异有统计学意义（χ2=12.250，P=0.000）；试验组对留置针留置安全知识的4个方面知晓情况均优于对照组（P=0.000）；试验组对护理满意度较对照组好（P=0.000）。 结论　持续质量管理增加了神经科住院患者留置针留置安全、增进了患者对相关健康知识的掌握，提高了患者对护理的满意，值得临床推广。

留置时间与静脉留置针所致静脉炎的相关性研究

目的：探讨留置时间与静脉留置针所致静脉炎的相关性，寻求安全的使用方法。方法：运用静脉炎调查分析量表，对608例患者使用静脉留置针的情况进行调查分析。结果：共有43例患者发生静脉炎，留置时间＞7天组及6～7天组，与其他各组间比较P＜0.05，差异有经计学意义；而其余三组间比较P＞0.05，没有显著性差异。留置时间与静脉炎发生率的相关系数为0.9315。结论：留置时间与静脉留置针所致静脉炎有正相关性，留置时间超过5天后，静脉炎的发生率即显著升高。

DecislV鱼骨图在静脉留置针管理的临床应用

目的讨论总结DecislV鱼骨图在静脉留置针中的应用效果。 方法纳入泌尿外科病房2012年4月-7月采用静脉留置针的患者200例，并随机将其分为干预组和对照组。对照组采用常规护理方法护理，干预组应用鱼骨图理论为基础进行程序化护理，并随访观察两组的护理效果。 结果干预组留置针渗出、堵管的并发症发生率低于对照组，差异有统计学意义（P＜0.05）。 结论应用DecislV鱼骨图对患者进行程序化护理能减少留置针的异常拔管率，延长患者留置针的留置时间，减少留置针所带来的相关并发症。

留置针引流在乳腺良性肿瘤开放手术的应用效果分析

目的分析乳腺良性肿瘤开放手术后创腔使用留置针引流的临床疗效。方法回顾性收集2018年7月至2021年6月期间四川大学华西医院乳腺外科收治的109例乳腺良性肿瘤患者（手术创腔放置留置针引流）的临床资料，评价患者的住院时间、留置针放置时间、临床效果、术后相关并发症及美容效果。结果109例放置留置针引流的乳腺良性肿瘤患者均行日间手术，住院时间均为1 d，术后留置针放置时间为（2.6±0.5）d，未出现切口感染、积液、脂肪液化、出血等并发症。患者术后乳房外形满意，活动不受影响。结论应用留置针引流乳腺良性肿瘤患者的术后创腔，操作简单，临床疗效好，患者满意度高，外形影响小。

Advantage of Venous Indwelling Needle in Radionuclide Imaging

ObjectiveTo investigate the application value of the intravenous indwelling needle in radionuclide imaging examination. MethodsA total of 120 patients underwent single photon emission computed tomography for bone and kidney dynamic imaging between October 2012 and April 2013 were randomly divided into group injected by venous indwelling needle (observagtion group) and group injected by traditional steel needle (control group), with 60 cases in each. We calculated the one-time success rate of venipuncture, the leakage rate of intravenous injection, residual radioactive dosage within the syringe and average exposure time of medical staff to radionuclide in the two groups of patients. ResultsThe one-time success rate of venipuncture in observation group was similar to that in the control group (P > 0.05). During the injection, no leakage was found in observation group, while 4 leakage in 37 patients underwent bone imaging and 3 leakage in 23 patients underwent kidney dynamic imaging in the control group were found; there was no significant difference between the two groups (P > 0.05). The residual radioactive dosage within the syringe in observation group was lower than that in the control group, and the exposure time of medical staff to radionuclide in observation group was also lower than that in the control group (P < 0.01). ConclusionsIntravenous indwelling needle for venous puncture can avoid leakage of radioactive imaging agent, reduce the residual radiological dosage within the syrings, increase the one-time puncture success rate and imaging resolution of dynamic scan, and improve the diagnostic accuracy and work efficiency effectively. Besides, the intravenous indwelling needle technique can reduce average exposure time of medical staff to radionuclide, acheaving the goal of optimized protection.