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Effectiveness of the Instructional Module on Knowledge and Interpretation of ABGs Among Critical Care Nurses 重症护理护士ABGs知识与解释教学模块的有效性
Pub Date : 2021-09-26 DOI: 10.11648/J.AJNS.20211005.11
U. Zeb, Said Alam, FA Ali, M. Hanif, S. Ali
Arterial Blood Gases interpretation are considered as one of the significant investigations in the critical care areas that guides in appropriate direction to make better decision for diagnosis, treatment and expected outcome of the concerned disorders. Nurses are considered as the primary care providers in critical care units therefore their knowledge regarding ABGs interpretation and analysis may play a vital role in the management of the seriously ill patient admitted with respiratory, cardiovascular, acid base disorder and renal disease. The main intention of the study was to appraise the Effectiveness of the Instructional Module on Knowledge and Interpretation of ABGs among Critical Care Nurses. A quantitative quasi-experimental study design was used with a sample of 30 CCN by census method from Ayub Teaching hospital Abbottabad. Data was collected through a reliable and validated questionnaire before and after assigning with the instructional module. Data was analyzed by SPSS-22. The study result showed that the pretest knowledge score of the critical care nurses in the pre stage intervention was 53.3% which was poor on the grading scale. Overall mean score was found as 51.9963+26.54 in the pre assessment phase while 74.6333+15.98 was reported in the post phase of giving the instructional module with a mean significant difference of 22.63+39.50. Statistically the instructional module was found effective in enhancing the nurse’s knowledge with a –value of 0.004. The findings of the study depict that instructional module has a positive and significant association with the level knowledge of nurses regarding ABGs interpretation.
动脉血气判读是危重症诊断、治疗和预后预测的重要研究方向之一。护士被认为是重症监护病房的初级保健提供者,因此,他们对ABGs的解释和分析的知识可能在呼吸系统、心血管、酸碱疾病和肾脏疾病住院的重症患者的管理中起着至关重要的作用。本研究的主要目的是评估危重病护理护士ABGs知识和解释教学模块的有效性。采用定量准实验研究设计,以阿伯塔巴德Ayub教学医院的30名CCN为样本,采用人口普查方法。在分配教学模块之前和之后,通过可靠和有效的问卷收集数据。数据采用SPSS-22进行分析。研究结果显示,危重护理护士在干预前的预测知识得分为53.3%,在评分量表上较差。测评前总分为51.9963+26.54分,测评后总分为74.6333+15.98分,测评前总分为22.63+39.50分。统计上,教学模块在提高护士知识方面有效,-值为0.004。研究结果表明,教学模块与护士对ABGs解释的知识水平有显著的正相关。
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引用次数: 0
Application Effect of Humanized Nursing in the Perioperative Period of Gastrointestinal Tumor 人性化护理在胃肠肿瘤围手术期的应用效果
Pub Date : 2021-07-08 DOI: 10.11648/J.AJNS.20211004.12
Wang Yan, Chenfan Xia, Tang Chun Yan
To observe the effect of humanized nursing in the perioperative period of gastrointestinal tumor. A total of 118 cases of gastrointestinal tumor patients treated in our hospital from March 2021 to May 2021 were selected. Patients were randomly assigned to the routine care control group or humanized nursing intervention group according to their willingness. The gastrointestinal function, psychological status, postoperative complications and nursing satisfaction status of the two groups were compared after intervention. The recovery rate of gastrointestinal function was faster in the study group, that is, the time of initial anal exhaust and initial defecation was lower in the study group than in the control group, and the incidence of abdominal distension was lower in the study group (P<0.05). The psychological status of the study group was significantly better than that of the control group, that is, the scores of all items of the Symptom Checklist-90 (SCL-90) in the study group were lower than those in the control group (P<0.05). Compared with the control group, the incidence of postoperative complications in the study group was lower and the nursing satisfaction was better (P < 0.05). The findings demonstrate application of humanized nursing for patients in the perioperative period of gastrointestinal tumor not only effectively promote the recovery process of patients, but also alleviate the adverse mood of patients and improve the quality of hospital nursing work, which has clinical application usefulness.
