Central venous catheterization(CVC)is a fundamental clinical procedure widely performed across medical specialties.However,the complication rate of subclavian vein catheterization ranges from 6%to 11%.[1]Common compli...Central venous catheterization(CVC)is a fundamental clinical procedure widely performed across medical specialties.However,the complication rate of subclavian vein catheterization ranges from 6%to 11%.[1]Common complications include hemothorax,pneumothorax,air embolism,arterial puncture,and aortic perforation.[2]Herein,we report a rare case of accidental puncture of the aorta during subclavian CVC,which was successfully managed with a ventricular septal defect(VSD)occluder.展开更多
Objective: To evaluate the application effect of ultrasound-guided central venous catheterization in the teaching of anesthesia residents. Methods: Forty anesthesia resident companions who received standardized reside...Objective: To evaluate the application effect of ultrasound-guided central venous catheterization in the teaching of anesthesia residents. Methods: Forty anesthesia resident companions who received standardized residency training in our department from July 2018 to July 2020 were randomly divided into an ultrasound group and a control group, with 20 participants in each group. The ultrasound group was taught by ultrasound-guided central venipuncture, while the control group was taught by traditional anatomy. After ten training punctures, all trainees were assessed twice. Results: Both groups could master the technique of central venipuncture. The success rate of first puncture and the overall success rate of puncture in the ultrasound group were significantly higher than those in the control group (p p < 0.05). Conclusion: Compared with the traditional anatomical localization teaching, the use of ultrasound-guided technology can improve the success rate of puncture, save puncture time, reduce related complications, and have a better training effect.展开更多
BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the u...BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous(IO) access and central venous catheterization(CVC) in critically ill Chinese patients.METHODS: In this prospective clustered randomized controlled trial, eight hospitals were randomly divided into either the IO group or the CVC group. Patients who needed emergency vascular access were included. From April 1, 2017 to December 31, 2018, each center included 12 patients. We recorded the data mentioned above.RESULTS: A total of 96 patients were enrolled in the study. There were no statistically significant differences between the two groups regarding sex, age, body mass index, or operator satisfaction with the used devices. The success rates of the first attempt and the procedure time were statistically significant between the IO group and the CVC group(91.7% vs. 50.0%, P<0.001;52.0 seconds vs. 900.0 seconds, P<0.001). During the study, 32 patients were conscious. There was no statistically significant difference between the two groups regarding the pain score associated with insertion. There were statistically significant differences between the two groups regarding the pain score associated with IO or CVC infusion(1.5 vs. 0.0, P=0.044). Complications were not observed in the two groups.CONCLUSIONS: IO access is a safe, rapid, and effective technique for gaining vascular access in critically ill adults with inaccessible peripheral veins in the emergency departments.展开更多
Objective: To investigate the effectiveness of ultrasound-guided central venous catheterization when compared to the conventional procedure. Method: A prospective cohort study was carried out over a 9-month period fro...Objective: To investigate the effectiveness of ultrasound-guided central venous catheterization when compared to the conventional procedure. Method: A prospective cohort study was carried out over a 9-month period from February to October 2016 involving 144 inpatients at PICU of Irmandade da Santa Casa de Sao Paulo Hospital, undergoing central venous catheterization. The patients were matched in pairs of identical patients according to the levels of potentially intervening variables (age, nutritional status, puncture site, professional experience), differing only as to the CVC technique: ultrasound-guided (USG-CVC) or conventional (C-CVC). Discarding data from non-paired patients, the remaining did forming 47 pairs, matched as two related samples: USG-CVC and C-CVC groups. Success parameters: number of puncture attempts;time spent at CVC;success rate and complications. Results: In the USG-CVC group, the number of attempts (mean = 2.04) and the time spent at catheterization (mean = 11.89 minutes) were lower (t = 2.34, df = 46, t 0.95 = 2.02, p t = 3.07, df = 46, t 0.95 = 2.02, p < 0.05), respectively, when compared to the results obtained for the control group (C-GVC), (mean = 3.21) and (mean = 28.26 minutes), respectively. As to success, there was observed a significant difference (F (1, 46) = 16.6;Q (1) = 12.5, p < 005) when considering only one trial (USG -CVC = 27/47;C-CVC = 9/47), but no significant difference (F (1, 46) = 3.76;Q (1) = 3.56, p > 0.05) when considering several attempts. Complications were found less frequently in the USG-CVC group (3/47) than in the CVC-C (13/47), (F (1, 46) = 8.24;Q (1) = 7.14, p < 0.05). Conclusion: USG-CVC was found to be more effective than the conventional technique, especially regarding success at the first puncture attempt.展开更多
Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically...Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.展开更多
Objective: to explore the application and nursing countermeasures of umbilical vein catheterization in premature infants. Methods: 100 premature infants were selected from our hospital from January 2021 to February 20...Objective: to explore the application and nursing countermeasures of umbilical vein catheterization in premature infants. Methods: 100 premature infants were selected from our hospital from January 2021 to February 2022. They were divided into control group (50 cases, peripheral venous indwelling needle treatment) and observation group (50 cases, umbilical vein indwelling treatment) by computer lottery. The indwelling condition, treatment condition and adverse events of the two groups were observed and compared. Results: the success rate of one-time puncture in the observation group was 96.00%, higher than 80.00% in the control group (P < 0.05);The puncture point search time (84.54 ± 15.69) s and the compression coagulation time (264.54 ± 30.55) s were shorter than those in the control group (288.36 ± 15.54) s and (480.25 ± 42.22) s (P < 0.05);The retention time was (6.05 ± 1.27) d, which was longer than that in the control group (4.22 ± 1.65) d (P < 0.05);The number of intravenous indwelling needles (12.69 ± 5.04) was less than that in the control group (16.45 ± 7.28) (P < 0.05);The duration of intravenous treatment (20.47 ± 2.24) d and the total incidence of adverse events was 4.00%, lower than that of the control group (24.65 ± 2.66) d and 20.00% (P < 0.05). Conclusion: the effective application of umbilical vein catheterization during the treatment of premature infants can effectively improve the success rate of one-time puncture and make intravenous therapy more effective. Strengthening relevant nursing intervention can effectively reduce the incidence of adverse events and make intravenous therapy more safe, so as to better maintain the health and safety of children.展开更多
