ObjectiveTo explore the influence of evidence-based nursing care of catheterization on the incidence of urinary tract injury and urinary tract infection in patients with spinal cord injury and long-term indwelling catheters.MethodsFrom July 1st, 2017 to November 30th, 2018, 100 patients with spinal cord injury indwelling catheters in Department of Spinal Surgery were prospectively selected as the research objects. According to the admission time, patients admitted between July 2017 and February 2018 were assigned into the control group (n=50), and patients admitted between March 2018 and November 2018 were assigned into the observation group (n=50). Traditional catheter placement was used in the control group, while evidence-based catheter placement was used in the observation group. The incidences of catheter-related urethral injury and urinary tract infection after the catheterization were compared between the two groups.ResultsThere was no statistically significant difference in gender, age, diagnosis, or length of hospital stay between the two groups (P>0.05). Catheter placement was performed 57 times in the control group and 59 times in the observation group during hospitalization. After catheterization, the incidences of urethral hemorrhage and gross hematuria in the control group [22.80% (13/57) and 15.78% (9/57), respectively] were higher than those in the observation group [both were 1.69% (1/59)], with statistical differences between the two groups (P<0.05). The incidence of urinary tract infection in the control group differed from that in the observation group [42.0% (21/50) vs. 18.0% (9/50), P=0.009].ConclusionThe evidence-based urinary catheterization method for patients with spinal cord injury and long-term indwelling catheter can effectively prevent catheter-related urinary tract injury, reduce the incidence of catheter-related urinary tract infection during hospitalization, and improve the quality of clinical care.
Objective To study the catheter-related infection (CRI) in cancer patients treated with central venous catheterization. Methods A prospective study with 196 cancer patients was conducted to analyze the types of catheter-related infection and pathogen, as well as the relationship between CRI and the following factors: insert location, gender, age, remained time, or bone marrow suppression. Results Of the total 196 cases, 16 cases were diagnosed as CRI and the CRI rate was 8.2%. The types of CRI were five cases of pathogen colonization, four cases of insert location infection and seven cases of catheter-related bloodstream infection. Of the total 244 specimens, 20 were positive including 7 pathogenic bacteria in either Gram positive or Gram negative types, the dominating pathogens were staphylococcus aureus, staphylococcus epidermidis, acinetobacter baumannii and klebsiella pneumoniae. CRI was related to both insert location and age which were both the independent risk factors. Conclusion The concept of prevention should be set up, and the comprehensive measures should be taken to reduce CRI, such as choosing an appropriate insert location and complying with a strict catheter insert standard.
ObjectiveTo systematically review the effectiveness and safety of anatomic landmarks positioning method (ALM) and real-time two-dimensional ultrasound (RTUS) guidance in the internal jugular vein cannulation.
MethodsWe searched PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI for randomized controlled trials (RCTs) concerning the effectiveness and safety of ALM and RTUS in the internal jugular vein catheterization up to May 1st, 2014. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assess methodological quality of included studies. Then meta-analysis was performed using RevMan 5.3 software.
ResultsA total of 10 RCTs involving 1 973 cases were included in the metaanalysis. The results of meta-analysis showed that, compared with the ALM method, the RTUS method reduced puncture failure rate (OR=0.08, 95%CI 0.05 to 0.15, P<0.000 01). For safety, compared with the ALM method, the RTUS method was significantly lower in arterial injury rate (peto-OR=0.22, 95%CI 0.14 to 0.37, P<0.000 01), and the incidence of pneumothorax (peto-OR=0.13, 95%CI 0.04 to 0.40, P=0.000 3).
ConclusionCompared to the ALM method, the RTUS method has characteristics such as causing fewer traumas, and having higher success rate and fewer complications. Due to limited quantity and quality of the included studies, the above conclusion still needs to be verified by conducting more studies.
Objective To explore the related factors of upper urinary tract deterioration (UUTD) in spinal cord injury patients using intermittent catheterization (IC-SCI) in the community. Methods Patients with spinal cord injury in the Chinese community were selected for investigation between August 3 and August 31, 2020. The included patients were divided into UUTD group and non-UUTD group. The basic information, intermittent catheterization practices, and urinary complications were compared between the two groups. Logistic regression was used to analyze the risk factors contributing to UUTD. Results A total of 431 patients were surveyed. Among them, there were 310 males and 121 females, 246 cases in the non-UUTD group and 185 cases in the UUTD group. There were statistically significant differences in the disease duration, gender, etiology, urinary incontinence, urinary tract infection, bladder calculi and nephrolithiasis between the two groups (P<0.05); there was no statistically significant difference in the other indicators between the two groups (P>0.05). The results of logistic regression analysis showed that urinary tract infection [odds ratio (OR)=3.229, 95% confidence interval (CI) (1.706, 6.110), P<0.001], nephrolithiasis [OR=4.846, 95%CI (2.617, 8.973), P<0.001], and urinary incontinence [OR=2.345, 95%CI (1.116, 4.925), P=0.024] were risk factors for UUTD. Conclusion Urinary tract infection, nephrolithiasis and urinary incontinence are independent risk factors for UUTD in community-based IC-SCI patients and deserve attention for preventive strategies.