目的:观察人性化护理在胃肠肿瘤围手术期的效果。选取2021年3月至2021年5月在我院治疗的胃肠道肿瘤患者118例。根据患者意愿随机分为常规护理对照组和人性化护理干预组。比较干预后两组患者的胃肠功能、心理状态、术后并发症及护理满意度情况。研究组胃肠功能恢复速度较快,即首次肛门排气和首次排便时间均低于对照组,腹胀发生率低于对照组(P<0.05)。研究组的心理状态显著优于对照组,即研究组的SCL-90各单项得分均低于对照组(P<0.05)。与对照组比较,研究组术后并发症发生率较低,护理满意度较好(P < 0.05)。研究结果表明,人性化护理在胃肠道肿瘤围手术期患者中的应用,不仅能有效促进患者的康复进程,还能缓解患者的不良情绪,提高医院护理工作的质量,具有临床应用价值。
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引用次数: 0
In the Eye of the Hurricane - A Qualitative Study on What Is at Stake for Close Family Members to Patients Hospitalized with COVID-19 飓风之眼-关于COVID-19住院患者的亲密家庭成员面临的风险的定性研究
Pub Date : 2021-07-02 DOI: 10.11648/J.AJNS.20211004.11
C. Bernild, M. Missel, Ilkay Dagyaran, Signe Westh Christensen, S. Berg
COVID-19 causes patient trajectories that are sudden, unpredictable and imbedded in a worldwide panic as well as lack of medical experience and knowledge. This study aims to understand how close family members to patients hospitalized with COVID-19 are affected by the situation. Individual, in-depth interviews with twelve close family members to patients hospitalized with COVID-19 were conducted. The interviews were analyzed with a hermeneutic approach using reflexive methodology. Theoretical conceptualization ensured a critical interpretation. Three empirical themes were identified: fear and unpredictability, not being able to be there and being the “key caregiver”. Family members´ fear is compounded as the whole world is preoccupied with the same fear and uncertainty about COVID-19. Due to the volatile situation, a shift in coping strategies throughout the trajectory was illuminated as well as an ambivalence towards the health system´s treatment regime on COVID-19 implying a total separation between the patient and their close family member. In conclusion, close family members of patients hospitalized with COVID-19 are in a vulnerable situation, characterized by a high degree of unpredictability and seriousness causing fear of losing their loved ones, as well as powerlessness due to visiting restrictions. Hospitalization with COVID-19 is an unpredictable situation, where the family members are separated from their loved ones. Family members are dependent on the communication with health care professionals. Therefore, talking to family members during COVID-19 must be prioritized and it is found necessary to develop relevant and systematic practices for communication and collaboration practices.
COVID-19导致患者轨迹突然、不可预测,并陷入全球恐慌,以及缺乏医疗经验和知识。这项研究旨在了解与COVID-19住院患者关系密切的家庭成员如何受到这种情况的影响。对12名COVID-19住院患者的近亲属进行了个别深入访谈。访谈分析与解释学的方法使用反思的方法。理论概念化保证了批判性的解释。确定了三个经验主题:恐惧和不可预测性,不能在那里和成为“主要照顾者”。随着整个世界都沉浸在对COVID-19的同样恐惧和不确定性中,家庭成员的恐惧也在加剧。由于局势动荡,整个过程中应对策略的转变以及对卫生系统COVID-19治疗方案的矛盾心理意味着患者与其亲密家庭成员之间的完全分离。综上所述,COVID-19住院患者的近亲属处于弱势地位,其特点是高度不可预测性和严重性导致失去亲人的恐惧,以及由于探视限制而产生的无力感。因新冠肺炎住院是无法预测的情况,家人与亲人分离。家庭成员依赖于与卫生保健专业人员的沟通。因此,必须优先考虑在COVID-19期间与家庭成员进行交谈,并认为有必要制定相关和系统的沟通和协作实践。
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引用次数: 3
The Beneficial Effects of the Buttonhole Technique Used for the Cannulation of Arteriovenous Fistula Among Hemodialysis Patients: A Literature Review 扣眼技术用于血液透析患者动静脉瘘插管的有益效果:文献综述
Pub Date : 2021-06-29 DOI: 10.11648/j.ajns.20211003.19
H. Yin, Cai-Yi Zhou, Haiyan Yu, W. Ren
