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外周静脉置入中心静脉导管术在高原地区肿瘤患者中的应用观察

目的　探讨外周静脉置入中心静脉导管（PICC）术在高原地区肿瘤患者中的临床应用，为西藏地区更好开展PICC技术提供依据。 方法　回顾性分析2010年8月－2012年4月113例肿瘤患者临床资料。 结果　穿刺成功111例，失败2例，成功率为98.2%。发生相关并发症14例，发生率12.4%，其中导管异位6例（5.3%），导管相关性感染3例（2.7%），栓塞2例（1.8%），机械性静脉炎2例（1.8%），导管部分脱出1例（0.8%）。 结论　PICC置管是一种置管成功率高，保留时间长，并发症较少、可靠有效的静脉治疗新途径，可在高原地区广泛推广应用。

对规范化培训护士外周静脉置入中心静脉导管维护技能的调查分析

【摘要】　目的　了解规范化培训护士对经外周静脉置入中心静脉导管（PICC）相关知识的认知及掌握情况。　方法　采取问卷调查方式，对2009年-2010年已在医院肿瘤科轮转工作过的57名规范化培训护士进行PICC维护知识的不记名调查。　结果　规范化培训护士对揭除穿刺处敷料的方向、穿刺处皮肤消毒面积、PICC导管是否可直接接触无菌胶带、脉冲式冲管及正压式封管的方法等内容，回答正确率均在90.9%以上；而对于PICC术后首次更换敷料的时间、注射器型号的选择、导管相关性血流感染等内容，回答正确率为69.09%。　结论　为降低PICC相关并发症的发生率，保证PICC维护质量安全，对规范化培训护士进行具有针对性、持续性、全面性的PICC维护培训刻不容缓

X线透视引导下经外周静脉置入中心静脉导管误入胸壁静脉处置一例

超声引导下颈内静脉阻断法预防经外周静脉置入中心静脉导管异位颈内静脉的效果观察

目的　观察超声引导下颈内静脉阻断对预防外周静脉置入中心静脉导管（PICC）时发生颈内静脉异位的效果。 方法　2011年6月－12月将326例PICC置管的患者随机分为观察组和对照组各163例，观察组在送管时运用B型超声引导下阻断颈内静脉；对照组在送管时采用传统的偏头压肩法阻断颈内静脉。置管后通过胸部X线片比较两组患者导管异位率。 结果　观察组发生导管异位2例，对照组发生12例，两组导管异位率差异有统计学意义（χ2=7.537，P=0.006）。 结论　超声引导下颈内静脉阻断法对预防PICC置管时发生导管异位于颈内静脉具有较高的临床意义。

Clinical Efficacy of Comfeel Transparent Paste in Treating Peripheral Inserted Central Cathether-associated Allergic Dermatitis

ObjectiveTo investigate the efficacy and nursing strategy of Comfeel transparent paste in treating peripheral inserted central catheter (PICC)-associated allergic dermatitis. MethodsSixty patients with PICC puncture-associated local allergic dermatitis treated between June 2011 and March 2013 were randomly divided into experimental group and control group with 30 patients in each group. The experimental group was treated with dexamethasone sodium phosphate and Comfeel transparent paste, while the control group was treated with dexamethasone sodium phosphate and 3M transparent dressing. The curative effect was compared between the two methods. ResultsTwelve patients were cured with a curing rate of 40.0% in the control group and 22 patients were cured, and the curing rate was 73.3% in the experimental group. The difference between them was significant (P<0.05). ConclusionTreatment with dexamethasone sodium phosphate and Comfeel transparent paste for PICC-associated allergic dermatitis is quite effective, and the patients felt comfortable with low pains. In addition, it reduces the extubation rate of PICC and improves the care quality.

