2种浅静脉穿刺留置方法的效果比较

目的 探讨改进浅静脉穿刺留置的临床应用及效果评价.方法 选取2010年1月～2010年6月在本院呼吸内科行浅静脉留置输液的160例患者,随机分为对照组(74例)及实验组(86例).实验组采用改进的浅静脉穿刺、固定、护理方法,对照组采用常规浅静脉留置穿刺护理方法.比较2纽患者穿刺疼痛程度、患者对静脉留置接受程度、并发症发生率等.结果 实验组穿刺疼痛程度较对照组减轻(p=0.015),且实验组患者对留置针接受程度更高(p=0.031).实验组并发症发生率低于对照组(p＝0.001).结论 通过改进浅静脉穿刺置管护理方法,降低了穿刺留置时的疼痛感,降低了置管并发症发生率,从而提高了患者对浅静脉留置的接受程度.     

桡动脉穿刺法在婴幼儿采血中的临床应用

目的 探讨桡动脉穿刺法在婴幼儿采血中的临床应用效果.方法 将106例需要采血的患儿随机分成2组,桡动脉组54例,股静脉组52例,对2组一次性穿刺成功率、穿刺处局部疼痛发生率、标本合格率3个指标进行比较.结果 桡动脉组一次性穿刺成功率94.4%,高于股静脉组80.8%(P＜0.05);桡动脉组穿刺处局部疼痛发生率3.7%,低于股静脉组19.23%(P＜0.05);桡动脉组标本合格率98.1%,高于股静脉组84.6%(P＜0.05).结论 桡动脉穿刺法是婴幼儿采血的最佳方法.     

老年患者静脉穿刺后局部淤血相关因素分析及防护对策

目的 为了最大限度地保护患者血管,探讨老年患者静脉穿刺后局部淤血相关因素及防护对策.方法 选择2011年1月～6月在本科住院,因静脉输液引起的105例局部淤血的老年患者,对静脉穿刺后发生局部淤血的原因进行分析.结果 造成局部淤血外渗的原因有5种,其中最主要的原因是按压因素、操作因素,其次是机械因素、患者因素和药物因素.结论 加强静脉穿刺基本功训练,指导患者掌握正确的按压方法并采取积极的防范措施对减少局部淤血有良好的效果.     

皮下二次静脉穿刺法在穿刺失败后的应用

静脉穿刺是临床护理工作中常用的技术操作之一.每一位病人都不愿意在静脉输液中被扎二针,怎样保证一针率,我们发现护理人员娴熟而精湛的操作技术,不仅可以消除病人对输液的紧张情绪,而且可以赢得病人的信任,使之积极配合治疗,因此提高浅静脉穿刺成功率,具有十分重要意义.经多年的临床经验,下面介绍一种皮下二次静脉穿刺在穿刺失败后的补救方法.     

静脉留置针在急诊护理中的使用

目的 探讨静脉留置针在急诊抢救中的使用,为危重患者的抢救赢得时间.方法 随机选取患者930例,分成观察组(470例,静脉留置针)和对照组(460例,一般一次性静脉输液针),在穿刺方法 、采集血标本、抢救时间、抢救成功率、患者满意等方面进行观察比较.结果 观察组的抢救成功率明显高于对照组.结论 在急诊抢救中留置针建立的静脉通道,能保证及时给药,提高转运的安全性,能同时采集血标本,减少重复穿刺率,提高护理工作效率,提高抢救成功率,为危重患者的抢救赢得时间.     

静脉留置针留置时间的研究进展

静脉留置针又称套管针,由先进的生物性材料制成,作为头皮针的换代产品,静脉留置针穿刺输液作为一项较新的护理技术已广泛应用于临床[1].留置针的使用,其优点是减轻患者由于反复穿刺而造成的痛苦,保护血管,减少液体外渗,同时保证合理用药的时间,而且很大程度减轻了护士的工作量,且能保持静脉管道的持续通畅,便于抢救[2].在护理中,其留置时间是一个十分重要的问题,留置时间过长,可使患者发生局部并发症的危险性增加;过短则增加患者的花费及多次穿刺带来的痛苦.为此本文从静脉留置针留置时间、并发症及对策等方面进行综述.     

18例颅内静脉系统血栓经股静脉置管溶栓的护理体会

总结了18例经股静脉置管溶栓治疗颅内静脉系统血栓患者的临床疗效及护理体会,包括颅内高压的护理,抗凝治疗的护理,外置鞘管及穿刺处皮肤的护理和生活护理.认为经股静脉置管溶栓治疗颅内静脉系统血栓的临床疗效确切,提高护理人员对本病的认识、掌握护理要领对改善患者预后具有重要的意义.     