Arteriovenous fistula (AVF) is a “life-line” for hemodialysis patients. Complications associated with AVF cannulation including the occurrence of vessel stenosis and formation of false aneurysms can substantially shorten the length of AVF survival and its utilization. To minimize the damages to vessel walls of AVF, various needling techniques involving the utilization of sharp or blunt needles, and rotating puncture sites are applied in clinical practice. The buttonhole cannulation (BHC) method appears to be a successful technique to solve the problem of puncturing difficult AVFs. However, it is controversial whether BHC should be extended widely to actual practice to generate further beneficial effects or be restricted in clinical use due to a higher risk of adverse AVF complications. This review reports and elaborates on the methods used to create BHC tunnels, the effects of BHC on patient outcomes compared with other cannulation techniques with regard to both objective and subjective aspects, the advantages and disadvantages of BHC, and the measures for improving BHC. According to the published literature, utilizing BHC for AVF cannulation can effectively prevent the complications associated with AVF, while formulating and implementing the standardized BHC procedure, together with comprehensive staff training and self-management education for patients, can substantially reduce the risk of infection. Future studies with rigorous design need to investigate the long-term effects and strengthen the existing evidence regarding the utilization of BHC.
动静脉瘘(AVF)是血液透析患者的生命线。AVF插管的并发症包括血管狭窄的发生和假性动脉瘤的形成,大大缩短了AVF的生存时间和利用时间。为了尽量减少对AVF血管壁的损伤,临床实践中应用了各种针刺技术,包括使用锋利或钝的针,以及旋转穿刺部位。钮孔穿刺(BHC)方法是一种成功的技术,可以解决刺穿困难的avf问题。然而,六六六是否应该广泛推广到实际实践中以产生进一步的有益效果,或者由于AVF不良并发症的风险较高而限制临床使用,目前存在争议。这篇综述报告并详细阐述了创建BHC隧道的方法,与其他插管技术相比,BHC在客观和主观方面对患者预后的影响,BHC的优缺点,以及改善BHC的措施。已发表的文献表明,利用BHC进行AVF插管可有效预防AVF相关并发症的发生,而制定和实施标准化的BHC程序,并对工作人员进行全面的培训和对患者进行自我管理教育,可大大降低感染风险。未来的研究需要严谨的设计,以调查长期的影响,并加强现有的证据关于六六六的利用。
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引用次数: 0
Adoption the Competence Exam as an Innovation Approach to Improve Nurses' Quality 以能力考试为创新途径提高护士素质
Pub Date : 2021-06-25 DOI: 10.11648/j.ajns.20211003.18
M. Al-Jubouri, Mohammed Baqer Abd Ali
Background: The competence exam is an action to develop nursing students' competencies before graduation to be prepared for clinical settings. Many nursing schools around the world require passing standardized tests in terms of graduation in a nursing program. However, there is no such an exam in Iraq. Method: Rogers Diffusion of Innovation Theory is helpful to determine the adoption of a behavior and to decide which components need extra effort if diffusion is to occur. This theory is used to apply the competence exam as an innovative approach to improve nurses' quality in Iraq. Results: Organization, faculty, and curriculum are the main three concepts that can be integrated based on Rogers Diffusion of Innovation Theory to adopt a competence exam. The outcome would affect nurses' quality directly, and an evaluation can determine the effectiveness of this innovation Conclusion: Adopting a competence exam prepares nursing students for the real clinical settings.