Investigation of Caregivers' Self-nursing Ability for Children with Peripherally Inserted Central Catheter

ObjectiveTo investigate the knowledge and need of caregivers who perform self-nursing for children with peripherally inserted central catheter (PICC), in order to provide evidence for health education for children in-patients and children discharged from hospital with central venous catheter. MethodsSelf-designed questionnaire was used to investigate 364 caregivers who performed nursing for 162 PICC pediatric in-patients bwtween December 2013 and July 2015. The investigation was carried out on the general information, nursing knowledge, and the acquisition approach of caregivers' existing nursing knowledge. ResultsThe majority of indwelling PICC pediatric caregivers were elderly people, and the common care model was alternate caring carried out by core family members. The children were cared by the elderly in 59 families (36.42%). Twenty-one families had the parents of the children as the major caregivers (12.96%), and alternate caring by parents and the elderly happened in 82 families (50.62%). The total score of the investigation was ranged from 5 to 29 with an average of 11.37±5.68. Nineteen children were discharged with catheter, whose caregivers got a score from 6 to 11, averaging 8.41±4.33. ConclusionThe ratio of self-nursing knowledge in caregivers for pediatric PICC patients is generally low, especially in those caregivers for patients discharged with central venous catheter. Nursing administrators should pay attention to training of the nurses, trying to improve the knowledge of nurses on PICC health education. Different forms of health education should be carried out for different caregivers. Finally, health education model should also be continuously improved to raise the quality of PICC pediatric nursing.

新生儿外周静脉置入中心静脉导管堵管原因分析

目的探讨新生儿经外周静脉置入中心静脉导管（PICC）堵塞原因，寻求措施以减少堵管发生率。 方法对2010年1月－2013年3月97例留置PICC发生管道堵塞的患儿资料进行分析，总结堵管原因并提出护理对策。 结果97例PICC置管患儿中，17例发生堵管，发生率17.5%，堵管后再通成功12例。低年资护士维护者堵管发生较多；夜间堵管较多。 结论针对新生儿PICC堵管的主要原因给予相应护理干预能降低PICC堵管率。

运用改良塞丁格技术经外周静脉置入中心静脉导管临床应用实践

目的　总结运用改良塞丁格技术实现经外周静脉置入中心静脉导管（PICC）的方法与经验。 方法　2009年11月－2012年3月对51例肿瘤患者应用改良塞丁格技术置入PICC，其中10例在超声引导下施行。 结果　50例首次操作置管成功，1例首次置管失败，1周后再次置入成功，无重要并发症。 结论　改良塞丁格技术行PICC 置管具有良好的临床实用性、安全性和可靠性。

弹力绷带在经外周静脉置入中心静脉导管置管中的固定作用及效果

目的　讨论弹力绷带在经外周静脉置入中心静脉导管（PICC）置管中的固定作用及对减少局部渗血、渗液和预防机械性静脉炎的效果。 方法　选择2011年6月－2012年3月在某三甲医院重症医学科（ICU）行PICC置管的100例患者，按穿刺时间先后顺序单号纳入对照组，双号归于试验组,每组各50例。对照组置管后在穿刺局部放置8层无菌方纱，外用 10 cm×12 cm的透明敷料外固定；试验组在对照组的基础上增加弹力绷带固定,分别观察两组患者置管后24、72 h局部渗血、渗液、机械性静脉炎的发生情况。 结果　在24、72 h两个时间点，试验组渗血、渗液发生率少于对照组（χ2=4.57，P＜0.05）；静脉炎发生率在24 h时低于对照组（χ2=4.00，P＜0.05），但在72 h差异无统计学意义。 结论　PICC置管患者使用弹力绷带固定不仅可防止穿刺点渗血渗液，减少机械性静脉炎的发生，而且可减轻护士工作量，值得临床推广使用。

化学疗法经外周静脉置入中心静脉导管路径医护一体化管理模式探讨

【摘要】　目的　总结肿瘤患者化学疗法经外周静脉置入中心静脉导管（peripherally inserted central catheter， PICC）路径医护一体化管理模式的经验与效果，提高医护团队的工作效率。　方法　针对化学疗法PICC路径管理前医护合作存在的问题，通过优化配置医护团队，建立PICC临床路径管理制度，规范PICC技术操作、技术维护质量标准等措施，实现PICC医护一体化管理模式。　结果　医护一体化管理模式能有效地提高医护工作效率，降低PICC并发症，患者满意度提高。　结论　实施肿瘤患者化学疗法PICC路径医护一体化的管理模式，使护理工作流程更加合理化，PICC技术管理更加规范，可为患者节约住院费用，并加快病床周转。