ObjectiveTo explore the influence of evidence-based nursing care of catheterization on the incidence of urinary tract injury and urinary tract infection in patients with spinal cord injury and long-term indwelling catheters.MethodsFrom July 1st, 2017 to November 30th, 2018, 100 patients with spinal cord injury indwelling catheters in Department of Spinal Surgery were prospectively selected as the research objects. According to the admission time, patients admitted between July 2017 and February 2018 were assigned into the control group (n=50), and patients admitted between March 2018 and November 2018 were assigned into the observation group (n=50). Traditional catheter placement was used in the control group, while evidence-based catheter placement was used in the observation group. The incidences of catheter-related urethral injury and urinary tract infection after the catheterization were compared between the two groups.ResultsThere was no statistically significant difference in gender, age, diagnosis, or length of hospital stay between the two groups (P>0.05). Catheter placement was performed 57 times in the control group and 59 times in the observation group during hospitalization. After catheterization, the incidences of urethral hemorrhage and gross hematuria in the control group [22.80% (13/57) and 15.78% (9/57), respectively] were higher than those in the observation group [both were 1.69% (1/59)], with statistical differences between the two groups (P<0.05). The incidence of urinary tract infection in the control group differed from that in the observation group [42.0% (21/50) vs. 18.0% (9/50), P=0.009].ConclusionThe evidence-based urinary catheterization method for patients with spinal cord injury and long-term indwelling catheter can effectively prevent catheter-related urinary tract injury, reduce the incidence of catheter-related urinary tract infection during hospitalization, and improve the quality of clinical care.
Objective To explore the related factors of upper urinary tract deterioration (UUTD) in spinal cord injury patients using intermittent catheterization (IC-SCI) in the community. Methods Patients with spinal cord injury in the Chinese community were selected for investigation between August 3 and August 31, 2020. The included patients were divided into UUTD group and non-UUTD group. The basic information, intermittent catheterization practices, and urinary complications were compared between the two groups. Logistic regression was used to analyze the risk factors contributing to UUTD. Results A total of 431 patients were surveyed. Among them, there were 310 males and 121 females, 246 cases in the non-UUTD group and 185 cases in the UUTD group. There were statistically significant differences in the disease duration, gender, etiology, urinary incontinence, urinary tract infection, bladder calculi and nephrolithiasis between the two groups (P<0.05); there was no statistically significant difference in the other indicators between the two groups (P>0.05). The results of logistic regression analysis showed that urinary tract infection [odds ratio (OR)=3.229, 95% confidence interval (CI) (1.706, 6.110), P<0.001], nephrolithiasis [OR=4.846, 95%CI (2.617, 8.973), P<0.001], and urinary incontinence [OR=2.345, 95%CI (1.116, 4.925), P=0.024] were risk factors for UUTD. Conclusion Urinary tract infection, nephrolithiasis and urinary incontinence are independent risk factors for UUTD in community-based IC-SCI patients and deserve attention for preventive strategies.
The management of neurogenic lower urinary tract dysfunction due to spinal cord injury is one of the most challenging tasks in rehabilitation. Considerable progress has been made in the management of lower urinary tract dysfunction in patients with spinal cord injury over the past few decades. However, urinary complications remain one of the most serious complications in patients with spinal cord injury. Lower urinary tract dysfunction in patients with spinal cord injury present with a variety of symptoms and signs that require comprehensive evaluation. The management of lower urinary tract dysfunction in patients with spinal cord injury require tailored and individualized treatment approaches. Based on the clinical practice of rehabilitation at home and abroad, this paper expounds the progress of the assessment and rehabilitation of lower urinary tract dysfunction after spinal cord injury, and puts forward some suggestions for the reference of clinical staff.
