【Abstract】Objective To investigate the diagnostic and therapeutic value of selective angiography and embolization treatment in massive biliary hemorrhage in emergency. Methods Eleven cases of massive biliary bleeding were selectively angiographied and embolized with thread segment and gelatin sponge grain by Seldinger technique in emergency. Results Massive biliary bleeding in this series included bleeding after biliary surgery (7), post-laparoscopic cholecystectomy bleeding (1), bleeding from traumatic injury to liver (1), and rupture of huge hepatic cancer (2). There were 9 cases with abnormal angiographic findings including contrast medium leakage (9), tumor vessels and tumor tissue staining (2) and signs of pseudo-aneurysm formation (4). All the bleedings were stopped after emergency intervention but 2 cases with recurrent massive bleeding after 48 hours. Conclusion Emergency trans-catheter embolization treatment is an effective and safe method for biliary massive hemorrhage. It is also important to keep the biliary tract unobstructed.
Objective To find the most effective treatment for a patient with difficult selective biliary cannulation (DSBC) during endoscopic retrograde cholangiopancreatography (ERCP) by EBM practice. Methods Evidence was retrieved from The Cochrane Library (Issue 1, 2010), ACP online, NGC (1998 to June 2010), PubMed (1950 to June 2010), and CBM (1994 to June 2010). The collected evidence was then graded. Results After preliminary research, we identified 18 relevant articles. The evidence showed that pre-cutting technique could increase cannulation success rates in DSBC and was safe, effective, and time-saving for an experienced endoscopist. Pancreatic duct occupation was easier to perform than pre-cutting technique and could also increase selective cannulation success rates in DSBC. According to the evidence, together with endoscopist’s experience and the preference of the patient and his family, needle-knife precut papillotomy was performed. Successful selective biliary cannulation was accomplished after pre-cutting. Conclusion The current evidence suggests that pre-cutting technique and pancreatic duct occupation could increase selective cannulation success rates in DSBC. Patients’ condition and endoscopist’s experience should be considered properly before the operation.
ObjectiveTo explore the current status of nursing researches about catheter-related infections in recent 5 years in China, and provide reference for further research.MethodsThe China National Knowledge Infrastructure database and Wangfang database were selected to search for literature about catheter-related infections published in recent 5 years in 10 nursing journals of Statistic Source, with the terms of " catheter-related bloodstream infection” or " ventilator-associated pneumonia” or " catheter-related urinary tract infection”. Statistical analysis was conducted.ResultsA total of 216 papers were included. The number of papers was not increased year by year. In terms of the object of study, the studies on ventilator-associated pneumonia were the most, accounting for 71.3%. Only 36.5% of the studies had accurate diagnostic criteria. In terms of the type of study, experimental studies were the most (109 articles). The content was concentrated on the best practice intervention studies (149 articles). The data collection methods gave priority to active surveillance/screening, including 113 articles.ConclusionsThe present focused attention is not enough to the researches about catheter-related infections in nursing field, and rigorous design is lacking in published studies. There are only a few nursing studies about catheter-related infections with high quality and high level of evidence. The quantity and quality of nursing researches about catheter-related infections still need to be improved. Nurses should pay more attention to the control and prevention of catheter-related infections, and should improve their research capacity.