Central venous access is one of the most common surgery procedures worldwide, especially in pediatric surgery. Local and regional complications as the result of venous catheter permanence time are frequently described...Central venous access is one of the most common surgery procedures worldwide, especially in pediatric surgery. Local and regional complications as the result of venous catheter permanence time are frequently described as: thrombosis, infection, edema and local cellulite, movement and loss of the catheter. Other severe complications such as endocardiac and hemorrhagic lesions are also described and considered the cause of catheter early removal. In the literature few studies have addressed vascular and perivascular lesions and complications as the result of central venous access to peripheral veins, given the difficulty of setting up venous catheterization experimental models to study blood vessels and perivascular tissue alterations after catheterization. In the present venous catheterization experimental model, rabbits were divided into two groups based on the time that the venous catheters were maintained in their veins. Group a composed of 7 New Zealand male rabbits was submitted to a 15-day treatment;and the 6 New Zealand male rabbits of group B were treated during 90 days. Both groups presented similar inflammatory conditions since there was no significant difference between groups. Therefore, the results may well suggest that the endothelial inflammatory reaction could have developed at an early initial short period and by maintaining the catheter, the inflammatory reactions would have decreased or disappeared. Aimed at studying these vascular and perivascular alterations in venous catheterization, the present study proposes an experimental rabbit model that allows the analysis of differences in local vascular and perivascular histological variations and compares histological differences between both venous catheterization groups each of them with different periods of treatment.展开更多
BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SU...BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SUMMARY A 75-year-old male patient was admitted for laparoscopic radical nephrectomy.Under ultrasound guidance,right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt.Sudden hypotension developed after surgical positioning and persisted until the end of the operation,lasting for about 4 h.In the recovery room,a massive hemothorax was identified on chest radiography and computed tomography.The patient recovered following chest tube drainage of 1.6 L blood.CONCLUSION Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance.So the proper use of ultrasound is important.展开更多
With the popularization of central venous catheterization in recent years,the problems arising from intravenous therapy have gradually increased.Fibrin sheath is the complication with the highest incidence rate in cen...With the popularization of central venous catheterization in recent years,the problems arising from intravenous therapy have gradually increased.Fibrin sheath is the complication with the highest incidence rate in central venous catheterization,which has always been a major problem in intravenous therapy.So the prevention and treatment of fibrin sheath has become a hot spot of research in recent years.Hence,this paper summarizes the research on fibrin sheath in recent years.展开更多
Central venous catheterization is widely used in the emergency setting. This review aims to assess central venous catheterization from the perspectives of types of catheters, sites of insertion, and tech- niques. In e...Central venous catheterization is widely used in the emergency setting. This review aims to assess central venous catheterization from the perspectives of types of catheters, sites of insertion, and tech- niques. In emergency conditions, non-tunneled catheters are preferred because the technique for its insertion is not complicated and less time-consuming. The size of catheter depends on the purpose of catheterization. For example, a large bore catheter is needed for rapid infusion. The ideal catheterization site should bear fewer thromboses, lower infectious rate, and fewer mechanical complications. Thus the femoral vein should be avoided due to a high rate of colonization and thrombosis while the subclavian vein seems to exhibit fewer infectious complications compared with other sites. The ultrasound-guided technique increases the success rate of insertion while decreases the mechanical complications rate,展开更多
Objective:To systematically evaluate the clinical effects of cluster nursing intervention in preventing central venous catheter-related infection in intensive care unit.Methods:A randomized controlled study was search...Objective:To systematically evaluate the clinical effects of cluster nursing intervention in preventing central venous catheter-related infection in intensive care unit.Methods:A randomized controlled study was searched from China National Knowledge Internet(CNKI),Wanfang,Chinese Scientific Journals Database(VIP),Chinese Biomedical Literature Service System(SinoMed),PubMed,Embase and Cochrane library databases from the establishment to May 1,2020.Two reviewers independently evaluated and cross checked the quality of the study.Revman 5.3 was used to conduct the meta-analysis.Results:A total of 21 randomized controlled trials with 6,030 patients were included.Meta-analysis showed that the incidence of central venous catheter-related infection(relative risk(RR)=0.29,95%confidence interval(CI)[0.23,0.37]),the incidence of catheter plugging(RR=0.25,95%CI[0.16,0.39])and catheter prolapse(RR=0.18,95%CI[0.11,0.29])were significantly different between the two groups.Conclusion:Cluster nursing intervention could prevent central venous catheter-related infection in intensive care unit.展开更多
