浅静脉留置针在神经外科中的应用

近年来,随着社会经济的迅猛发展,交通工具的逐渐普及,车祸外伤造成颅脑损伤的事件也日渐增多。因此,静脉输液治疗已成为临床护理治疗与支持的重要手段。由于,神经外科患者病情危重,并多伴有意识障碍或精神症状,大多不配合治疗,导致常规针头输液失败,不但造成患者静脉损伤,而且加重护理工作量。浅静脉留置针操作简便,管腔柔软,能较长时间留置在血管内,已被广泛应用于临床。     

循证护理在儿科浅静脉留置针应用中的实践

循证护理(evidence-based nursing,EBN)是伴随着循证医学的发展而出现的一种新的临床护理模式,它既是一种新的思维方式,又是在这种认识方式指导下为临床研究和实践提供科学的方法论[1].循证护理也称为"以实证为基础的护理",它是指护理人员在护理实践中运用现有的最好的科学证据对病人实施的护理.目前,循证护理正在成为现代护理发展的方向,已被逐步应用于护理实践.随着医疗技术的不断发展,人们对护理人员的素质和服务水平的要求也不断提高.2004年1月,我院儿科开展浅静脉留置针技术,静脉留置针在儿科的应用,既可减轻患儿反复穿刺的痛苦,保护血管,有利于临床用药和紧急抢救;同时又可减轻护理工作量,提高护理工作效率和质量.但是由于小儿血管细小,充盈度差,较难做到一针见血.我们于2005年3～10月将循证护理运用于小儿浅静脉留置针临床应用的实践中,收到良好的效果,现报告如下.     

腋静脉留置针在肥胖危重婴幼儿救治中的应用

目的 探讨腋静脉留置针在肥胖危重儿救治中的应用.方法 将2009年1月~2012年12月我科收治的98例肥胖危重儿随机分为腋静脉留置针组(42例)与外周静脉留置针组(56例),观察两组患儿的首针穿刺成功、留置时间及并发症.结果 腋静脉组留置针留置时间较长,患儿首针穿刺成功率较高,脱管、堵管、静脉炎、渗血和外渗发生率均较外周静脉留置针组低.结论 在肥胖危重婴幼儿救治中,选择腋静脉留置针穿刺置管优于外周静脉留置针置管.     

静脉留置针在儿科的应用与护理分析

目的总结静脉留置针在儿科诊疗护理中的应用体会。方法收集行输液治疗的患儿1620例,随机分为观察组和对照组,观察组采用静脉留置针进行穿刺输液,对照组采用常规输液穿刺,比较两组患儿1次穿刺成功率及家属满意度情况,并进行统计分析。结果观察组患儿1次穿刺成功率及家属满意度均明显高于对照组(P0.001)。结论在儿科输液中,静脉留置针穿刺较传统头皮针穿刺具有优势,临床操作过程中与患儿家属进行相应的沟通,可有利提高护理满意度,提高护理效果。     

静脉留置针采集血标本在儿科的应用

目的探讨静脉留置针采集血标本在儿科应用的优点。方法将1600例患儿随机分为实验组和对照组。实验组使用静脉留置针采血,对照组使用注射器采血,并对两种方法的穿刺成功率进行对比。结果实验组穿刺成功率高,无溶血现象;对照组穿刺成功率低,且易使标本溶血。结论静脉留置针采集血标本的优点是穿刺部位易掌握、血管易暴露、针头易固定,且方便、安全、有效,穿刺成功率高,值得儿科推广应用。     

经腋静脉置入留置针在新生儿病房的应用研究

目的 探讨经腋静脉置入留置针在新生儿输液中的应用及效果.方法 将205例行输液治疗的新生儿随机分为观察组和对照组.观察组采用经腋静脉置入留置针进行输液,对照组采用传统方法经头皮静脉及四肢浅静脉置入留置针进行输液,比较两组一次穿刺成功率和留置时间以及并发症发生情况.结果 观察组的留置时间明显长于对照组,发生液体外渗、堵管、静脉炎、针体滑出的发生率明显少于对照组,差异有统计学意义(P＜0.005);两组一次穿刺成功率无明显差异(P＞0.05).结论 经腋静脉置入留置针具有留置时间长、并发症少、经济实惠、操作简单等优点,同时也减少了患儿反复穿刺的痛苦,保持了输液治疗的连贯性,减轻了护士的工作量,降低了医疗成本,提高了护理质量和家属满意度.     

