ObjectiveTo explore the current status of nursing researches about catheter-related infections in recent 5 years in China, and provide reference for further research.MethodsThe China National Knowledge Infrastructure database and Wangfang database were selected to search for literature about catheter-related infections published in recent 5 years in 10 nursing journals of Statistic Source, with the terms of " catheter-related bloodstream infection” or " ventilator-associated pneumonia” or " catheter-related urinary tract infection”. Statistical analysis was conducted.ResultsA total of 216 papers were included. The number of papers was not increased year by year. In terms of the object of study, the studies on ventilator-associated pneumonia were the most, accounting for 71.3%. Only 36.5% of the studies had accurate diagnostic criteria. In terms of the type of study, experimental studies were the most (109 articles). The content was concentrated on the best practice intervention studies (149 articles). The data collection methods gave priority to active surveillance/screening, including 113 articles.ConclusionsThe present focused attention is not enough to the researches about catheter-related infections in nursing field, and rigorous design is lacking in published studies. There are only a few nursing studies about catheter-related infections with high quality and high level of evidence. The quantity and quality of nursing researches about catheter-related infections still need to be improved. Nurses should pay more attention to the control and prevention of catheter-related infections, and should improve their research capacity.
ObjectivesTo systematically review the efficacy and safety of catheter-directed thrombolysis (CDT) versus anti-coagulation (AC) for deep vein thrombosis (DVT). MethodsWe searched PubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases to collect randomized clinical trials (RCTs) about CDT versus AC for DVT from inception to March 2018. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs and 989 patients were included. Meta-analysis showed that there was no significant difference between the two group in incidence of post-thrombotic syndrome (RR=0.73, 95%CI 0.49 to 1.09, P=0.13), iliofemoral venous patency rate (RR=2.57, 95%CI 0.59 to 11.24, P=0.21), bleeding (RR=2.03, 95%CI 0.50 to 8.28, P=0.32), severe bleeding (RR=1.77, 95%CI 0.91 to 3.42, P=0.09) and recurrence rate of venous thromboembolism (RR=1.00, 95%CI 0.42 to 2.36, P=0.99). However, the incidence of moderate-severe PTS decreased in CDT group was lower than that in the control group (RR=0.70, 95%CI 0.53 to 0.92, P=0.01). ConclusionsCompared with the control group, catheter-directed thrombolysis does not reduce the incidence of PTS and VTE recurrence rate, cannot improve the long-term patency of the iliofemoral vein, yet can prevent the occurrence of moderate to severe PTS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To systematically evaluate the influence of PICC (peripherally inserted central catheter) ultrasound guidance on success rates and incidences of complications of elbow catheterization. Methods The Cochrane Library (Issue 3, 2012), Library of JBI evidence-based nursing center, MEDLINE, EMbase, CBM, VIP, CNKI and WanFang Data were searched for relevant studies to influence on success rates of puncture and catheterization and complications from upper arm placement of PICC ultrasound guidance as well as conventional PICC placement from inception to March, 2012. The data were extracted according to the inclusion and exclusion criteria by two reviewers, the quality of included studies was also evaluated. Meta-analysis was conducted using RevMan 5.1, or only descriptive analysis was conducted instead. Results Eleven randomized controlled trials, five clinical controlled trials and four cohort studies were included, involving 4 052 patients. The results of meta-analysis showed that, upper arm placement of PICC ultrasound guidance combined with modified Seldinger technique was associated with significantly higher one-time success rates of puncture and catheterization than conventional PICC placement below the elbow, with significant differences (OR=4.71, 95%CI 1.97 to 11.28, P=0.000 5; OR=8.63, 95%CI 1.92 to 38.82, P=0.005). Conventional elbow catheterization had a significantly higher incidence of phlebitis than catheterization on the elbow that under the guidance of PICC ultrasound and modified Seldinger technique (OR=0.13, 95%CI 0.08 to 0.21, Plt;0.000 01). Conclusion Elbow catheterization under the guidance of PICC ultrasound combined with modified Seldinger technique has an obvious advantage in improving the success rates of puncture and catheterization and reducing the incidence of complications, compared with conventional elbow catheterization.
Objective To investigate the role of low-dose heparin added to total nutrient admixture (TNA) solutions in the prevention of catheter related infections (CRIs). Methods One-hundred three newborn infants with periph-erally inserted central catheter (PICC) were divided into heparin group (n=63) and control group (n=40). The patients in the heparin group received TNA with 0.5 U/ ml heparin. The patients in the control group received TNA without heparin. We retrospectively analyzed the incidence of CRTs in the two groups. Results We found that the incidence of CRIs was 0 in the heparin group and 12.5% (5/40) in the control group. The incidence of catheter obstruction was 6.3% (4/63) in the heparin group and 20% (8/40) in the control group. The incidence of catheter-tip colonization was 1.58% (1/40) in the heparin group and 17.5% (7/40) in the control group. The incidences of CRIs, catheter obstruction, and catheter-tip colonization were signiicantly lower in the heparin group than those in the control group (Plt;0.05). Conclusion TNA solutions with 0.5U/ml heparin have decreased catheter obstruction and CRIs.