Objective To investigate the effect and safety of the treatment of renal cysts with color Doppler ultrasound guided percutaneous puncture catheterization drainage and repeated 99% ethanol perfusion. MethodsFifty-eight...Objective To investigate the effect and safety of the treatment of renal cysts with color Doppler ultrasound guided percutaneous puncture catheterization drainage and repeated 99% ethanol perfusion. MethodsFifty-eight patients with primary renal cysts were treated with color Doppler ultrasound guided percutaneous puncture catheterization drainage and 99% ethanol perfusion. If the cyst volume was<500 mL, the complete evacuation of the cyst was followed by injection with 99% ethanol in a volume equal to 25% of the total cyst volume, twice per day, 10 min for each injection. If the cyst volume was>500 mL, injection was given three times per day, 20 min for each injection, and the patient was asked to move in different positions to help distributing the ethanol over the cyst wall. ResultsFifty-eight cysts were detected in the 58 patients. Puncture was performed and the success rate was 100%. Central venous catheter was introduced into the cysts. After follow-up for 0.5 to 3 years, 56 renal cysts were disappeared. The cure rate was 96.6%, and the complications such as bleeding, infection, and organ injuries were not found. ConclusionThe treatment of renal cyst with color Doppler ultrasound guided percutaneous puncture catheterization drainage and 99% ethanol injection is an effective and safe method for the patients with renal cysts.展开更多
BACKGROUND Long-term chemotherapy for patients with gastric cancer(GC),facilitated by peripherally inserted central catheter(PICC)catheterization,reduces vascular damage and enhances drug delivery efficiency but carri...BACKGROUND Long-term chemotherapy for patients with gastric cancer(GC),facilitated by peripherally inserted central catheter(PICC)catheterization,reduces vascular damage and enhances drug delivery efficiency but carries risks of catheter-related complications.A combination of group psychological nursing and physical mo-vement care significantly mitigates the risk of venous thrombosis and improves psychological well-being,and enhances motor function,underscoring its clinical importance.AIM To assess group psychological and physical movement nursing in preventing venous thrombosis in patients with PICC GC.METHODS Sixty-five GC patients with PICC,admitted from January 2022 to January 2023,were randomly divided into two groups using the lottery method:A control group(n=35,routine nursing)and an observation group(n=30,routine nursing plus psychological nursing and physical movement nursing).Both groups re-ceived continuous care for 2 weeks.Pre-nursing and post-nursing data on psycho-logical state,physical function,chemotherapy-related thrombosis incidence,and cancer-related fatigue were analyzed using SPSS 26.0 and GraphPad Prism 8.0.RESULTS After nursing,both groups showed reduced Hamilton Anxiety Scale scores and increased General Perceived Self-Efficacy Scale scores,with the observation group performing better(P<0.05).The Functional Comprehensive Assessment score for the observation group after nursing was(65.42±2.35)points,lower than the control group’s(62.19±4.33)points(P<0.05).Although no significant difference was observed in the incidence of venous thrombosis between the two groups(χ2=0.815,P=0.367),the observation group had lower incidence.Both groups showed decreased Revised Piper Fatigue Scale scores,with the observation group scoring lower(P<0.05).CONCLUSION Group psychological and physical movement nursing for patients with PICC reduces venous thrombosis risk,improves psychological well-being,cancer-related fatigue,and physical function,making it highly promotable.展开更多
Objective: to explore the effect of comprehensive nursing on reducing complications of central venous catheter inflammation. Methods: 80 cases of central venous catheter patients in our hospital were selected as the r...Objective: to explore the effect of comprehensive nursing on reducing complications of central venous catheter inflammation. Methods: 80 cases of central venous catheter patients in our hospital were selected as the research object, and randomly assigned to the observation group and the control group with 40 cases in each group. The observation group was given comprehensive care, while the control group was given routine care, and the complications and satisfaction of patients during the care period were counted. Results: according to the statistics of research data, the catheter obstruction, thrombus and infection rate in the observation group were lower than those in the control group, and the satisfaction degree in the control group was lower than that in the observation group, the difference was statistically significant (p<0.05). Conclusion: according to the data of this research object, comprehensive care is higher than conventional care in reducing and controlling central venous catheter inflammation and patients' satisfaction with comprehensive care is also relatively considerable.展开更多
Objective:To evaluate the therapeutic effects of intravenous infusion using intravenous indwelling needles(IIN)versus peripherally inserted central catheters(PICC)in patients with acute leukemia during maintenance tre...Objective:To evaluate the therapeutic effects of intravenous infusion using intravenous indwelling needles(IIN)versus peripherally inserted central catheters(PICC)in patients with acute leukemia during maintenance treatment.Methods:Eighty-six patients with acute leukemia admitted to the First Affiliated Hospital of Baotou Medical College from July 2022 to March 2023 were randomly divided into the IIN group and the PICC group,with 43 patients in each group.Results:Significant differences were observed between the two groups in terms of the number of punctures and puncture time(P<0.05).Although the intubation cost was lower in the IIN group than in the PICC group,the maintenance treatment duration was shorter in the IIN group(P<0.05).There were no significant differences between the two groups in terms of disease symptoms,treatment-related toxicity,and side effects(P>0.05).However,anxiety,treatment compliance,and patient satisfaction were significantly lower in IIN group compared to the PICC group(P<0.05).Additionally,the incidence of vein-related complications in the IIN group was higher than in the PICC group(P<0.05).Conclusion:Compared with intravenous indwelling needles,PICCs demonstrate superior application outcomes.Although the cost of PICC placement is relatively high,its ability to prolong maintenance treatment,alleviate patient anxiety,reduce vein-related complications,and improve treatment compliance makes it a valuable method worth promoting.展开更多