Objective To construct a risk prediction score model for serious adverse event (SAE) after cardiac catheterization in patients with adult congenital heart disease (ACHD) and pulmonary hypertension (PH) and verify its predictive effect. Methods The patients with PH who underwent cardiac catheterization in Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology from January 2018 to January 2022 were retrospectively collected. The patients were randomly divided into a model group and a validation group according to the order of admission. The model group was divided into a SAE group and a non-SAE group according to whether SAE occurred after the catheterization. The data of the two groups were compared, and the risk prediction score model was established according to the results of multivariate logistic regression analysis. The discrimination and calibration of the model were evaluated using the area under the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow test, respectively. Results A total of 758 patients were enrolled, including 240 (31.7%) males and 518 (68.3%) females, with a mean age of 43.1 (18.0-81.0) years. There were 530 patients in the model group (47 patients in the SAE group and 483 patients in the non-SAE group) and 228 patients in the validation group. Univariate analysis showed statistical differences in age, smoking history, valvular disease history, heart failure history, N-terminal pro-B-type natriuretic peptide, and other factors between the SAE and non-SAE groups (P<0.05). Multivariate analysis showed that age≥50 years, history of heart failure, moderate to severe congenital heart disease, moderate to severe PH, cardiac catheterization and treatment, surgical general anesthesia, and N-terminal pro-B-type natriuretic peptide≥126.65 pg/mL were risk factors for SAE after cardiac catheterization for ACHD-PH patients (P<0.05). The risk prediction score model had a total score of 0-139 points and patients who had a score>50 points were high-risk patients. Model validation results showed an area under the ROC curve of 0.937 (95%CI 0.897-0.976). Hosmer-Lemeshow goodness-of-fit test: χ2=3.847, P=0.797. Conclusion Age≥50 years, history of heart failure, moderate to severe congenital heart disease, moderate to severe PH, cardiac catheterization and treatment, general anesthesia for surgery, and N-terminal pro-B-type natriuretic peptide≥126.65 pg/mL were risk factors for SAE after cardiac catheterization for ACHD-PH patients. The risk prediction model based on these factors has a high predictive value and can be applied to the risk assessment of SAE after interventional therapy in ACHD-PH patients to help clinicians perform early intervention.
The management of neurogenic lower urinary tract dysfunction due to spinal cord injury is one of the most challenging tasks in rehabilitation. Considerable progress has been made in the management of lower urinary tract dysfunction in patients with spinal cord injury over the past few decades. However, urinary complications remain one of the most serious complications in patients with spinal cord injury. Lower urinary tract dysfunction in patients with spinal cord injury present with a variety of symptoms and signs that require comprehensive evaluation. The management of lower urinary tract dysfunction in patients with spinal cord injury require tailored and individualized treatment approaches. Based on the clinical practice of rehabilitation at home and abroad, this paper expounds the progress of the assessment and rehabilitation of lower urinary tract dysfunction after spinal cord injury, and puts forward some suggestions for the reference of clinical staff.
ObjectiveTo explore the effect and significance of continuous nursing in patients with clean intermittent catheterization.
MethodsFrom July to December 2013, 47 patients with spinal cord injury still relying on clean intermittent catheterization were selected as the control group, whom were given the routine care and guidance. From January to June 2014, 51 patients with spinal cord injury still relying on clean intermittent catheterization were selected as the study group; in addition to routine nursing instruction before leaving hospital, they were also guided with the continuous nursing. In the way of telephone follow-up, we analyzed the results via the questionnaire of the effect of continuous nursing for spinal cord injured patients with clean intermittent catheterization.
ResultsThe incidence of catheter related complications such as urinary tract infections in the study group was significantly lower than that in the control group (P<0.05). The caregivers' ability for patients in the study group was significantly higher than that in the control group (P<0.01).
ConclusionThe continuous follow-up nursing instruction can improve the nursing ability of caregivers, and effectively reduce the occurrence of catheter related complications.