Objective To explore the risk factors of catheter-associated bloodstream infections ( CRBSI) in intensive care unit ( ICU) of primary hospital. Methods A total of 623 patients with central venous catheters were recruited in the study. 60 of themsuffered fromCRBSI served as an observation group and other 563 cases without CRBSI served as control. Univariate analysis was used to scan possible risk factors. Then logistic regression analysis was used to exclude the confounding factors. Results The overall incidence rate of CRBSI was 9. 63% ( 60 /623) . There were significant differences in APACHE score, type of catheter, location of catheter, duration of central venous catheter, intravenous nutrition, use of steroid, times of intubation, urgent intubations, nutritional status, diabetes, and MODS between the two groups. Logistic regression analysis revealed that higher APACHE score, double-lumen catheter, femoral vein catheter, catheter indwelling more than two weeks, intravenous nutrition, intubation more than 2 times, and emergency intubation were risk factors of CRBSI. Conclusions Higher APACHE score, double-lumen catheter, femoral vein catheter, catheter indwelling more than two weeks, intravenous nutrition, intubation more than 2 times, and emergency intubation were major risk factors of CRBSI in ICU of primary hospital.
ObjectiveTo explore the effect of catheter directed thrombolysis (CDT) in treatment of acute deep venous thrombosis (ADVT) in lower extremity. MethodsLimb circumference at 15 cm above and below the knee at affected side, as well as patency improvement score of 46 patients with ADVT in lower extremity, who received treatment in The Rocket Army General Hospital of PLA between January 2014 and October 2015, were colleted retrospectively, to analyze the effect of CDT in treatment of ADVT in lower extremity. ResultsAll patients were placed catheter successfully, 5 patients were placed catheter by 'contralateral mountain' technique retrograde, 40 patients were placed catheter through the limb popliteal vein at affected side anterograde, guiding by ultrasound, 1 patient was placed catheter through femoral vein at affected side. All of 46 patients got successful thrombolysis, and thrombolysis time was (4.7±1.8) d (3-12 d). There were 8 patients suffered from complications in different situation, and got treatment of drug withdrawal or tube drawing all ease, no one died. Compared with before CDT treatment in same group, the limb circumference at 15 cm above (P=0.028, P=0.017, P=0.031) and below (P=0.035, P=0.038, P=0.047) the knee at affected side, and patency improvement score (P=0.023, P=0.028, P=0.031) in all patients group, 22-45 years group, and 46-74 years group were all lower after CDT treatment. The limb circumference at 15 cm above (P=0.073, P=0.387, P=0.358) and below (P=0.416, P=0.625, P=0.253) the knee at affected side after CDT treatment were not differed with corresponding indexes of healthy side in the same group of all patients group, 22-45 years group, and 46-74 years group. Ultrasound after treatment showed that, blood vessel recanalization occurred in 15 patients (32.6%), partial blood vessel recanalization occurred in 28 patients (60.9%), but thrombus of 3 patients (6.5%) didn't removed, the total effective rate was 93.5% (43/46). Forty three patients were followed up for 1-24 months, the median is 18-month. During follow-up period, skin color obviously deepened after the activity occurred in 5 patients, obvious limb acid bilges occurred in 19 patients, vein thrombosis (DVT) recurred in 9 patients of 28 patients with partial blood vessel recanalization, in addition, thrombosis syndrome (PTS) occurred in 11 patients. ConclusionCDT is the most direct and effective way to treat ADVT.
ObjectiveTo assess the efficacy and safety of low-(10 mg) and high-dose (20 mg) of recombinant tissue typeplasminogen activator (rt-PA) catheter-directed thrombolysis for lower limb ischemia by using meta-analysis. MethodsThe literatures of randomized clinical trials (RCT) concerning low-versus high-dose rt-PA catheter-directed thrombolysis for lower limb ischemia study were searched using the national and international electronic databases.The literatures were screened and quality evaluated according to the inclusion and exclusion criteria, and analyzed by using the Cochrane Center the RevMan 5.2 software. ResultsA total of 4 RCT studies, with a total of 360 patients (192 patients in low dose group and 168 patients in high-dose group) were included.No statistical difference were noted in low-versus high-dose group with regard to ankle-brachial index (RR=0.20, 95%CI=-0.43-0.02, P=0.07), 30 days amputation-free survival (RR=1.00, 95%CI=0.94-1.08, P=0.91), 6 months the probability of restenosis (RR=1.00, 95%CI=0.60-1.67, P=1.00), and the incidence of groin hematoma (< 5 cm, RR=1.24, 95%CI=0.56-2.77, P=0.59).But the incidence of bleeding and the incidence of stress ulcer in low-dose group were lower than those in high-dose group (RR=2.38, 95%CI=1.10-5.15, P=0.03;RR=2.49, 95%CI=1.21-5.13, P=0.01). ConclusionTwo doses of rt-PA treatment of limb ischemia similar efficacy, but the incidence of low-dose regimen of complications is significantly lower than the high dose regimen.
