Effect of Hyperperfusion on Successful Collection of Arterial Blood Gas Specimens in Patients With Acute Heart Failure

Objective: To assess the efficacy and safety of modified Hartel approach in the treatment of primary trigeminal neuralgia with radiofrequency thermocoagulation. Methods: A total of 89 patients with primary trigeminal neuralgia in Nanjing Drum Tower Clinical College of Xuzhou Medical University from July 2021 to July 2022 were prospectively included, and were divided into experimental group (n=45, modified Hartel approach: selecting 2.0 cm lateral to and 1.0 cm below angulus oris as insertion point) and control group (n=44, traditional Hartel approach: selecting 2.5 cm lateral to the angulus oris as insertion point) according to the random number table method. There were 19 males and 26 females in the experimental group, and aged (67.6±8.8) years. Meanwhile, there were 19 males and 25 females in the control group, and aged (64.8±11.7) years. All the patients were treated by CT-guided radiofrequency thermocoagulation. The success rate of one-time puncture, number of punctures, the time of puncture, operation time, numerical rating scale (NRS) scores and complications were recorded and compared between the two groups. Results: The success rate of one-time puncture in experimental group was 64.4% (29/45), which was higher than that in control group 31.8% (14/44) (P<0.05). The number of punctures [M (Q1, Q3)], the time of puncture [M (Q1, Q3)] and operation time in the experimental group were 1 (1, 2), 218 (206, 378) s, (19.9±2.7) min, which were less than those of control group [2 (1, 3), 390 (231, 598) s, (27.0±3.9) min] (all P<0.05). The NRS scores [M (Q1, Q3)] of 1 day, 1 month and 3 months after surgery in the experimental group were 1 (1, 2), 1 (0, 2) and 1(0, 1), respectively, which were lower than the baseline level [6 (6, 7)] (all P<0.05). The NRS scores [M (Q1, Q3)] of 1 day, 1 month and 3 months after surgery in the control group were 1 (1, 2), 1 (0, 2) and 1 (0, 2), respectively, which were lower than the baseline level [6 (6, 7)] (all P<0.05). There was no statistically significant difference in the incidence of nausea and vomiting, facial numbness, and decreased masticatory muscle strength between the two groups (all P>0.05) In the experimental group, two patients had puncture needles into the oral cavity, with timely detection and replacement of puncture needles, and no infection occurred. There was no cerebrospinal fluid leakage and decreased corneal reflex in both groups. Conclusion: The modified Hartel approach can significantly improve the success rate of one-time puncture via foramen ovale, reduce the operation time and the incidence of postoperative facial swelling, which is a safe and effective puncture method.

To compare the safety, effectiveness, and feasibility of contrast-enhanced ultrasound (CEUS) versus conventional ultrasound-guided percutaneous nephrolithotomy (PCNL) in patients with nondilated collecting system. Between July 2018 and July 2020, 160 kidney stone patients with nondilated collecting system planned for PCNL were randomly assigned into two groups, CEUS with retrograde ureteral contrast injection and conventional ultrasound with retrograde ureteral normal saline injection. Patient's demographics, the success rate of puncture, success rate of a single-needle puncture, number of punctures, puncture time, perioperative outcomes, stone-free rate, and incidence of complications were compared. The success rate of a single-needle puncture for CEUS-guided PCNL was higher than that in the conventional ultrasound group (88.5% vs. 73.7%, p = 0.02). Patients performed with CEUS-guided PCNL required less needle passes (p = 0.02), shorter needle puncture time (p = 0.031), and shorter channel establishment time (p = 0.04) than those guided with conventional ultrasound. The postoperative hemoglobin decrease in the CEUS-guided PCNL group was less than that of the control group (p = 0.02). There was no significant difference in operating time, length of hospital stays, kidney function change, and complications between the two groups (p > 0.05). The 1-month stone-free rate was 94.9% in the CEUS group and 90.8% in the control group (p > 0.05). Compared with conventional ultrasound, CEUS-guided PCNL may facilitate ultrasound-guided PCNL for patients without hydronephrosis, and benefited with a higher success rate of a single-needle puncture, less needle passes, shorter puncture time, and lower postoperative Hb drop. Chinese Clinical Trial Registry: ChiCTR1800016981 KEY POINTS: • Compared with conventional ultrasound, CEUS-guided PCNL is a safe and efficacious procedure for kidney stone patients with nondilated collecting system. • Compared with conventional ultrasound, CEUS-guided PCNL benefited with a higher success rate of a single-needle puncture, less needle passes, shorter puncture time, and lower postoperative Hb drop. • CEUS-guided PCNL associated with the more accurate needle puncture and acceptable complications.