快乐无痛注射在小儿静脉穿刺中的应用

目的 探讨"快乐无痛注射"综合护理对提高小儿穿刺一次成功率的效果.方法 将80例患儿随机分为2组,各40例.实验组先发贴画哄逗,并在穿刺部位皮肤消毒,再用棉签蘸2%利多卡因和654-2混合液涂擦穿刺点后再行穿刺;对照组按常规方法 消毒后穿刺.观察2组患儿穿刺时血管充盈度、恐惧、疼痛、哭闹、反抗反应发生例数,一次穿刺成功率,患儿和家属满意度等指标.结果 实验组血管扩张明显,无严重恐惧、反抗、哭闹及疼痛现象;一次成功率高;对护理工作的满意度明显高于对照组,差异均有统计学意义(p<0.01).结论 快乐无痛注射混合液有明显的扩管、止痛效果,可扩张局部血管,减轻静脉穿刺时患者的痛苦,提高静脉穿刺成功率.     

PICC置管术的护理体会

经外周静脉穿刺置入中心静脉导管(PICC)是一种从周围静脉导入且末端位于中心静脉的深静脉置管技术.本文介绍了我科28例放置PICC导管病例的临床资料及护理措施,总结了PICC常见并发症的原因及对策,以期为提高临床PICC成功率,减少并发症提供一些依据.     

浅静脉留置针贴膜开窗应用后临床效果的观察

目的:探讨减少浅静脉留置针贴膜(以下简称贴膜)更换次数,减少静脉炎的发生,延长静脉留置针留置时间的方法.方法:将402例使用浅静脉留置针患者随机分为实验组(贴膜开窗组)和对照组(完整贴膜组).开窗组穿刺后将贴膜中间开一窗口贴于穿刺处,用一次性输液敷贴覆盖,每天消毒穿刺口,并更换输液敷贴,除贴膜与皮肤分离外,不更换贴膜;对照组每天及时更换贴膜.结果:试验组与对照组在留置针脱出率上具有极显著性意义(P＜0.01);在局部的反应如穿刺点疼痛、红斑、肿胀、静脉条索状、穿刺点渗出等静脉炎发生率上差异有显著性意义(P＜0.05).结论:实验组能减少贴膜的更换次数,减少了留置针脱出率和静脉炎的发生率,延长静脉针的留置时间.     

Two cases of the retroaortic left renal vein and a morphogenetic consideration of the anomalous vein

The left renal vein rarely passing behind the abdominal aorta is called "the retroaortic left renal vein". We encountered two cases of the retroaortic left renal vein during the student course of dissection at Iwate Medical University School of Medicine in the years 1986-1997. The incidence of the retroaortic left renal vein was calculated at 2/266 or 0.75%. We observed and recorded the two cases of the retroaortic left renal vein by photographs and line drawings. Then, to consider the morphogenesis of the anomalous vein, we studied 16 cases of the renal collar (the circumaortic renal venous ring) from 149 bodies. Moreover, we observed and recorded the relations between the left renal vein and the lumbar veins in 19 bodies dissected in 1996. Results were compared with those of the reports by some different authors and conclusions were as follows. 1. The incidence of the retroaortic left renal vein is estimated approximately at 0.75%. 2. The retroaortic left renal vein is derived from the renal collar (circumaortic renal venous ring) at an embryonic stage and is completed by the regression and disappearance of the ventral (preaortic) limb and the persistence of the dorsal (postaortic) limb at a later stage. The ventral limb originates from the anastomosis between the subcardinal veins and the dorsal limb originates from the anastomosis between the supracardinal veins (external vertebral venous plexus). The left lumbar veins drain into the inferior vena cava by using the intersupracardinal anastomosis (external vertebral venous plexus). The dorsal limb and the left lumbar veins are considered to use a same venous route passing dorsal to the abdominal aorta. Indeed, in the 16 cases of the renal collar studied, the dorsal limb use the left second lumbar vein in 7 cases, the third lumbar vein in 6 cases, the fourth lumbar vein in 1 case, both the second and the third lumbar veins in 1 case and unknown lumbar vein in 1 case. Moreover, in the two cases of the retroaortic left renal vein the dorsal limb use the third lumbar vein. 3. The retroaortic left renal vein of our cases leaves the renal hilus behind the renal artery (usually in front of the artery) at the level of the intervertebral disc between the second and the third lumbar vertebrae (just one verteral body lower than usual) and flows into the inferior vena cava by using the left third lumbar vein. The reason why ventral (normal) route of the left renal vein disappear may be that the vein leaves the renal hilus at the lower level and the more dorsal position than usual.     

Post-traumatic thrombosis of the portal vein

Blunt trauma to the abdomen is an exceptional cause of portal vein thrombosis. To our knowledge, 8 cases have been reported in the literature. When thrombosis of the portal vein occurs, a complete search for all the known main causes must be carried out before entertaining this diagnosis. Other causes may be cirrhosis, tumors and inflammation of the abdomen, coagulation disorders and hematologic diseases including latent myeloproliferative syndrome. We report a case in a 25-year-old man with an uneventful past history who presented with thrombosis of the portal vein after a violent blunt trauma which occurred during a rugby play. In this young man, none of the other potential causes was found, in particular bone marrow culture on medium with low growth-factor concentration allowed us to eliminate a latent myeloproliferative syndrome. The only triggering factor remaining was the recent abdominal trauma. After an 18-month follow-up, no other element has been observed which could have caused thrombosis of the portal vein.     