ObjectiveTo evaluate tip location of peripherally inserted central catheter (PICC) by using the carina as evaluation mark, so as to provide clinical references for blinding manipulation of PICC. MethodsA retrospective analysis about the effects of tip location of PICC by using the carina as evaluation mark on inpatients with malignant tumour was conducted in tumour centre of the West China Hospital from March 2013 to April 2014. Chest X radiography was applied to evaluate the tip location of PICC. Statistical analysis was performed using SPSS software (version 19.0) and the outcomes were presented by frequency and percentage. ResultsA total of 612 cases of blinding manipulation of PICC were evaluated, of which, 502 (82%) were located in the central venous and 110 (18%) were located in the noncentral venous. The numbers of those with the catheter tips located in the non-central venous were 38 in the right atrium, 33 in the internal jugular vein, 24 in the innominate vein, 8 in the axillary vein, and 7 in the subclavian vein, respectively. ConclusionThe effects of blinding manipulation of peripherally-inserted central catheter by using the carina as evaluation mark are relatively good. But it still needs to be improved.
ObjectiveTo investigate the species and resistance phenotypes of the pathogens causing catheter-associated urinary tract infection (CAUTI) in critically ill patients in West China Hospital of Sichuan University, and to provide the basis for the prevention and treatment of this kind of infection. MethodsThe clinical data and findings of the laboratory examination of the patients, who were admitted to intensive care units and suffered from CAUTI in our hospital during January 2012 to December 2014, were retrospectively analyzed. The pathogens isolates from the urine specimens of the patients with CAUTI and their resistance phenotypes were analyzed. ResultsThree hundred and seventy patients suffering from CAUTI were included in this study. Five hundred and seventeen strains of pathogens were isolated from the urine specimens of these patients, including 222 isolates (42.9%) of fungus, 181 isolates (35.0%) of gram negative bacteria, and 114 isolates (22.0%) of gram positive bacteria. In terms of species distribution, Candida albicans (105 isolates, 20.3%), C.glabrata (78 isolates, 15.1%) and C.glabrata (30 isolates, 5.8%) were the predominant fungus. Among the gram negative bacteria, Escherichia coli (81 isolates, 15.7%), Klebsiella pneumoniae (37 isolates, 7.2%), and Acinetobacter calcoaceticus-baumannii complex (23 isolates, 4.4%) were the main species. Enterococcus faecium (79 isolates, 15.3%) and E.faecalis (13 isolates, 2.5%) were the frequently isolated gram positive bacteria. Analysis of the resistance phenotype showed that the resistance rates to itraconazole, voriconazole and fluconazole of Candida spp. were above 10%. Thirty percent of the isolates of E.coli and K.pneumoniae, and 60% of the isolates of A.calcoaceticus-Baumannii complex were resistant to many of the regular antibiotics. Imipenem resistance rate of A.calcoaceticus-Baumannii complex was 60.8%. Sixty percent of the isolates of E.faecium and E.faecalis were resistant to many of the regular antibiotics. The vancomycin-resistant isolates accounted for 16.5% of E.faecium and 31.0% of E.faecalis. ConclusionCandida species are the major pathogens for CAUTI in critically ill patients in our hospital and show the resistance to azoles. We should focus on the drug resistance of gram negative bacteria and gram positive bacteria. The rational use of antibiotics and application of effective infection control measures are important to decrease the CAUTI.
Objective To formulate an evidence-based treatment plan for a child patient with Asymptomatic Wolff-Parkinson-White (WPW) Syndrome. Methods Based on the clinical problems whether the patients with asymptomatic WPW syndrome need prevent catheter ablation or not, we used “asymptomatic WPW syndrome” as the keywords and searched The Cochrane Library (Issue 3, 2007), MEDLINE (1981 to 2007), ACP Journal Club (1991 to 2007), BMJ Clinical Evidence (1999 to 2007) and NGC (1998 to 2007) for systematic reviews, randomized controlled trials (RCTs), controlled clinical trials and treatment guidelines. The methodological quality of the included studies was assessed to identify the current best evidence. Results Two RCTs were retrieved in MEDLINE. The results showed arrhythmic events increased significantly in the high-risk control group than those in the ablation group, and in the patients with multi-pathways than those with only one pathway. Based on the current evidence, integrated with clinical expertise and the patients’ values, the patients underwent electrophysiologic test and the result showed the dominance pathway in the right side and the concealed accessory pathway in the left side. Then prevent catheter ablation was performed, and no cardiovascular complications occurred in the following 12 months, which confirmed that the plan was proved optimal. Conclusion The findings of this study should reassure physicians and parents alike that in the children with the WPW syndrome who are at high risk for arrhythmias, ablation is an appropriate option.