Objective To compare the clinical value of contrast-enhanced ultrasound and conventional ultrasound-guided puncture biopsy in peripulmonary lesions of different sizes. Materials and Methods 110 patients with peripulmonary lesions were randomly divided into two groups: the conventional ultrasound-guided group and the contrast-enhanced ultrasound-guided group. The lesions in the two groups were further divided into two groups according to the size of the lesions, and the tissues taken after puncture biopsy were sent for pathological examination. The pathological results were compared with the postoperative pathological results and other examination results, and the complications were recorded at the same time. Results In the conventional ultrasound group, the success rate of single puncture was 72.7% and the success rate of puncture was 80.0%; in the contrast group, the success rate of single puncture was 90.9% and the success rate of puncture was 94.6%. The difference between the two groups was statistically significant. There was no significant difference in needle bleeding and pneumothorax between the two groups. In the <30 mm group, there was no significant difference in the success rate of single puncture and the success rate of puncture between the two groups according to the size of the lesions. In the ≥30 mm group, the success rate of single puncture (97.1%) and puncture success rate (97.1%) in the contrast guidance group were higher than those in the conventional ultrasound guidance group (70.3%, 78.4%) and the difference was statistically significant (p < 0.05). Conclusion Compared with conventional ultrasound, for peripheral pulmonary lesions guided by contrast-enhanced ultrasonography, especially when the maximum diameter of the lesion is ≥ 30 mm, needle biopsy has better guiding significance; for peripheral lung lesions with a maximum diameter of <30 mm, contrast-enhanced ultrasonography is compared with conventional ultrasound guidance. The puncture success rate was not significantly different.

Objective To evaluate the success rate of one-time popliteal vein puncture between two different techniques (Fluoroscopy-guided puncture through pepliteal phlebography via dorsal superficial vein,named control grooup and Color Doppler Ultrasound-guided puncture,treatment group),and compare their advantages and disadvantages, btween the two groups mentioned above. Methods 52 eases of deep vein thrombosis (DVT) were randomly divided into 2 groups,control group (n=24) and therapy group (n=28). Control group were treated with Fluoroscopy-guided puncture through popliteal phlebography,therapy group were treated with Color Doppler Ultrasound-guided puncture, respectively. Following that, we compared two groups of patients with a success rate of puncture and the failure rate. Results The success rate of one-time puncture of treatment group is 85.71%, and more significant difference than control group (58.83%,P=0.028) and has lower rate of failure (0 vs 8.33%,p=0. 154)but not stetistical differenee and less hematoma. Conclusions Color Doppler Ultrasound-guided puncture of popliteal vein has a higher success rate and safety. Key words: Deep venous thrombosis; Color doppler ultrasound; Intrevention; Thrombolitic therapy

Retention of ureteral catheter to establish artificial hydronephrosis is a routine step of percutaneous nephrolithotomy procedure, which can improve the success rate of puncture, but it can prolong the procedure time and increase the risk of postoperative infection, especially for immunocompromised elderly patients. Therefore, this study aims to investigate the safety and effectiveness of ultrasound-guided percutaneous nephrolithotomy without indwelling ureteral catheter for older patients with upper urinary calculi. The clinical data of 119 older patients admitted to the Affiliated Hospital of Jining Medical University for percutaneous nephrolithotomy from January 2019 to December 2021 were retrospectively analyzed. The patients were divided into study and control groups according to whether the physician decided to use ureteral catheter during the procedure, and the differences in the success rate of one-time puncture, operative time, single-stage stone removal rate, postoperative hospital stay, and complication rate were compared between the 2 groups. There were no significant differences in the success rate of one-time puncture and single-stage stone removal rate between the 2 groups (P > .05). The operation time were significantly shorter in the study group [(30.0–61.0) minute vs (54.8–106.8) minute, P = .00], and the intraoperative bleeding was less in the study group [(5–20) mL vs (10–30) mL, P = .03]. The postoperative hospital stay was shorter in the study group [(2.5–4.0) days vs (3.0–5.0) days, P = .00], and the medical expenses were lower in the study group [(17,309.5–22,652.7) yuan vs (19,148.0–24,407.6) yuan, P = .02]. The incidence of systemic inflammatory response syndrome was lower in the study group (3.5% vs 19.4%, P = .007). There were no statistically significant differences in complications such as postoperative fever, renal artery embolism and blood transfusion between the two groups (P > .05). Ultrasound-guided percutaneous nephrolithotomy without indwelling ureteral catheter for elderly patients with upper urinary stones is safe and feasible.