背景:能力考试是培养护理学生毕业前的能力,为临床环境做好准备的一项行动。世界上许多护理学校都要求学生通过标准化考试才能毕业。然而,伊拉克没有这样的考试。方法:罗杰斯的创新扩散理论有助于确定一种行为的采用,并决定如果要发生扩散,哪些组成部分需要额外的努力。运用这一理论,将能力考试作为提高伊拉克护士素质的创新途径。结果:组织、教师和课程是基于罗杰斯创新扩散理论可以整合的三个主要概念,以采用能力测试。改革的结果直接影响到护士的素质,对改革的效果进行评价是决定改革成效的关键。结论:实施能力考试是为护生进入真正的临床环境做准备。
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引用次数: 0
Consideration of Factors Affecting Nurses’ Attitude of Pointing out Inter-professional Errors 影响护士指出跨专业错误态度的因素探讨
Pub Date : 2021-06-22 DOI: 10.11648/j.ajns.20211003.17
Etsuko Okamoto, Satsuki Shiratoi
In recent years, good communication and non-technical skills are recognized as critical to the delivery of high-quality patient care and to improving patient safety and clinical outcomes. The purpose of this study is to investigate the acquisition of non-technical skills by nurses and clarify the factors influencing nurses’ behavior while pointing to the multi-professional errors in health care teams in relation to non-technical skills such as communication and leadership. A mail-in questionnaire survey was administered to 1,834 nurses who work for advanced treatment hospitals throughout Japan. The questionnaire consisted of 84 items, including a scale for measuring the nurses’ attitude toward pointing out problems and non-technical skills. Multiple regression analyses were conducted, with the score on the scale for attitude toward pointing out problems as the objective variable and personal attributes, such as years of experience and job titles, and personality traits of individuals, such as non-technical skills, as separate explanatory variables (simultaneous forced entry). The number of responses to the questionnaire was 412. As a result of the multiple regression analyses, factors that affect nurses’ attitudes toward pointing out problems were affected more strongly by “assertiveness” and “leadership,” which fell under non-technical skills that are personality traits of individuals, than by basic attributes, which include years of experience and job titles. Nurses’ non-technical skills, such as “assertiveness” and “leadership,” which are personality traits of individuals, had an effect on their attitudes whereby they pointed out problems. These findings will be used in future intervention studies to improve these non-technical skills of leadership and self-assertion, improve communication and, as a result, reduce errors.
近年来,良好的沟通和非技术技能被认为是提供高质量患者护理和改善患者安全和临床结果的关键。本研究旨在调查护士非技术技能的习得情况,厘清影响护士行为的因素,同时指出医疗团队在沟通、领导等非技术技能方面存在的多专业错误。一项邮寄问卷调查对日本各地高级治疗医院的1834名护士进行了调查。问卷共84个项目,包括一个测量护士指出问题态度和非技术技能的量表。采用多元回归分析,将指出问题的态度量表得分作为客观变量,将个人属性(如工作年限和职称)和个人个性特征(如非技术技能)作为单独的解释变量(同时强行进入)。问卷的回复数为412。作为多元回归分析的结果,影响护士指出问题态度的因素更强烈地受到“自信”和“领导能力”的影响,这些因素属于个人的非技术技能,而不是基本属性,包括多年的经验和职位。护士的非技术技能,如“自信”和“领导能力”,这些是个人的个性特征,对他们指出问题的态度有影响。这些发现将用于未来的干预研究,以提高这些非技术技能的领导和自我主张,改善沟通,从而减少错误。
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引用次数: 0
Feasibility Investigation of Developing a Revised MEWS Score for Cardiovascular Specialty 修订心血管专科MEWS评分的可行性研究
Pub Date : 2021-06-10 DOI: 10.11648/J.AJNS.20211003.16
Yanling Zhang, Haiyan Zhuo, Huai-mei Bi, Juxian Wu