Objective: to explore the clinical application effect of improved fixation scheme in deep venous catheter nursing for patients undergoing deep venous catheter catheterization. Methods: 80 patients with deep venous cat...Objective: to explore the clinical application effect of improved fixation scheme in deep venous catheter nursing for patients undergoing deep venous catheter catheterization. Methods: 80 patients with deep venous catheter were selected as samples, all of whom were treated and nursed in our hospital. The time of case inclusion was from July 2020 to April 2021. After the patients were enrolled, they were randomly divided into groups with 40 cases in each group. The exploration group should adopt the deep venous catheter to improve the fixation, while the general group should use the conventional fixation method. It needs to compare the nursing satisfaction, adverse reaction rate, nursing comfort, fixation effect and skin injury between the two groups. Results: compared with the general group, the nursing comfort level of the inquiry group was relatively high, with certain difference in comparison index (p < 0.05). There was significant difference in nursing satisfaction between the inquiry group and the general group, with the inquiry group occupying the significant advantage (p < 0.05). there was significant difference in the fixation effect between the inquiry group and the general group, and there was less displacement in the inquiry group (p < 0.05). there was significant difference in the total incidence of adverse reactions between the inquiry group and the general group, the inquiry group was lower than the general group (p < 0.05), and the incidence of skin injury in the inquiry group was lower than the general group (p < 0.05) Conclusion: the improved fixation method can improve the nursing comfort of patients with deep venous catheter and improve the overall nursing satisfaction of patients.展开更多
Central venous catheterization（CVC）-related venous thrombosis is a common but serious clinical complication, thus prevention and treatment on this problem should be extensively investigated. In this research, we aim...Central venous catheterization（CVC）-related venous thrombosis is a common but serious clinical complication, thus prevention and treatment on this problem should be extensively investigated. In this research, we aimed to investigate the incidence rate of CVC-related venous thrombosis in senile patients and give a further discussion on the related risk factors and predictors. A total of 324 hospitalized senile male patients subjected to CVC were selected. Retrospective investigation and analysis were conducted on age, underlying diseases, clinical medications, catheterization position and side, catheter retention time, and incidence of CVC-related venous thrombosis complications. Basic laboratory test results during catheterization and thrombogenesis were also collected and analyzed. Among the 324 patients, 20 cases（6.17%） of CVC-related venous thrombosis were diagnoseds. The incidence rate of CVC-related venous thrombosis in subclavian vein catheterization was significantly lower than that in femoral vein catheterization（P〈0.01） and that in internal jugular vein catheterization（P〈0.05）. No statistically significant difference was found between femoral vein catheterization and internal jugular vein catheterization（P〉0.05）. Previous venous thrombosis history（P〈0.01）, high lactate dehydrogenase level（P〈0.01）, low high-density lipoprotein（HDL） level（P〈0.05）, and low albumin level（P〈0.05） were found as risk factors or predictors of CVC-related venous thrombosis in senile male patients. Subclavian vein catheterization was the most appropriate choice among senile patients to decrease the incidence of CVC-related venous thrombosis. Previous venous thrombosis history, high lactate dehydrogenase level, low HDL level, and low albumin level were important risk factors in predicting CVC-related venous thrombosis.展开更多
Objective: to observe the application effect of intravenous therapy nursing group in continuous care of patients discharged from hospital with PICC catheter. Methods: seventy patients with PICC catheter discharged fro...Objective: to observe the application effect of intravenous therapy nursing group in continuous care of patients discharged from hospital with PICC catheter. Methods: seventy patients with PICC catheter discharged from our hospital from May 2018 to May 2020 were selected as the object, and the patients were randomly divided into two groups by dice method. The control group received conventional continuous care, and the observation group received intravenous therapy nursing intervention. The effects of the two methods on the patients were compared. Results: the number of cases of adverse conditions in the observation group was less than that in the control group, and the difference between groups was significant (P < 0.05). Conclusion: patients discharged with PICC catheterization should carry out continuous nursing according to the nursing group of intravenous therapy, reduce the influence of adverse factors on patients, and prolong the indwelling time.展开更多
Objective: to investigate the relationship between the incidence of central venous catheter infection and catheter indwelling position and time. Methods: 357 inpatients from the departments of oncology, cardiology, ge...Objective: to investigate the relationship between the incidence of central venous catheter infection and catheter indwelling position and time. Methods: 357 inpatients from the departments of oncology, cardiology, general surgery and endocrinology of our hospital were selected as clinical research objects. All patients were divided into femoral vein group (157 patients), subclavian vein group (135 patients), and internal jugular vein group (55 patients) according to different catheterization position. The relationship between mild central venous catheterization infection and catheter indwelling site was also discussed. In addition, according to the catheter indwelling time, 357 patients were divided into: group ≤7d (169 cases), group 8-14d (97 cases), and group ≥15d (91 cases). The relationship between central venous catheter-associated infection and catheter retention time was analyzed by clinical observation. Results: the clinical analysis showed that the incidence of central vein infection was different due to the different indwelling position of catheter. The femoral vein catheterization group was significantly higher than the subclavian and jugular vein catheterization group, the difference was statistically significant (P < 0.05). 97 patients in 8-14d group and patients in ≥15d group had a significantly higher incidence of venous catheter associated infection than those in ≤7d group, and the difference was statistically significant (P < 0.05). Conclusion: according to the current clinical studies, the incidence of infection in patients with central venous catheterization is relatively high, and subclavian vein puncture should be selected as far as possible in the process of central venous catheterization for patients. And the catheter indwelling time should be reduced as far as possible to reduce the overall probability of vascular infection.展开更多