Objective To evaluate the therapeutic efficacy of percutaneous transhepatic portal vein catheterization and thrombolysis on acute superior mesenteric vein thrombosis. Methods The treatment and therapeutic efficacy of 7 cases of acute superior mesenteric vein thrombosis underwent percutaneous transhepatic portal vein catheterization and thrombolysis under ultrasound guidance from August 2005 to April 2009 were analyzed. Results All the patients succeeded in portal vein catheterization and no bile leakage or abdominal bleeding occurred during the procedure. The clinical symptoms such as abdominal pain, abdominal distension， and passing bloody stool relieved were relieved and liquid diet began at postoperative of day 2-5. Emergency operation was done in one case and there was no intestinal fistula. The angiography after the operation showed that the majority of thrombosis were cleared and the blood of portal vein and superior mesenteric vein flowed smoothly. During the follow-up of 3 months to 3 years, all the patients’ status maintained well and no recurrence occurred. Conclusion Treatment of acute superior mesenteric vein thrombosis by percutaneous transhepatic portal vein thrombolysis is safe and effective.
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.
ObjectiveTo analyze the causes and potential risk factors of re-catheterization after failure of no urinary catheter in patients undergoing lung cancer surgery.MethodsThe clinical data of 1 618 patients without urinary catheter indwelling during the perioperative period of thoracic surgery in our hospital from 2013 to 2019 were retrospectively analyzed, including 791 males and 827 females, with a median age of 58 years, ranging from 27 to 85 years. And the risk factors for re-insertion after failure of urinary catheter were investgated.ResultsThe rate of catheter re-insertion was 1.5% (24/1 618). Compared with patients without re-insertion, patients with re-insertion had longer operation time [120.0 (95.0, 130.0) min vs. 120.0 (115.0, 180.0) min, P=0.015] and more intraoperative fluid infusion [800.0 (600.0, 1 100.0) mL vs. 1 150.0 (725.0, 1 350.0) mL, P=0.008]. Further multivariate analysis found that the operation time (OR=1.014, P=0.004, 95%CI 1.005-1.024) and intraoperative fluid infusion (OR=1.001, P=0.022, 95%CI 1.001–1.002) were independent risk factors for re-insertion.ConclusionThe rate of catheter re-insertion in lung cancer patients is relatively low, and conventional no placement of catheter is safe and feasible after lung cancer surgery. Increasing operation time or intraoperative infusion volume may increase the risk of catheter re-insertion after lung cancer surgery.
ObjectiveTo investigate the effect of suprapubic catheterization(SPC) by using central venous catheter (CVC) on the perioperative complications in middle and low rectal cancer surgery. MethodsThe clinical data of 141 patients with middle and low rectal cancer underwent operation in Shengjing Hospital of China Medical University from April 2012 to January 2015 were collected. There were 65 patients performed SPC by using CVC, 76 patients performed routine transurethral catheterization(TUC). The incidences of bacteriuria and urinary retention, recatheterization rate, duration of catheterization, and catheter-related pain were analyzed and compared between these two groups. Results①Compared with the TUC, the SPC by using CVC could significantly reduce the incidence of bacteriuria(P=0.002), espe-cially in female(P=0.006), ≥60 years old(P=0.001), low rectal cancer(P=0.003), open surgery(P=0.018), Miles(P=0.016), and Dixon(P=0.032).②There was no significant difference in the incidence of urinary retention(P=0.464) between the SPC by using CVC and the TUC.③Compared with the TUC, the SPC by using CVC could significantly reduce the inci-dence of recatheterization rate(P=0.001), especially in the patients with male(P=0.016), ≥60 years old(P=0.008), low rectal cancer(P=0.019), laparoscopic surgery(P=0.013), and Miles(P=0.037).④Compared with the TUC, the point of catheter-related pain was significantly lower in the SPC by using CVC(P=0.001), no matter males(P=0.005) or females(P=0.010), aged 60 years and older(P=0.023) or younger(P=0.034), middle rectal cancer(P=0.017) or low rectal cancer(P=0.046), open surgery(P=0.033) or laparoscopic surgery(P=0.021), Dixon(P=0.019) or Miles(P=0.035).⑤The duration of catheterization was similar between the SPC by using CVC and the TUC(P=0.597). ConclusionSPC by using CVC is a safer, more effective and more acceptable method of bladder drainage in middle and low rectal cancer surgery as compared with routine TUC.