Objective: Cardiovascular disease is a series of diseases with high morbidity, high fatality rate, rapid changes in condition, and it is highly prone to emergencies and severe illnesses, and it is the primary disease that leads to death of patients. The modified early warning score (MEWS) is lacks specialized indicators and can’t personalize risk prediction for cardiovascular patients. Explore the establishment of a scoring system suitable for evaluating the condition of inpatients in the Department of Cardiovascular Medicine to provide a reference basis for accurate assessment and adequate early warning of the patient's disease, and for targeted nursing plans. Methods: The questionnaire was designed through literature analysis, brainstorming, and expert interviews, and a questionnaire survey was conducted for nursing staff in the Department of Cardiology. Analyze the survey results through SSPS software. Results: According to the survey analysis, 73.9% of the experts surveyed considered it necessary or very necessary to establish a modified early warning score in cardiovascular medicine (MEWS); Approx. Chi-square value of the Bartlett sphericity test was 3760.769 (with 28 degrees of freedom), which reached a significant level (P< 0.000), indicating that the reliability and validity of the scale were high. The corrected MEWS score scale was composed of 8 observation indexes, including systolic blood pressure, diastolic blood pressure, respiration, heart rate, oxygen saturation, arrhythmia, consciousness, and chest pain. Conclusion: Cardiovascular medical nursing staff had a high degree of approval for establishing the corrected MEWS score; The constructed MEWS score for cardiovascular internal disease correction is feasible, objective and practical to a certain extent, and can provide a basis for further exploration of practical application.
目的:心血管疾病是发病率高、致死率高、病情变化快、极易发生急症和重症的一系列疾病,是导致患者死亡的首要疾病。修正预警评分(MEWS)缺乏专门的指标,不能对心血管患者进行个性化的风险预测。探索建立适合心血管内科住院患者病情评估的评分体系,为准确评估和充分预警患者病情,制定有针对性的护理方案提供参考依据。方法:采用文献分析法、头脑风暴法、专家访谈法设计问卷,对心内科护理人员进行问卷调查。通过SSPS软件对调查结果进行分析。结果:根据调查分析,73.9%的受访专家认为有必要或非常有必要建立心血管医学修正预警评分(MEWS);约。Bartlett球形度检验的卡方值为3760.769(28个自由度),达到显著水平(P< 0.000),说明量表的信度和效度较高。修正后的MEWS评分量表由收缩压、舒张压、呼吸、心率、血氧饱和度、心律失常、意识、胸痛等8项观察指标组成。结论:心血管内科护理人员对建立修正后的MEWS评分的认可程度较高;所构建的MEWS评分用于心血管内科疾病矫正具有一定的可行性、客观性和实用性,可为进一步探索实际应用提供基础。
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引用次数: 2
The Effects of Self-Efficacy on Cognitive Function in Patients with Acute Stroke: Verification of the Medicating Effect of Family Support 自我效能感对急性脑卒中患者认知功能的影响:家庭支持治疗效果的验证
Pub Date : 2021-05-26 DOI: 10.11648/J.AJNS.20211003.15
Sanghee Kim
Background: Post–stroke cognitive impairment (PSCI) is a common consequence of stroke. Many factors that affect cognitive function are known, but the effects of self-efficacy and family support have not been identified. Objectives: This study was a descriptive correlation investigation to determine the mediating effects of family support on the relationship between self-efficacy and cognitive function in stroke patients. Methods: This descriptive cross-sectional study recruited 339 adult patients with acute stroke. Data were collected using structured questionnaires between January and June 2020 and analyzed by multiple regression analysis using SPSS 25.0. The mediating effect of resilience on the relationship between emotional labor and job satisfaction was analyzed using multiple regression analysis according to Baron and Kenny’s procedure. Results: In this study, self-efficacy in patients with acute stroke showed a positive relationship with cognitive function (r=.467, p<.05) and family support (r=.341, p<.001), and family support and cognitive function also showed a positive relationship (r=.356, p<.05). In addition, family support was shown to have a partial mediating effect on the relationship between self-efficacy and cognitive function in patients with acute stroke (β=.26, p<.001). Conclusions: To improve the cognitive function of acute stroke patients, their self-efficacy and family support must be evaluated, and interventions are necessary to enhance self-efficacy and improve family support.