Compared with a classic wrist puncture for radial artery catheterization, a distal radial artery puncture has the advantage of reducing the incidence of radial artery occlusion in anatomic and physiological procedures. This study aimed to explore the difference in clinical effects between the distal radial artery and classic radial artery approaches in percutaneous coronary intervention. A total of 620 patients who underwent coronary angiography and/or percutaneous coronary intervention in our hospital from December 2017 to December 2018 were enrolled in this study. These patients were divided into two groups based on the puncture site: a distal radial artery group and a classic radial artery group. There were 312 patients in the radial artery group and 308 patients in the classic radial artery group. The puncture time, puncture success rate, surgery time, implanted stents, puncture site hemorrhage, hematoma, aneurysm, and iliac artery occlusion rate were observed. There was no significant difference in puncture time, puncture success rate, surgery time, implanted stent, puncture site hemorrhage, hematoma and aneurysm (P>0.05), while the radial artery occlusion rate was lower in the distal radial artery group, and the difference was statistically significant (P<0.05). The results of this study showed that the distal radial artery approach had a lower rate of brachial artery occlusion, indicating that it could be used as an alternative to the classic radial artery approach.

：Objective To evaluate the safety and effect oftransradialartery approach for coronary intervention in the aged.Methods There were 314 cases whichwere more than 60 years old with coronary artery disease in hospital from Mar 2007 to May2009, who accepted coronary intervention.They were randomly divided into Transradialgroup(TRA, n=157) and Transfemoral group(TRF, n=157).The success rate and time ofpuncture, x-ray exposure time, procedure duration, complication in puncture site andpulmonary embolism were observed in the two groups.Results 149 out of 157 cases success inTRA group and 155 cases in TRF group.The success rate was not different.The success rateof puncture,xray exposure time and procedure duration had no difference between the twogroups.But the complication in puncture site and pulmonary embolism were more in TRF groupthan in TRA group. Conclusions Pereutaneous transradial artery approach is secure andeffective for coronary intervention treatment in the aged and has few vascularcomplications. Key words: Aged; Radial artery; Femoral artery; Angioplasty;

The distal radial artery presents a particular challenge for puncture and catheterization due to its diminutive size, tortuous path, and tendency to spasm, increasing the risk of procedural failure and injury. Ultrasound guidance improves success rates and reduces risk in radial artery catheterization. This study evaluates the efficacy and safety of a refined dynamic needle tip positioning technique for distal radial artery access. One hundred twelve patients were randomized to either the modified dynamic needle tip positioning technique (MDNTP) or palpation guidance groups (palpation group), each with 56 participants. The primary outcomes were the success rate of the initial puncture and overall puncture success rate, while secondary outcomes included procedural time and complications such as puncture site hematoma and radial artery occlusion within 24 h. The MDNTP group exhibited superior initial puncture success (71.43% vs 46.43%, p < 0.05) and fewer puncture attempts (median 1 (1, 2) vs 2 (1, 4), p < 0.05), resulting in a higher overall puncture success rate (98.21% vs 87.50%, p = 0.028). Notably, sheath insertion times were significantly shorter (17 (12, 21) s vs 57 (32, 100) s, p = 0.001) and the Sheath insertion success rate was higher (96.43% vs 82.14%, p = 0.015) in the MDNTP group. Furthermore, the incidence of puncture site hematomas was reduced (5.36% vs 19.64%, p = 0.022), although puncture time was longer (60 (28, 116) s vs 40 (15, 79) s, p = 0.033). Despite these differences, total procedural time and the incidence of radial artery occlusion at 24 h postoperatively were comparable between the two groups. The MDNTP technique boosts the success of distal radial artery puncture and catheterization, reducing the risk of complications associated with the procedure.