静脉留置针引起静脉炎相关分析及护理对策

静脉留置针因其操作简单,可减少反复静脉穿刺带来的痛苦,目前已广泛应用于临床,而静脉炎的发生是静脉留置针最常见的并发症。我们通过对174例患者应用静脉留置针后并发静脉炎进行分析,为减少静脉炎的发生和并发静脉炎后的护理提供了依据,现将结果报告如下。1对象和方法1·1对象     

静脉留置针在大熊猫输液上的应用

本文通过对62例使用静脉留置针代替头皮针穿刺输液的大熊猫进行临床观察,总结了穿刺前准备、血管的选择、穿刺方法、适合长时间留置的大熊猫及封管液的选择等。应用静脉留置针可以减少穿刺次数,保护血管,使输液更加方便,提高工作效率,为临床输液、输血提供可靠的通路。     

头皮式静脉留置针静注甘露醇的护理探讨

目的总结头皮式静脉留置针静注甘露醇的护理措施,提高头皮式留置针在静注甘露醇的有效留置率。方法对静脉留置针静滴甘露醇的非计划性拔管原因进行统计分析,并对要因进行整改,观察整改前、后静脉留置有效率。结果护理措施整改后头皮式静脉留置针静注甘露醇的有效留置率显著提高。结论加强头皮式静脉留置针留置期间的护理,可有效提高头皮式静脉留置针静注甘露醇的有效留置率。     

改进后的静脉留置针穿刺方法及护理

目的：探讨头皮式留置针穿刺方法的改进,以提高穿刺的成功率,减轻病人的痛苦。方法对我科2013年1～12月住院治疗的112例术前患者,采用改进后的静脉留置针穿刺方法进行穿刺,同时给予相关护理,观察其临床效果。结果改进后的静脉留置针穿刺方法显著减少了静脉穿破的几率。结论改进后的静脉留置针穿刺方法可有效的减轻反复穿破血管给患者带来的痛苦及经济负担,提高了病人的满意度,也提高了护理质量。     

Evaluation of coronary bed function by positron emission tomography using 13N-ammonium during cold stimulation

The present investigation was to study the time course of changes in myocardial blood flow (MBF) in response to cold stimulation. Thirty-eight patients having risk factors of cardiovascular complications were examined. The time course of MBF changes was estimated by positron emission tomography (PET) using 13N-ammonium at rest and during a cold test (CT). Endothelium-dependent vasodilation of the brachial artery was determined from the results of a reactive hyperemia test, by applying ultrasonic duplex scanning. No significant MBF increase in response to the cold test was an indicator of coronary arterial endothelial dysfunction at cardiac 13N-ammonium PET. Agreement of the results of brachial arterial ultrasonography during reactive hyperemia and cardiac 13N-ammonium PET in the presence of the cold test suggests that endothelial dysfunction is generalized. Cardiovascular risk factors, such as left ventricular hypertrophy, smoking, dyslipidemia, and diabetes mellitus, substantially affect coronary arterial function. Left ventricular hypertrophy is an independent factor that influences the size of the coronary reserve and, in combination with endothelial dysfunction, worsens coronary microcirculation.     

Evaluation of coronary bed function by positron emission tomography using 13N-ammonium during cold stimulation

The purpose of the present investigation was to study the time course of changes in myocardial blood flow (MBF) in response to cold stimulation. Thirty-eight patients having risk factors of cardiovascular complications were examined. The time course of MBF changes was estimated by positron emission tomography (PET) using 13N-ammonium at rest and during a cold test (CT). Endothelium-dependent vasodilation of the brachial artery was determined from the results of a reactive hyperemia test, by applying ultrasound duplex scanning. No significant MBF increase in response to the cold test was an indicator of coronary arterial endothelial dysfunction at cardiac 13N-ammonium PET. Agreement of the results of brachial arterial ultrasonography during reactive hyperemia and cardiac 13N-ammonium PET in the presence of the cold test suggests that endothelial dysfunction is generalized. Cardiovascular risk factors, such as left ventricular hypertrophy, smoking, dyslipidemia, and diabetes mellitus, substantially affect coronary arterial function. Left ventricular hypertrophy is an independent factor that influences the amount of the coronary reserve and, in combination with endothelial dysfunction, worsens coronary microcirculation.     