背景:脑卒中后认知障碍(PSCI)是脑卒中的常见后果。许多影响认知功能的因素是已知的,但自我效能感和家庭支持的影响尚未确定。目的:本研究采用描述性相关研究,探讨家庭支持在脑卒中患者自我效能感与认知功能之间的中介作用。方法:本描述性横断面研究招募了339例急性脑卒中成年患者。2020年1 - 6月采用结构化问卷收集数据,采用SPSS 25.0进行多元回归分析。根据Baron和Kenny的程序,运用多元回归分析心理弹性在情绪劳动与工作满意度关系中的中介作用。结果:在本研究中,急性脑卒中患者的自我效能感与认知功能呈正相关(r=。467, p< 0.05)和家庭支持(r=。341, p<.001),家庭支持与认知功能也呈正相关(r=。356年,p < . 05)。此外,家庭支持对急性脑卒中患者自我效能感与认知功能之间的关系具有部分中介作用(β=。26日,p <措施)。结论:要改善急性脑卒中患者的认知功能,必须对其自我效能感和家庭支持进行评估,提高自我效能感和改善家庭支持是必要的干预措施。
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引用次数: 0
A Non-invasive Focused Extracorporeal Shock Wave Therapy System Promotes Increased Tissue Oxygen Saturation in Chronic Wounds in Persons with Diabetes 一种无创聚焦体外冲击波治疗系统促进糖尿病患者慢性伤口组织氧饱和度的增加
Pub Date : 2021-05-21 DOI: 10.11648/J.AJNS.20211003.14
Windy E. Cole, Stacey Coe, G. Maislin, Valerie Marmolejo
Diabetes affects 30.3 million Americans and is on the rise. Chronic lower extremity ulceration in patients with diabetes is a common complication that can lead to major morbidity and mortality if not addressed expeditiously. Despite numerous advances in wound care and healing over the past two decades, these ulcerations continue to pose a significant clinical problem. This case series aimed to evaluate the effectiveness of focused extracorporeal shock wave therapy (F-ESWT) administered via a pulsed acoustic cellular expression system in enhancing localized wound tissue oxygenation and perfusion in chronic wounds. Fifteen subjects with a history of diabetes and a chronic wound of the foot or ankle that had failed to achieve wound area reduction of 50% or greater after at least 4 weeks of standard of care treatment underwent four weekly treatments of F-ESWT administered via a pulsed acoustic cellular expression system. Near-infrared spectroscopy (NIRS) was used to determine the effectiveness of F-ESWT on tissue oxygen saturation within the wound bed. All subjects demonstrated a statistically significant increase in tissue oxygen saturation within the wound bed as well as a decrease in wound area. Seven wounds healed. Results of this case study suggest that F-ESWT promotes increased tissue oxygenation within the wound bed and neovascularization, potentially facilitating accelerated wound resolution of chronic lower extremity ulcerations in patients with diabetes.