Objective To explore the therapeutic effect of catheter-directed thrombolysis combined with vena cava filter on deep venous thrombosis (DVT) of lower extremity.Methods The clinical data of 65 patients with DVT of lower extremities from January 2008 to August 2009 were analyzed retrospectively, whose course of diseases were not more than 7 d and clinical type included central type and mixed type. Thirty-two cases were treated with catheter-directed thrombolysis combined with vena cava filter, while administrating treatment of anticoagulation and activating blood circulation to dissipate blood stasis, which were named as study group. Thirty-three cases were treated traditionally with thrombolysis, anticoagulation, and activating blood circulation to dissipate blood stasis, which were named as control group. The course of therapy was continued 10-14 d, then the efficacy in two groups patients was evaluated. Results It was (7.35±1.42) cm that circumference difference before treatment between affected extremties and unaffected extremties in study group, which of 3, 7, and 14 d after treatment was (4.21±1.12) cm， (2.87±0.98) cm, and (1.22±1.02) cm, respectively. Circumference difference between before and after treatment had significant difference in study group (Plt;0.01). It was (6.97±1.27) cm that circumference difference before treatment between affected extremties and unaffected extremties in control group, which of 3, 7, and 14 d after treatment was (5.72±1.31) cm, (4.58±0.88) cm, and (3.18±1.24) cm, respectively. Circumference difference between before treatment and 3, 7, and 14 d after treatment had significant difference in control group (Plt;0.05 or Plt;0.01). Circumference difference before treatment in two groups had no significant difference (Pgt;0.05). Circumference difference after treatment at different time points in two groups was significantly different, respectively (Plt;0.01). Circumference difference after treatment at different time points in study group was significantly less than that in control group, respectively (Plt;0.01). After 14 d, complete recanalization rate （71.88%, 23/32） and cure rate (71.88%, 23/32) of iliofemoral vein in study group were significant higher than that (36.36%, 12/33) in control group (Plt;0.01). No pulmonary embolism occurred. Conclusion In terms of ideal therapy targets of DVT of lower extremity, the catheterdirected thrombolysis combined with vena cava filter is obviously superior to traditional thrombolysis treatment.
ObjectiveTo evaluate tip location of peripherally inserted central catheter (PICC) by using the carina as evaluation mark, so as to provide clinical references for blinding manipulation of PICC. MethodsA retrospective analysis about the effects of tip location of PICC by using the carina as evaluation mark on inpatients with malignant tumour was conducted in tumour centre of the West China Hospital from March 2013 to April 2014. Chest X radiography was applied to evaluate the tip location of PICC. Statistical analysis was performed using SPSS software (version 19.0) and the outcomes were presented by frequency and percentage. ResultsA total of 612 cases of blinding manipulation of PICC were evaluated, of which, 502 (82%) were located in the central venous and 110 (18%) were located in the noncentral venous. The numbers of those with the catheter tips located in the non-central venous were 38 in the right atrium, 33 in the internal jugular vein, 24 in the innominate vein, 8 in the axillary vein, and 7 in the subclavian vein, respectively. ConclusionThe effects of blinding manipulation of peripherally-inserted central catheter by using the carina as evaluation mark are relatively good. But it still needs to be improved.
ObjectiveTo reduce the incidence of peritoneal dialysis (PD) catheter complications through a continuous quality improvement (CQI) process. MethodsTwenty-nine patients with catheters inserted (from January 2011 to March 2011) before CQI, and another 41 patients with catheters inserted (between April 2011 and January 2012) after CQI were observed and analyzed. The possible causes of complications of catheter were summarized, and then on the basis of that, a PDCA four-step (plan-do-check-act) method was designed with a view to reducing the incidence of postoperative complications. ResultsPD catheter dysfunction decreased from 6.90% to 2.44%. The incidence of leakage decreased from 44.83% to 9.76%. ConclusionCQI is a useful method to reduce the incidence of postoperative complications of PD catheter in peritoneal dialysis.
ObjectiveTo evaluate the safety and efficacy of second central venous catheterization in tunnel cuffed dialysis catheter (TCC) dysfunction with fibrin sheath.MethodA total of 14 maintenance hemodialysis patients who required second central venous catheterization were enrolled in West China Hospital of Sichuan University from June 2016 to June 2017 and the clinical information and procedure-related complications were recorded.ResultsAll of the 14 patients were successfully performed with second central venous catheterization, of whom 4 cases had superior vena cava cannulation, 7 cases had right brachiocephalic vein cannulation, 2 cases had internal jugular vein cannulation, and 1 case had external jugular vein cannulation. No procedure-related major complication occurred. During the follow-up, catheter malfunction occurred in 2 cases, which improved by urokinase seal and catheter change, respectively. The rest patients’ catheter function remained normal.ConclusionsWith increasing difficult to construction and maintenance of vascular access, preservation of central vein resource is of high importance. For patients with TCC dysfunction with fibrin sheath, second central venous catheterization based on percutaneous brachiocephalic vein or superior vena cava cannulation is a safe and effective method to establish the lifeline for hemodialysis patients.