To study the clinical characteristics of ultrasound-guided central venous catheterization at various sites in infants with shock, and to explore how to quickly select the site for central venous puncture in infants with shock. The medical data of 112 infants who were diagnosed with shock and underwent central venous catheterization in the Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, from January 2016 to December 2020 were reviewed retrospectively. The patients were divided into an ultrasound group (n=70) and a body surface location group (n=42) according to whether the catheterization was carried out under ultrasound guidance. The application of ultrasound-guided catheterization at various sites in infants was summarized and analyzed, and the success rate of one-time puncture, overall success rate, catheterization time, and complications were compared between these sites. Compared with the body surface location group, the ultrasound group had a significantly higher success rate of one-time puncture, a significantly shorter catheterization time, and a significantly reduced incidence rate of complications in internal jugular vein and femoral vein catheterizations (P<0.05). In the ultrasound group, the proportion of internal jugular vein catheterization was the highest (51%, 36/70), followed by femoral vein catheterization (33%, 23/70), and subclavian vein catheterization (16%, 11/70). For the comparison between different puncture sites under ultrasound guidance, internal jugular vein catheterization showed the shortest time of a successful catheterization [5.5 (5.0, 6.5) minutes] (P<0.05). There was no significant difference in the incidence rate of complications among the different puncture sites groups (P>0.05). In infants with shock, ultrasound-guided internal jugular vein catheterization can be used as the preferred catheterization method for clinicians.

PurposeTo investigate the puncture accuracy and feasibility of contrast-enhanced ultrasound (CEUS) guided percutaneous nephrolithotomy (PCNL) in flank position for patients with no apparent hydronephrosis.MethodsBetween May 2018 and June 2020, 72 kidney stone patients with no or mild hydronephrosis were randomized into two groups: a CEUS-guided PCNL group and a conventional ultrasound (US)-guided group. Patients’ demographics and perioperative outcomes were compared, including the success rate of puncture via calyceal fornix, the success rate of a single-needle puncture, puncture time, operative time, postoperative hemoglobin loss, stone-free rate, incidence of complications and postoperative stay.ResultsThe success rate of puncture via calyceal fornix for CEUS-guided group was significantly higher than that for conventional US-guided group (86.1 vs. 47.2%, p = 0.002). Patients performed with CEUS-guided PCNL required shorter renal puncture time than those guided with conventional US (36.5 s vs. 61.0 s, p < 0.001). The median postoperative hemoglobin loss in the CEUS-guided group was significantly lower than that in conventional US-guided group (2.5 vs. 14.5 g/L, p < 0.01). There was no statistically significant difference in the success rate of a single-needle puncture, operative time, stone-free rate, incidence of complications and postoperative stay between the two groups.ConclusionCEUS guidance facilitates identification of the renal calyx fornix, and benefits more precise renal puncture and less hemoglobin loss in PCNL. CEUS-guided PCNL in flank position is a feasible approach to the treatment of kidney stone patients with no apparent hydronephrosis.Trial registration number: ChiCTR1800015417.

<i>Objective</i> To explore the effect of PDCA evidence-based nursing intervention on arterial blood gas analysis in the respiratory department. <i>Methods</i> Sixty patients who underwent blood gas analysis in our hospital from February 2021 to March 2021 were selected as the control group; while the same number of patients who underwent blood gas analysis from July 2021 to August 2021 were selected as the observation group to implement PDCA evidence-based nursing practice. The effects of one-time success rate, qualified specimen rate, incidence of redness, swelling and ecchymosis at puncture point, sample turnover time and nurses' knowledge level were compared between the two groups. <i>Results</i> The success rate of one-time puncture and the qualified rate of specimens in the observation group were higher than those in the control group (P < 0.05). Meanwhile, the incidence of redness, swelling and ecchymosis at the puncture point and the turnover time of specimens in the observation group were lower than those in the control group (P < 0.05). After the implementation of the improvement plan, the nurses' knowledge levels in the observation group were significantly increased compared with the control group (P < 0.05). <i>Conclusion</i> PDCA evidence-based nursing practice can effectively improve the knowledge level of nurses, shorten the sample turnover time, increase the success rate of one-time puncture and the qualified rate of samples, reduce the incidence of adverse events such as redness, swelling and ecchymosis at the puncture point, and improve the quality of clinical nursing.