Efficacy and safety of coronary stenting during diagnostic coronary angiography in patients with stable angina

The authors assessed the in-hospital and long-term (up to 6 months) results of coronary stenting conducted just after diagnostic coronarography during a common procedure in patients with stable angina pectoris on effort. The 2001-2002 study included 2277 patients. The clinical indications for catheterization were Functional Classes II-IV stable angina on effort in 83 % of patients and silent ischemia in 17%. The study excluded patients with previous coronarography, acute coronary syndrome on admission, renal failure, left ventricular ejection fraction <30%, and left trunk stenosis. All the patients received aspirin and clopidogrel before catheterization. RESULTS: 57% of patients had multivessel disease; full revascularization was performed in 59% of the patients with multivessel disease. The coronary intervention was successful in 100% of cases. Significant in-hospital events (myocardial infarction without Q wave) were in 1.2% of cases. The mean length of hospital stay was 2.9 +/- 2.4 days. The rate of stent thrombosis for as long as 30 days was 0.2%. Recurrent angina and/or positive exercise tests were in 12% during 6 months. CONCLUSION: immediate stening is effective and safe in most patients with stable angina during diagnostic catheterization. It does not increase immediate and late complications.     

Evaluation of various cardiovascular parameters during the intravenous administration of ranitidine

In this paper we evaluated whether a block of cardiac H2 histamine receptors by ranetidine could modify some non-invasive indices of cardiac function: PEP/LVET, heart rate, blood pressure. Five healthy volunteers underwent studies in baseline conditions and 5, 10, 15, 30, 45 minutes following i.v. injections of 1, 5 m/g Kg of ranitidine. None of the studied parameters showed any significant variation at the various time intervals. Ranetidine does not appear to alter the cardiovascular function at the dose we used.     

Smell intensity monitoring using metal oxide semiconductor odor sensors during intravenous olfaction test

The intravenous olfaction test using prosultiamine (PST) solution is simple to perform and has been used clinically in Japan. We monitored intranasal intensity of smell continuously in real time under various conditions of administration using metal oxide semiconductor odor sensors and established an optimal PST injection procedure. In this study, we found that 1) although there was fluctuation in the pattern of intensity of increase in smell in the PST original solution test, the pattern of increase in intranasal smell intensity could be stabilized by prolonging the injection time to 40 s and 2) dilution of PST with physiological saline was effective in preventing angialgia during intravenous injection. It appears that PST administration is best performed by adding 10 ml of saline to 10 mg (2 ml) of PST and injecting the resulting 12-ml solution (6x dilution) and that the best respiratory cycle for testing is once in every 2 s.     

Ants estimate area using Buffon's needle

We show for the first time, to our knowledge, that ants can measure the size of potential nest sites. Nest size assessment is by individual scouts. Such scouts always make more than one visit to a potential nest before initiating an emigration of their nest mates and they deploy individual-specific trails within the potential new nest on their first visit. We test three alternative hypotheses for the way in which scouts might measure nests. Experiments indicated that individual scouts use the intersection frequency between their own paths to assess nest areas. These results are consistent with ants using a 'Buffon's needle algorithm' to assess nest areas.     

Evaluation of the efficacy and safety of rivaroxaban using a computer model for blood coagulation

Rivaroxaban is an oral, direct Factor Xa inhibitor approved in the European Union and several other countries for the prevention of venous thromboembolism in adult patients undergoing elective hip or knee replacement surgery and is in advanced clinical development for the treatment of thromboembolic disorders. Its mechanism of action is antithrombin independent and differs from that of other anticoagulants, such as warfarin (a vitamin K antagonist), enoxaparin (an indirect thrombin/Factor Xa inhibitor) and dabigatran (a direct thrombin inhibitor). A blood coagulation computer model has been developed, based on several published models and preclinical and clinical data. Unlike previous models, the current model takes into account both the intrinsic and extrinsic pathways of the coagulation cascade, and possesses some unique features, including a blood flow component and a portfolio of drug action mechanisms. This study aimed to use the model to compare the mechanism of action of rivaroxaban with that of warfarin, and to evaluate the efficacy and safety of different rivaroxaban doses with other anticoagulants included in the model. Rather than reproducing known standard clinical measurements, such as the prothrombin time and activated partial thromboplastin time clotting tests, the anticoagulant benchmarking was based on a simulation of physiologically plausible clotting scenarios. Compared with warfarin, rivaroxaban showed a favourable sensitivity for tissue factor concentration inducing clotting, and a steep concentration-effect relationship, rapidly flattening towards higher inhibitor concentrations, both suggesting a broad therapeutic window. The predicted dosing window is highly accordant with the final dose recommendation based upon extensive clinical studies.