ObjectiveTo investigate the efficiency of double moxibustion combined with intermittent catheterization on urination diary in patients with neurogenic bladder (NB) after spinal cord injury (SCI).MethodsFrom August 2014 to August 2016, hospitalized patients with NB after SCI were reviewed retrospectively and classified into the moxibustion group and the routine group. The urination diary related indicators, International Urinary Incontinence Advisory Committee Urinary Incontinence Questionnaire Short Form (ICI-SQ-SF) score, and routine urine leucocyte count were collected.ResultsA total of 278 patients were enrolled in the study, in whom, the data of 96 were incomplete, and 26 got lost to follow-up. The routine group and the moxibustion group finally contained 70 and 86 respectively. There was no significant difference between the two groups in sex, age, average course of the disease, SCI segment or grading of injury (P>0.05). After 2 months treatment, the urine routine leucocyte count decreased to (5.72± 0.36)/μL in the routine group and (3.22±0.27)/μL in the moxibustion group, and the ICI-Q-SF score decreased to 8.61±0.45 in the routine group and 5.07±0.38 in the moxibustion group. The urine routine leucocyte count and ICI-Q-SF score were lower than those before treatment, and were lower in the moxibustion group than those in the routine group (P<0.05). In the 7th to 8th week, in the routine group, the average single urine volume was (300±70) mL, the interval between two micturition was (3.5±0.6) hours, the frequency of urinary incontinence was (3.3±0.4) times per week, and the average residual urine volume was (125±42) mL; in the moxibustion group, they were (326±78) mL, (3.8±1.1) hours, (2.3±0.3) times per week, and (103±37) mL, respectively. The indexes were not statistically significant different from those in the 1st to 2nd week (P>0.05), except the average single urine volume in the routine group and all the indexes in the moxibustion group (P<0.05). They were all better in the moxibustion group than those in the routine group (P<0.05).ConclusionThe treatment of moxibustion and intermittent catheterization may improve bladder function, reduce residual urine, reduce urinary incontinence and improve the quality of life for patients with NB after SCI.
Objective To summarize the blood supply to the sources and characteristics of advanced breast cancer，and explore the method，efficacy，and clinical applications of preoperative super-selective arterial catheterization chemoembolization under DSA for it. Methods Sixty patients with advanced breast cancer confirmed by the aspiration biopsy from February 2007 to October 2011 in this hospital were selected. Seldinger method was used，distributing of the tumor blood supply artery was identified and intubated the target artery by super-selective arterial catheterization via the femoral artery puncture under the DSA. Then，pirarubicin 60 mg plus paclitaxel 120 mg of two chemotherapy drugs was injected into slowly the target artery and the intervention infusion chemotherapy was performed，finally the tumor blood supply artery was embolizated by gelatin sponge particle. Results A total of 112 conclusive blood supply artery in 60 patients with DSA were found，including eight cases of single blood supply artery，52 cases of multiple blood supply arteries，mainly in the lateral thoracic artery and （or） internal thoracic artery-based. The complete remission rate was 25.0% （15/60），partial remission rate was 73.3% （44/60），stable disease rate was 1.7% （1/60），the total effective rate was 98.3% （59/60）. There was no progression disease. The median remission duration was 19 months，median survival time was 40 months. Conclusions The location of the original foci of breast cancer is closely related to blood supply arteries. The tumor in the lateral of the breast mainly dominates by the lateral thoracic artery blood supply. The tumor in the inner breast mainly dominates by the internal thoracic artery blood supply. The preoperative super-selective arterial catheterization chemoembolization under DSA can obviously improve the therapeutic effect，long-term survival，and the target of interventional chemoembolization.
ObjectiveTo evaluate the feasibility to use ultrasonic cardiac output monitoring (USCOM) for patients after coronary artery bypass grafting.
MethodsClinical data of 32 patients undergoing off-pump coronary artery bypass grafting in General Hospital of Shenyang Military Region between April and June 2013 were retrospectively analyzed. There were 17 male and 15 female patients with their age of 46-76 (63.2±7.6) years. USCOM and pulmonary artery catheterization (PAC) were used to measure cardiac output (CO) synchronously,and the results were compared between USCOM and PAC.
ResultsSixty-four pairs of data were collected from those 32 patients. No adverse event was observed with either USCOM or PAC. Mean CO was 4.27±0.92 L/min with USCOM and 4.49±0.75 L/min with PAC respectively,which were not statistically different (P=0.12) but significantly correlated (r=0.84,P<0.001).
ConclusionThere is close correlation between USCOM and PAC for CO measurement. USCOM can not only measure CO accurately,but also has the advantages of being noninvasive,easy to perform and low cost.