Sub-coraco-clavicular approach of the axillary vein

Twenty-five patients with known neuroendocrine tumour disease were biopsied with 1.2 mm and 0.9 mm biopsy-gun needles to evaluate the respective diagnostic accuracy of the 2 needle sizes. The influence of treatment-related fibrosis on the histopathological diagnosis was also evaluated. The overall diagnostic accuracy with the 0.9 mm needle was 69% as compared to 92% with the 1.2 mm needle. This difference, however, seems more related to needle guiding difficulties with the 0.9 mm needle than to insufficient tissue yield. When the tumour was hit with both the 0.9 and the 1.2 mm needle the tissue yield was inferior with the 0.9 mm needle in only one of 16 cases. The increased amount of fibrous tissue due to interferon treatment did not seem to negatively influence the diagnostic accuracy.     

Tuberculous thrombophlebitis of the portal vein

The myelin sheath and axon areas in the sciatic nerve of 20 adult rats were studied using the video-point-counting method (Quantimet). This automatic measurement procedure allows an exact and rapid determination of the above mentioned areas as a result of the differing intensities of the structures. The electron-microscopic pictures are projected at a magnification of 3500 onto the monitor through a lens system from a Vidikon-TV-tube, objective 32 mm. The areas of single nerve cross-sections, myelin sheath areas and total area are then measured. These area values are stated in picture points which can be calculated to absolute values. The statistical evaluation of both parameters shows a linear regression with a correlation coefficient of 0.94. These values are compared with the results obtained using the conventional manual methods of other authors, e.g. determination of lamellae number or myelin sheath thickness as well as axon circumference or axon diameter. The special advantages of this procedure are thereby pointed out.     

Portal vein replacement by hepatic vein transposition

Successful reconstruction after portal vein resection in extended liver surgery has been performed by end-to-end anastomosis, patch, or graft interposition. Previously described techniques to obtain venous grafts for portal replacement necessarily have either an additional incision or an unsuitable diameter. We developed a new method of portal vein replacement using the excised hepatic vein. This technique can be applied in major liver resections for tumors infiltrating the portal vein that have a safe distance from the hepatic vein.     

Varicose vein surgery and deep vein thrombosis

A questionnaire was sent to 363 members of the Vascular Surgical Society of Great Britain and Ireland about their use of deep vein thrombosis (DVT) prophylaxis at the time of varicose vein surgery. Replies were received from 289 surgeons (80 percent), of whom only 29 percent regarded varicose veins as an important risk factor for DVT. Only 12 percent used subcutaneous heparin prophylaxis routinely, while 71 percent did so selectively, being influenced by a history of thromboembolism (95 percent), obesity (47 percent), age (35 percent), recurrent varicose veins (22 percent) and inpatient status (16 percent). At the end of the operation 52 percent applied crepe bandages, 25 percent other bandages, 13 percent stockings and 10 percent Tubigrip. Subsequently, antiembolism stockings were prescribed by 55 percent. There is a wide variation in opinion regarding DVT prophylaxis for patients having varicose vein surgery, which has both clinical and medicolegal implications.     

Sonographic guidance when using the right internal jugular vein for central vein access

From January 1986 to March 1993, 29 patients aged between 40 and 60 years with primary high grade osteosarcoma of the extremity were treated at Rizzoli Institute with neoadjuvant chemotherapy. Before surgery patients received cisplatin and adriamycin. Postoperatively, patients with a good histologic response received the same two drugs preoperatively used, while in case of poor response ifosfamide and etoposide were added to cisplatin and adriamycin. Twenty-five patients (86%) were surgically treated with a limb salvage, whereas 4 patients (14%) were amputated. With a median follow-up of 8 years (5-12), the 8-year event-free survival was 57% and the 8-year overall survival was 62%. No chemotherapy-related deaths were recorded and toxicity was manageable. These results are significantly better than those achieved in 24 patients of the same age, treated at Rizzoli Institute between 1975 and 1985 only with surgery (87% of amputation and 17% of 8-year event-free and overall survival) and indicate an advantage for the use of neo-adjuvant chemotherapy also in patients with high grade osteosarcoma of the extremity older than 40 years.     

An unusual coursing of the facial vein

During the dissections of 50 adult cadavers for educational purposes, we found a 45-year-old male cadaver with an abnormally coursing facial vein which has joined the retromandibular vein at a higher level--in the parotid gland--on the right side of the face. This anomaly has also been detected radiologically.