Objective:To evaluate the efficacy and safety of the treatment of traumatic hemothorax by closed pleural drainage using a central venous catheter(CVC),compared with using a conventional chest tube.Methods:A prospectiv...Objective:To evaluate the efficacy and safety of the treatment of traumatic hemothorax by closed pleural drainage using a central venous catheter(CVC),compared with using a conventional chest tube.Methods:A prospective controlled study with the Ethics Committee approval was undertaken.A total of 407 patients with traumatic hemothorax were involved and they were randomly assigned to undergo closed pleural drainage with CVCs(n=214)or conventional chest tubes(n=193).The Seldinger technique was used for drainage by CVC,and the conventional technique for drainage by chest tube.If the residual volume of the hemothorax was less than 200 ml after the daily volume of drainage decreased to below 100 ml for two consecutive days,the treatment was considered successful.The correlative data of efficacy and safety between the two groups were analyzed using t or chi-squared tests with SPSS 13.0.A P value of less than 0.05 was taken as indicating statistical significance.Results:Compared with the chest tube group,the operation time,fraction of analgesic treatment,time of surgical wound healing,and infection rate of surgical wounds were significantly decreased(P<0.05)in the CVC group.There were no significant differences between the two groups in the success rate of treatment and the incidence of serious complications(P>0.05),or in the mean catheter/tube indwelling time and mean medical costs of patients treated successfully(P>0.05).Conclusions:Management of medium or large traumatic hemothoraxes by closed thoracic drainage using CVC is minimally invasive and as effective as using a conventional large-bore chest tube.Its complications can be prevented and it has the potential to replace the large-bore chest tube.展开更多
基金supported by a grant from the Beijing Union Medical College Foundation-Rui E Emergency Medicine Research Fund in 2025。
文摘Central venous catheterization(CVC)is a fundamental clinical procedure widely performed across medical specialties.However,the complication rate of subclavian vein catheterization ranges from 6%to 11%.[1]Common complications include hemothorax,pneumothorax,air embolism,arterial puncture,and aortic perforation.[2]Herein,we report a rare case of accidental puncture of the aorta during subclavian CVC,which was successfully managed with a ventricular septal defect(VSD)occluder.
文摘Objective: To evaluate the application effect of ultrasound-guided central venous catheterization in the teaching of anesthesia residents. Methods: Forty anesthesia resident companions who received standardized residency training in our department from July 2018 to July 2020 were randomly divided into an ultrasound group and a control group, with 20 participants in each group. The ultrasound group was taught by ultrasound-guided central venipuncture, while the control group was taught by traditional anatomy. After ten training punctures, all trainees were assessed twice. Results: Both groups could master the technique of central venipuncture. The success rate of first puncture and the overall success rate of puncture in the ultrasound group were significantly higher than those in the control group (p p < 0.05). Conclusion: Compared with the traditional anatomical localization teaching, the use of ultrasound-guided technology can improve the success rate of puncture, save puncture time, reduce related complications, and have a better training effect.
基金supported by the Capital Clinical Characteristic Applied Research Project(z151100004015118)the Fostering and Exploring Project of Key Clinical Projects in the Peking University Third Hospital(BYSY2014006)the Health Science Promotion Project of Beijing(TG-2017-83)。
文摘BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous(IO) access and central venous catheterization(CVC) in critically ill Chinese patients.METHODS: In this prospective clustered randomized controlled trial, eight hospitals were randomly divided into either the IO group or the CVC group. Patients who needed emergency vascular access were included. From April 1, 2017 to December 31, 2018, each center included 12 patients. We recorded the data mentioned above.RESULTS: A total of 96 patients were enrolled in the study. There were no statistically significant differences between the two groups regarding sex, age, body mass index, or operator satisfaction with the used devices. The success rates of the first attempt and the procedure time were statistically significant between the IO group and the CVC group(91.7% vs. 50.0%, P<0.001;52.0 seconds vs. 900.0 seconds, P<0.001). During the study, 32 patients were conscious. There was no statistically significant difference between the two groups regarding the pain score associated with insertion. There were statistically significant differences between the two groups regarding the pain score associated with IO or CVC infusion(1.5 vs. 0.0, P=0.044). Complications were not observed in the two groups.CONCLUSIONS: IO access is a safe, rapid, and effective technique for gaining vascular access in critically ill adults with inaccessible peripheral veins in the emergency departments.
文摘Objective: To investigate the effectiveness of ultrasound-guided central venous catheterization when compared to the conventional procedure. Method: A prospective cohort study was carried out over a 9-month period from February to October 2016 involving 144 inpatients at PICU of Irmandade da Santa Casa de Sao Paulo Hospital, undergoing central venous catheterization. The patients were matched in pairs of identical patients according to the levels of potentially intervening variables (age, nutritional status, puncture site, professional experience), differing only as to the CVC technique: ultrasound-guided (USG-CVC) or conventional (C-CVC). Discarding data from non-paired patients, the remaining did forming 47 pairs, matched as two related samples: USG-CVC and C-CVC groups. Success parameters: number of puncture attempts;time spent at CVC;success rate and complications. Results: In the USG-CVC group, the number of attempts (mean = 2.04) and the time spent at catheterization (mean = 11.89 minutes) were lower (t = 2.34, df = 46, t 0.95 = 2.02, p t = 3.07, df = 46, t 0.95 = 2.02, p < 0.05), respectively, when compared to the results obtained for the control group (C-GVC), (mean = 3.21) and (mean = 28.26 minutes), respectively. As to success, there was observed a significant difference (F (1, 46) = 16.6;Q (1) = 12.5, p < 005) when considering only one trial (USG -CVC = 27/47;C-CVC = 9/47), but no significant difference (F (1, 46) = 3.76;Q (1) = 3.56, p > 0.05) when considering several attempts. Complications were found less frequently in the USG-CVC group (3/47) than in the CVC-C (13/47), (F (1, 46) = 8.24;Q (1) = 7.14, p < 0.05). Conclusion: USG-CVC was found to be more effective than the conventional technique, especially regarding success at the first puncture attempt.