糖尿病影响了3030万美国人,而且这个数字还在上升。糖尿病患者的慢性下肢溃疡是一种常见的并发症,如果不及时处理,可导致严重的发病率和死亡率。尽管在过去的二十年里伤口护理和愈合取得了许多进步,但这些溃疡仍然是一个重大的临床问题。本病例系列旨在评估通过脉冲声细胞表达系统给予的聚焦体外冲击波治疗(F-ESWT)在增强慢性伤口局部伤口组织氧合和灌注方面的有效性。15名有糖尿病病史和足部或踝关节慢性伤口的患者,在经过至少4周的标准护理治疗后,伤口面积未能减少50%或更多,他们通过脉冲声细胞表达系统接受了每周4周的F-ESWT治疗。采用近红外光谱(NIRS)测定F-ESWT对伤口床内组织氧饱和度的影响。所有受试者均表现出统计上显著的伤口床内组织氧饱和度的增加以及伤口面积的减少。七个伤口愈合了。本病例研究的结果表明,F-ESWT促进伤口床内组织氧合和新生血管的增加,可能促进糖尿病患者慢性下肢溃疡的伤口加速愈合。
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引用次数: 0
Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients 中国老年患者心内电引导下PICC放置的P波形态分析
Pub Date : 2021-04-29 DOI: 10.11648/J.AJNS.20211001.29
Ying Wu, Guohua Huang, Jinai He, Qiufeng Li, Yutong Li
Objective: PICC can effectively protect upper extremity veins. It can reduce repetitive puncture and the incidence of phlebitis, relieve the pain, and improve the quality of life for those with long-term intravenous infusion, repeated infusion of stimulant drugs and blood products, and poor peripheral superficial vein conditions etc.. Successful PICC tip positioning can effectively avoid catheter-related complications during clinical care. If the catheter tip is misplaced, it may cause malfunction and related complications, such as venous thrombosis, bacteremia, arrhythmia, and heart valve injury etc. To investigate the correlation and clinical significance of monitoring P-wave characteristics, especially the occurrence of double peaks for precise tip positioning of peripherally inserted central catheter (PICC) guided by intracardiacelectrogram (IEGM). Methods: Enrolled 116 PICC patients (age≥60, no heart diseases) in our hospital. Conducted retrospective analysis on patients’ medical records, PICC catheterization data, IEGM-guided positioning records and nursing records. Observed and recorded patients’ P-wave changes (peaked P wave, bi-directional P wave and double-peaked P wave) at different catheter tip positions by real-time IEGM, and then analyzed the case number and positioning accuracy. Used chest X-ray to determine whether the catheter tip had reached the ideal position, the tracheal carina to the cavo-atrial junction (CAJ). Results: Among 116 patients (63 males, 53 females), bidirectional P waves were detected in 112 of them (96.55%) in ECG Lead II; 63 with peaked P waves (53.3%); 49 with double-peaked P waves but no peaked P waves (42.2%), meaning bidirectional P waves were seen when fed in the catheter and returned to double peaks when the catheter was withdrawn; 4 with no significant changes (3.4%). Chest X-ray proved that 49 of 49 cases with double-peaked P waves reached the ideal catheterization position (100% in accuracy), and 43 of 69 cases with peaked P waves succeeded as well (68.2% in accuracy). Conclusions: Double-peaked P waves in IEGM-guided PICC positioning for elderly patients can be considered as an indicator of the catheter tip entering the CAJ and supplementary support of peaked P wave and bidirectional P wave guidance for catheterization.
目的:PICC能有效保护上肢静脉。对于长期静脉输注、反复输注兴奋剂药物及血液制品、周围浅静脉状况不佳等患者,可减少反复穿刺及静脉炎的发生率,缓解疼痛,提高生活质量。PICC尖端定位成功,可有效避免临床护理中导管相关并发症的发生。如果导管尖端错位,可能会引起功能障碍及相关并发症,如静脉血栓形成、菌血症、心律失常、心脏瓣膜损伤等。目的探讨心内电图(IEGM)引导下p波特征监测特别是双峰出现的相关性及临床意义。方法:选取我院116例PICC患者(年龄≥60岁,无心脏疾病)。回顾性分析患者病历、PICC置管资料、心电图引导下的体位记录及护理记录。通过实时IEGM观察记录患者在不同导管尖端位置的P波变化(峰值P波、双向P波、双峰P波),分析病例数及定位精度。利用胸片确定导管尖端是否到达理想位置,气管隆突至腔房交界处(CAJ)。结果:116例患者中,男63例,女53例,其中112例(96.55%)在心电图导联ⅱ中检出双向P波;P波峰63例(53.3%);49例出现双峰P波,但无峰P波(42.2%),即在导管内输入时出现双向P波,拔管时出现双峰P波;4例无显著变化(3.4%)。胸部x线证实49例双峰P波患者中49例达到理想置管位置(准确率100%),69例峰值P波患者中43例成功置管(准确率68.2%)。结论:iegm引导下老年患者PICC定位时双峰P波可作为导管尖端进入CAJ的指标,对峰值P波和双向P波引导置管的补充支持。
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American Journal of Nursing Science
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