ObjectivesTo systematically review the influence for catheter mechanical dysfunction of different peritoneal dialysis catheterization methods.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched to collect randomized controlled trials (RCTs) and cohort studies on comparisons of different peritoneal dialysis catheterization from inception to March 31st, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Network meta-analysis was then performed by using ADDIS 1.16.6 software.ResultsA total of 33 studies (9 RCTs and 24 cohort studies) involving 3 301 patients were included. Network meta-analysis showed that the incidence of catheter mechanical dysfunctionwas the least and had statistically significant difference compared with that in percutaneous catheterization (OR=3.60; 95%CI, 1.64 and 15.38) and open surgery catheterization (OR=5.86; 95%CI, 2.68 and 14.53). Percutaneous catheterization was superior to open surgery catheterization, but there was no significant difference.ConclusionsLaparoscopic catheterization may be the best technique for catheter insertion in peritoneal dialysis considering catheter dysfunction. Each technology has its own advantages. Choice of insertion method should be based on the characteristics of both the patient and the insertion techniques.
ObjectiveTo investigate the diagnostic value of simultaneous culture of central venous catheter (CVC) blood and peripheral blood for catheter-related bloodstream infections (CRBSI). MethodsNon-septic patients who were treated with CVC for 1 to 7 days were enrolled from February 2011 to February 2015 in the First Hospital of Wuhan City. Blood were collected from both peripheral vein and CVC for bacterial culture once a day. The CVCs were removed from patients who got CRBSI from the first to sixth day and who did not by the end of the seventh day for semi-quantitative catheter culture, quantitative catheter culture, CVC culture and catheter exit-site pus culture. The diagnosis of CRBSI were based on 4 methods as follows:A, both peripheral and CVC blood were positive and the time of CVC blood positive were 2 hours earlier than peripheral blood; B, the colonies of semi-quantitative catheter cultures were ≥15 CFU and the microorganisms in both CVC and peripheral blood were the same; C, the colonies ratio of CVC and peripheral blood cultures were ≥5:1; D, the microorganisms in both the peripheral blood and catheter exit-site pus were the same. The diagnostic value of the four methods was compared. ResultsA total of 1 086 patients were finally included. From 1 to 7 days, 64 patients were peripheral blood positive, 79 were CVC blood positive. The patients diagnosed as CRBSI using A, B, C, and D methods were 58, 55, 51, and 36, respectively. Sixty patients were diagnosed as CRBSI based on the clinical and laboratory methods. For the number of patients diagnosed with CRBSI, there was no significant difference between A and B (P>0.05), as well as A and C (P>0.05), however, significant difference was found between A and D (P<0.05). In the diagnostic value of CRBSI, A is similar to B (sensitivity:93.33% vs. 91.67%, specificity:99.81% vs. 100%, Youden index:0.93 vs. 0.92). A, B and C had almost similar specificity (all >99%), however, A had higher sensitivity (93.33% vs. 76.67%, 58.33%) and Youden index (0.93 vs. 0.76, 0.58). ConclusionSimultaneous culture of CVC blood and peripheral blood has a good diagnostic value for CRBSI.
Objective To study the catheter-related infection (CRI) in cancer patients treated with central venous catheterization. Methods A prospective study with 196 cancer patients was conducted to analyze the types of catheter-related infection and pathogen, as well as the relationship between CRI and the following factors: insert location, gender, age, remained time, or bone marrow suppression. Results Of the total 196 cases, 16 cases were diagnosed as CRI and the CRI rate was 8.2%. The types of CRI were five cases of pathogen colonization, four cases of insert location infection and seven cases of catheter-related bloodstream infection. Of the total 244 specimens, 20 were positive including 7 pathogenic bacteria in either Gram positive or Gram negative types, the dominating pathogens were staphylococcus aureus, staphylococcus epidermidis, acinetobacter baumannii and klebsiella pneumoniae. CRI was related to both insert location and age which were both the independent risk factors. Conclusion The concept of prevention should be set up, and the comprehensive measures should be taken to reduce CRI, such as choosing an appropriate insert location and complying with a strict catheter insert standard.