文摘Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.
文摘Objective: to explore the application and nursing countermeasures of umbilical vein catheterization in premature infants. Methods: 100 premature infants were selected from our hospital from January 2021 to February 2022. They were divided into control group (50 cases, peripheral venous indwelling needle treatment) and observation group (50 cases, umbilical vein indwelling treatment) by computer lottery. The indwelling condition, treatment condition and adverse events of the two groups were observed and compared. Results: the success rate of one-time puncture in the observation group was 96.00%, higher than 80.00% in the control group (P < 0.05);The puncture point search time (84.54 ± 15.69) s and the compression coagulation time (264.54 ± 30.55) s were shorter than those in the control group (288.36 ± 15.54) s and (480.25 ± 42.22) s (P < 0.05);The retention time was (6.05 ± 1.27) d, which was longer than that in the control group (4.22 ± 1.65) d (P < 0.05);The number of intravenous indwelling needles (12.69 ± 5.04) was less than that in the control group (16.45 ± 7.28) (P < 0.05);The duration of intravenous treatment (20.47 ± 2.24) d and the total incidence of adverse events was 4.00%, lower than that of the control group (24.65 ± 2.66) d and 20.00% (P < 0.05). Conclusion: the effective application of umbilical vein catheterization during the treatment of premature infants can effectively improve the success rate of one-time puncture and make intravenous therapy more effective. Strengthening relevant nursing intervention can effectively reduce the incidence of adverse events and make intravenous therapy more safe, so as to better maintain the health and safety of children.
文摘Central venous access is one of the most common surgery procedures worldwide, especially in pediatric surgery. Local and regional complications as the result of venous catheter permanence time are frequently described as: thrombosis, infection, edema and local cellulite, movement and loss of the catheter. Other severe complications such as endocardiac and hemorrhagic lesions are also described and considered the cause of catheter early removal. In the literature few studies have addressed vascular and perivascular lesions and complications as the result of central venous access to peripheral veins, given the difficulty of setting up venous catheterization experimental models to study blood vessels and perivascular tissue alterations after catheterization. In the present venous catheterization experimental model, rabbits were divided into two groups based on the time that the venous catheters were maintained in their veins. Group a composed of 7 New Zealand male rabbits was submitted to a 15-day treatment;and the 6 New Zealand male rabbits of group B were treated during 90 days. Both groups presented similar inflammatory conditions since there was no significant difference between groups. Therefore, the results may well suggest that the endothelial inflammatory reaction could have developed at an early initial short period and by maintaining the catheter, the inflammatory reactions would have decreased or disappeared. Aimed at studying these vascular and perivascular alterations in venous catheterization, the present study proposes an experimental rabbit model that allows the analysis of differences in local vascular and perivascular histological variations and compares histological differences between both venous catheterization groups each of them with different periods of treatment.
文摘BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SUMMARY A 75-year-old male patient was admitted for laparoscopic radical nephrectomy.Under ultrasound guidance,right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt.Sudden hypotension developed after surgical positioning and persisted until the end of the operation,lasting for about 4 h.In the recovery room,a massive hemothorax was identified on chest radiography and computed tomography.The patient recovered following chest tube drainage of 1.6 L blood.CONCLUSION Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance.So the proper use of ultrasound is important.
文摘With the popularization of central venous catheterization in recent years,the problems arising from intravenous therapy have gradually increased.Fibrin sheath is the complication with the highest incidence rate in central venous catheterization,which has always been a major problem in intravenous therapy.So the prevention and treatment of fibrin sheath has become a hot spot of research in recent years.Hence,this paper summarizes the research on fibrin sheath in recent years.
文摘Central venous catheterization is widely used in the emergency setting. This review aims to assess central venous catheterization from the perspectives of types of catheters, sites of insertion, and tech- niques. In emergency conditions, non-tunneled catheters are preferred because the technique for its insertion is not complicated and less time-consuming. The size of catheter depends on the purpose of catheterization. For example, a large bore catheter is needed for rapid infusion. The ideal catheterization site should bear fewer thromboses, lower infectious rate, and fewer mechanical complications. Thus the femoral vein should be avoided due to a high rate of colonization and thrombosis while the subclavian vein seems to exhibit fewer infectious complications compared with other sites. The ultrasound-guided technique increases the success rate of insertion while decreases the mechanical complications rate,
文摘Objective:To systematically evaluate the clinical effects of cluster nursing intervention in preventing central venous catheter-related infection in intensive care unit.Methods:A randomized controlled study was searched from China National Knowledge Internet(CNKI),Wanfang,Chinese Scientific Journals Database(VIP),Chinese Biomedical Literature Service System(SinoMed),PubMed,Embase and Cochrane library databases from the establishment to May 1,2020.Two reviewers independently evaluated and cross checked the quality of the study.Revman 5.3 was used to conduct the meta-analysis.Results:A total of 21 randomized controlled trials with 6,030 patients were included.Meta-analysis showed that the incidence of central venous catheter-related infection(relative risk(RR)=0.29,95%confidence interval(CI)[0.23,0.37]),the incidence of catheter plugging(RR=0.25,95%CI[0.16,0.39])and catheter prolapse(RR=0.18,95%CI[0.11,0.29])were significantly different between the two groups.Conclusion:Cluster nursing intervention could prevent central venous catheter-related infection in intensive care unit.