Objective to explore the best bady position for the scalp acupuncture among infant.Methods A total of 160 cases in out patients received scalp acupuncture were recruited and randomly divided into the experiment group ( n =80 ) and control group ( n =80 ).Experiment group adopted the type of baby cartier and control group adopted the type of parents' arms encircle when they received the scalp acupuncture.Then,the success rate of one-time puncture,the repeated puncture times among infant that fluid volume was 50 ml and the satisfaction of patients' family on the nursing skill in two groups were observed and compared.Results The success rate of one-time puncture of experiment group was 90.00％ and 87.50％ of the control group,and the difference was statistically significant( P ＞0.05).The rate of repeated puncture of experiment group was 11.25％ which was significantly lower than 27.50％ of the control group( x2 =0.652,P ＜ 0.01 ),and the satisfaction of patients' family on the nursing skill of experiment group was 95.00％ which was significantly higher than 86.25％ of the control group( x2 ＝ 8.721,P ＜ 0.01 ).Conclusions The position of baby cartier is better than the position of parent' s arms encircle when infant receive the scalp acupuncture,which can be popularized in clinic. Key words: Body position; Infant; Scalp acupuncture; The position of baby cartier; The position of parent' s arms encircle

The objective of this research was to investigate the application effect of cervical spine magnetic resonance imaging (MRI) image segmentation algorithm guidance in the treatment of chronic pain with cervical epidural puncture. A total of 72 patients with chronic pain were selected and divided into a cervical spine MRI image-guided group (group A) and a blind puncture group with traditional experience (group B). The results showed that the puncture time of group A was 9.9 ± 8.2 (min), while that of group B was 15.2 ± 8.9 (min), so the puncture time of patients in group A was significantly shorter than that of group B (P < 0.05). The incidences of pain at the puncture site of patients in group A and group B were 6% and 10%, respectively. The incidence of pain at the puncture site in group A was significantly lower than that in group B (P < 0.05). The success rate of the first puncture in group A was 78%, and that in group B was 54%. The success rate of the first puncture in group A was significantly higher than that in group B (P < 0.05). The complication rate of group A was 22.22%, and that of group B was 80.56%. The incidence of complications in group A was significantly lower than that in group B (P < 0.05). In addition, there was no significant difference in the puncture depth between the two groups (P > 0.05). In summary, the guidance of cervical spine MRI image segmentation algorithm can reduce the time and times of puncture and improve the success rate of puncture, thereby reducing the incidence of postoperative complications.

Objective To explore the effects of nursing process optimization on reducing accidental risks of Emergency Department infusion in children. Methods By convenient sampling, totally 220 children admitted in Beijing Tiantan Hospital, Capital Medical University between June and September 2018 were selected into the control group by convenient sampling, who received routine nursing process, while another 220 children admitted from October 2018 to January 2019 were selected into the observation group, who received optimized nursing process. The success rate of one-time puncture of intravenous infusion, the incidence of risk events during the infusion, waiting time for infusion, consultation time, puncture time, needle extraction time, the rate of nursing satisfaction and the cases of nursing complaints and incidents of nurse-patient disputes between the two groups were compared. Results The one-time success rate of puncture among the children in the observation group was higher than that in the control group; the incidence of risk events during infusion was significantly lower than that in the control group, and the differences were statistically significant (P<0.05) . The waiting time, admission time, puncture time, and needle extraction time in the observation group were shorter than those in the control group, and the differences were statistically significant (P<0.05) . The rate of nursing satisfaction and the parents of the children in the observation group was higher than that in the control group; the cases of medical tangles and complaints about nursing work were lower than those in the control group, and the differences were statistically significant (P<0.05) . Conclusions Optimizing the nursing process can effectively reduce the accidental risks of emergency infusion in children, improve the one-time success rate of puncture, reduce the pain of children, improve the experience of seeking medical service, ensure the safety of children, and increase parents' satisfaction with the medical service industry, thus creating a positive image of the hospital. Key words: Child; Emergency service, hospital; Nursing process; Infusion; Accident

Objective To investigate the application effect of hirudoid in pediatric difficult and complicated veinpuncture. Methods 172 cases of children with venous puncture difficulty in our hospital from May 2015 to April 2017 were randomly divided into two groups. The control group was given routine venipuncture nursing intervention; the observation group was smeared with hirudoid ointment at the vascular site, and then was given the traditional venous puncture method. The puncture success rate, puncture time, and the incidence of adverse reactions at puncture site of the two groups were observed and compared. Results The one-time success rate of puncture in the observation group was 94.19%, which was higher than 60.47% in the control group (P<0.05). The puncture time of indwelling needle and PICC in the observation group were shorter than those in the control group (P<0.05). The incidence of adverse reactions at puncture site of the observation group was 11.63%, which was lower than that of the control group (31.40%) (P<0.05). Conclusion The use of hirudoid in pediatric difficult and complicated veinpuncture helps to increase the one-time success rate of puncture, shorten the puncture time, and reduce the related complications. Key words: Hirudoid; Children; Difficult and complicated veinpuncture