Objective To construct a risk prediction score model for serious adverse event (SAE) after cardiac catheterization in patients with adult congenital heart disease (ACHD) and pulmonary hypertension (PH) and verify its predictive effect. Methods The patients with PH who underwent cardiac catheterization in Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology from January 2018 to January 2022 were retrospectively collected. The patients were randomly divided into a model group and a validation group according to the order of admission. The model group was divided into a SAE group and a non-SAE group according to whether SAE occurred after the catheterization. The data of the two groups were compared, and the risk prediction score model was established according to the results of multivariate logistic regression analysis. The discrimination and calibration of the model were evaluated using the area under the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow test, respectively. Results A total of 758 patients were enrolled, including 240 (31.7%) males and 518 (68.3%) females, with a mean age of 43.1 (18.0-81.0) years. There were 530 patients in the model group (47 patients in the SAE group and 483 patients in the non-SAE group) and 228 patients in the validation group. Univariate analysis showed statistical differences in age, smoking history, valvular disease history, heart failure history, N-terminal pro-B-type natriuretic peptide, and other factors between the SAE and non-SAE groups (P<0.05). Multivariate analysis showed that age≥50 years, history of heart failure, moderate to severe congenital heart disease, moderate to severe PH, cardiac catheterization and treatment, surgical general anesthesia, and N-terminal pro-B-type natriuretic peptide≥126.65 pg/mL were risk factors for SAE after cardiac catheterization for ACHD-PH patients (P<0.05). The risk prediction score model had a total score of 0-139 points and patients who had a score>50 points were high-risk patients. Model validation results showed an area under the ROC curve of 0.937 (95%CI 0.897-0.976). Hosmer-Lemeshow goodness-of-fit test: χ2=3.847, P=0.797. Conclusion Age≥50 years, history of heart failure, moderate to severe congenital heart disease, moderate to severe PH, cardiac catheterization and treatment, general anesthesia for surgery, and N-terminal pro-B-type natriuretic peptide≥126.65 pg/mL were risk factors for SAE after cardiac catheterization for ACHD-PH patients. The risk prediction model based on these factors has a high predictive value and can be applied to the risk assessment of SAE after interventional therapy in ACHD-PH patients to help clinicians perform early intervention.
ObjectiveTo evaluate the feasibility to use ultrasonic cardiac output monitoring (USCOM) for patients after coronary artery bypass grafting. MethodsClinical data of 32 patients undergoing off-pump coronary artery bypass grafting in General Hospital of Shenyang Military Region between April and June 2013 were retrospectively analyzed. There were 17 male and 15 female patients with their age of 46-76 (63.2±7.6) years. USCOM and pulmonary artery catheterization (PAC) were used to measure cardiac output (CO) synchronously,and the results were compared between USCOM and PAC. ResultsSixty-four pairs of data were collected from those 32 patients. No adverse event was observed with either USCOM or PAC. Mean CO was 4.27±0.92 L/min with USCOM and 4.49±0.75 L/min with PAC respectively,which were not statistically different (P=0.12) but significantly correlated (r=0.84,P<0.001). ConclusionThere is close correlation between USCOM and PAC for CO measurement. USCOM can not only measure CO accurately,but also has the advantages of being noninvasive,easy to perform and low cost.
Objective To investigate the efficacy and safety of abdominal indwelling catheterization for the patients with large-volume ascites. Methods A total of 84 patients with liver cirrhosis complicated with large-volume ascites admitted in the first affiliated hospital of Xi’an Jiaotong University from January 2015 to December 2015 were retrospectively analyzed. Patients were divided into two groups, one was the puncture group and another was the catheterization group. The efficacy and safety were evaluated. Results Forty-four patients were enrolled in catheterization group, whereas forty patients were enrolled in puncture group. Symptoms associated with ascites had been eased and patients’ qualities of life had been improved in 2 weeks in each group. The tube fell out rate was 27.3% for patients in catheterization group. There was no operation related complications such as death, bleeding and intestinal perforation occurred. Either Child B stage or Child C stage, the dynamic changes of liver function and renal function in catheterization group were comparable to those in puncture group. No adverse event such as catheterization-related or puncture-related infection was observed. Conclusion Abdominal catheterization is effective and safe in management of large amount of ascites complicated with cirrhosis, however, the high rate of tube-fell-out should be paid more attention.