文摘Objective To investigate the effect and safety of the treatment of renal cysts with color Doppler ultrasound guided percutaneous puncture catheterization drainage and repeated 99% ethanol perfusion. MethodsFifty-eight patients with primary renal cysts were treated with color Doppler ultrasound guided percutaneous puncture catheterization drainage and 99% ethanol perfusion. If the cyst volume was<500 mL, the complete evacuation of the cyst was followed by injection with 99% ethanol in a volume equal to 25% of the total cyst volume, twice per day, 10 min for each injection. If the cyst volume was>500 mL, injection was given three times per day, 20 min for each injection, and the patient was asked to move in different positions to help distributing the ethanol over the cyst wall. ResultsFifty-eight cysts were detected in the 58 patients. Puncture was performed and the success rate was 100%. Central venous catheter was introduced into the cysts. After follow-up for 0.5 to 3 years, 56 renal cysts were disappeared. The cure rate was 96.6%, and the complications such as bleeding, infection, and organ injuries were not found. ConclusionThe treatment of renal cyst with color Doppler ultrasound guided percutaneous puncture catheterization drainage and 99% ethanol injection is an effective and safe method for the patients with renal cysts.
文摘BACKGROUND Long-term chemotherapy for patients with gastric cancer(GC),facilitated by peripherally inserted central catheter(PICC)catheterization,reduces vascular damage and enhances drug delivery efficiency but carries risks of catheter-related complications.A combination of group psychological nursing and physical mo-vement care significantly mitigates the risk of venous thrombosis and improves psychological well-being,and enhances motor function,underscoring its clinical importance.AIM To assess group psychological and physical movement nursing in preventing venous thrombosis in patients with PICC GC.METHODS Sixty-five GC patients with PICC,admitted from January 2022 to January 2023,were randomly divided into two groups using the lottery method:A control group(n=35,routine nursing)and an observation group(n=30,routine nursing plus psychological nursing and physical movement nursing).Both groups re-ceived continuous care for 2 weeks.Pre-nursing and post-nursing data on psycho-logical state,physical function,chemotherapy-related thrombosis incidence,and cancer-related fatigue were analyzed using SPSS 26.0 and GraphPad Prism 8.0.RESULTS After nursing,both groups showed reduced Hamilton Anxiety Scale scores and increased General Perceived Self-Efficacy Scale scores,with the observation group performing better(P<0.05).The Functional Comprehensive Assessment score for the observation group after nursing was(65.42±2.35)points,lower than the control group’s(62.19±4.33)points(P<0.05).Although no significant difference was observed in the incidence of venous thrombosis between the two groups(χ2=0.815,P=0.367),the observation group had lower incidence.Both groups showed decreased Revised Piper Fatigue Scale scores,with the observation group scoring lower(P<0.05).CONCLUSION Group psychological and physical movement nursing for patients with PICC reduces venous thrombosis risk,improves psychological well-being,cancer-related fatigue,and physical function,making it highly promotable.
文摘Objective: to explore the effect of comprehensive nursing on reducing complications of central venous catheter inflammation. Methods: 80 cases of central venous catheter patients in our hospital were selected as the research object, and randomly assigned to the observation group and the control group with 40 cases in each group. The observation group was given comprehensive care, while the control group was given routine care, and the complications and satisfaction of patients during the care period were counted. Results: according to the statistics of research data, the catheter obstruction, thrombus and infection rate in the observation group were lower than those in the control group, and the satisfaction degree in the control group was lower than that in the observation group, the difference was statistically significant (p<0.05). Conclusion: according to the data of this research object, comprehensive care is higher than conventional care in reducing and controlling central venous catheter inflammation and patients' satisfaction with comprehensive care is also relatively considerable.
基金supported by the Medical and Health Science and Technology Plan Project of Health and Health Commission of Inner Mongolia Autonomous Region(202201427).
文摘Objective:To evaluate the therapeutic effects of intravenous infusion using intravenous indwelling needles(IIN)versus peripherally inserted central catheters(PICC)in patients with acute leukemia during maintenance treatment.Methods:Eighty-six patients with acute leukemia admitted to the First Affiliated Hospital of Baotou Medical College from July 2022 to March 2023 were randomly divided into the IIN group and the PICC group,with 43 patients in each group.Results:Significant differences were observed between the two groups in terms of the number of punctures and puncture time(P<0.05).Although the intubation cost was lower in the IIN group than in the PICC group,the maintenance treatment duration was shorter in the IIN group(P<0.05).There were no significant differences between the two groups in terms of disease symptoms,treatment-related toxicity,and side effects(P>0.05).However,anxiety,treatment compliance,and patient satisfaction were significantly lower in IIN group compared to the PICC group(P<0.05).Additionally,the incidence of vein-related complications in the IIN group was higher than in the PICC group(P<0.05).Conclusion:Compared with intravenous indwelling needles,PICCs demonstrate superior application outcomes.Although the cost of PICC placement is relatively high,its ability to prolong maintenance treatment,alleviate patient anxiety,reduce vein-related complications,and improve treatment compliance makes it a valuable method worth promoting.
文摘Objective: to explore the clinical application effect of improved fixation scheme in deep venous catheter nursing for patients undergoing deep venous catheter catheterization. Methods: 80 patients with deep venous catheter were selected as samples, all of whom were treated and nursed in our hospital. The time of case inclusion was from July 2020 to April 2021. After the patients were enrolled, they were randomly divided into groups with 40 cases in each group. The exploration group should adopt the deep venous catheter to improve the fixation, while the general group should use the conventional fixation method. It needs to compare the nursing satisfaction, adverse reaction rate, nursing comfort, fixation effect and skin injury between the two groups. Results: compared with the general group, the nursing comfort level of the inquiry group was relatively high, with certain difference in comparison index (p < 0.05). There was significant difference in nursing satisfaction between the inquiry group and the general group, with the inquiry group occupying the significant advantage (p < 0.05). there was significant difference in the fixation effect between the inquiry group and the general group, and there was less displacement in the inquiry group (p < 0.05). there was significant difference in the total incidence of adverse reactions between the inquiry group and the general group, the inquiry group was lower than the general group (p < 0.05), and the incidence of skin injury in the inquiry group was lower than the general group (p < 0.05) Conclusion: the improved fixation method can improve the nursing comfort of patients with deep venous catheter and improve the overall nursing satisfaction of patients.
文摘Central venous catheterization（CVC）-related venous thrombosis is a common but serious clinical complication, thus prevention and treatment on this problem should be extensively investigated. In this research, we aimed to investigate the incidence rate of CVC-related venous thrombosis in senile patients and give a further discussion on the related risk factors and predictors. A total of 324 hospitalized senile male patients subjected to CVC were selected. Retrospective investigation and analysis were conducted on age, underlying diseases, clinical medications, catheterization position and side, catheter retention time, and incidence of CVC-related venous thrombosis complications. Basic laboratory test results during catheterization and thrombogenesis were also collected and analyzed. Among the 324 patients, 20 cases（6.17%） of CVC-related venous thrombosis were diagnoseds. The incidence rate of CVC-related venous thrombosis in subclavian vein catheterization was significantly lower than that in femoral vein catheterization（P〈0.01） and that in internal jugular vein catheterization（P〈0.05）. No statistically significant difference was found between femoral vein catheterization and internal jugular vein catheterization（P〉0.05）. Previous venous thrombosis history（P〈0.01）, high lactate dehydrogenase level（P〈0.01）, low high-density lipoprotein（HDL） level（P〈0.05）, and low albumin level（P〈0.05） were found as risk factors or predictors of CVC-related venous thrombosis in senile male patients. Subclavian vein catheterization was the most appropriate choice among senile patients to decrease the incidence of CVC-related venous thrombosis. Previous venous thrombosis history, high lactate dehydrogenase level, low HDL level, and low albumin level were important risk factors in predicting CVC-related venous thrombosis.
文摘Objective: to observe the application effect of intravenous therapy nursing group in continuous care of patients discharged from hospital with PICC catheter. Methods: seventy patients with PICC catheter discharged from our hospital from May 2018 to May 2020 were selected as the object, and the patients were randomly divided into two groups by dice method. The control group received conventional continuous care, and the observation group received intravenous therapy nursing intervention. The effects of the two methods on the patients were compared. Results: the number of cases of adverse conditions in the observation group was less than that in the control group, and the difference between groups was significant (P < 0.05). Conclusion: patients discharged with PICC catheterization should carry out continuous nursing according to the nursing group of intravenous therapy, reduce the influence of adverse factors on patients, and prolong the indwelling time.
文摘Objective: to investigate the relationship between the incidence of central venous catheter infection and catheter indwelling position and time. Methods: 357 inpatients from the departments of oncology, cardiology, general surgery and endocrinology of our hospital were selected as clinical research objects. All patients were divided into femoral vein group (157 patients), subclavian vein group (135 patients), and internal jugular vein group (55 patients) according to different catheterization position. The relationship between mild central venous catheterization infection and catheter indwelling site was also discussed. In addition, according to the catheter indwelling time, 357 patients were divided into: group ≤7d (169 cases), group 8-14d (97 cases), and group ≥15d (91 cases). The relationship between central venous catheter-associated infection and catheter retention time was analyzed by clinical observation. Results: the clinical analysis showed that the incidence of central vein infection was different due to the different indwelling position of catheter. The femoral vein catheterization group was significantly higher than the subclavian and jugular vein catheterization group, the difference was statistically significant (P < 0.05). 97 patients in 8-14d group and patients in ≥15d group had a significantly higher incidence of venous catheter associated infection than those in ≤7d group, and the difference was statistically significant (P < 0.05). Conclusion: according to the current clinical studies, the incidence of infection in patients with central venous catheterization is relatively high, and subclavian vein puncture should be selected as far as possible in the process of central venous catheterization for patients. And the catheter indwelling time should be reduced as far as possible to reduce the overall probability of vascular infection.
文摘Objective:To evaluate the efficacy and safety of the treatment of traumatic hemothorax by closed pleural drainage using a central venous catheter(CVC),compared with using a conventional chest tube.Methods:A prospective controlled study with the Ethics Committee approval was undertaken.A total of 407 patients with traumatic hemothorax were involved and they were randomly assigned to undergo closed pleural drainage with CVCs(n=214)or conventional chest tubes(n=193).The Seldinger technique was used for drainage by CVC,and the conventional technique for drainage by chest tube.If the residual volume of the hemothorax was less than 200 ml after the daily volume of drainage decreased to below 100 ml for two consecutive days,the treatment was considered successful.The correlative data of efficacy and safety between the two groups were analyzed using t or chi-squared tests with SPSS 13.0.A P value of less than 0.05 was taken as indicating statistical significance.Results:Compared with the chest tube group,the operation time,fraction of analgesic treatment,time of surgical wound healing,and infection rate of surgical wounds were significantly decreased(P<0.05)in the CVC group.There were no significant differences between the two groups in the success rate of treatment and the incidence of serious complications(P>0.05),or in the mean catheter/tube indwelling time and mean medical costs of patients treated successfully(P>0.05).Conclusions:Management of medium or large traumatic hemothoraxes by closed thoracic drainage using CVC is minimally invasive and as effective as using a conventional large-bore chest tube.Its complications can be prevented and it has the potential to replace the large-bore chest tube.
