Effects of nursing process optimization on reducing accidental risks of emergency infusion in children

Objective To investigate the clinical value of color Doppler ultrasound guidance in the puncture of new internal fistula in deep arteriovenous of hemodialysis patients. Methods Selected thirty patients with arteriovenous fistula not less than 5 mm deep in the Department of Hemodialysis Room of Wuhan First Hospital, and they were divided into observation group and control group by the method of random number generator in IBM SPSS Statistics 22.0 software, with 15 patients in each group. The control group was treated with conventional blind puncture by experienced nurses (849 times), while the observation group was treated with color Doppler ultrasound guided puncture (855 times). By comparing two groups of deep arteriovenous fistula in new fistula patients within 6 months of the one-time success rate of puncture, the incidence of adverse events such as subcutaneous hematoma, bleeding, pain, interruption or postponement of treatment, and accidental injury to arteries caused by puncture errors of internal fistula, and the patient′s satisfaction with the puncture and dialysis results was evaluated to observe the advantage of color Doppler ultrasound guidance in clinical application of deep arteriovenous new fistula puncture. Results The success rate of one-time puncture for internal fistula puncture in observation group was 98.95% (846/855), which was significantly higher than that in control group 81.27% (690/849), and the difference was statistically significant (χ2 = 149.753, P 0.05). The total incidence of adverse events caused by internal fistula puncture errors in the two groups was 1.99% (17/855) and 22.97% (195/849), respectively, and the difference was statistically significant (χ2=172.126, P < 0.01). The average rank of satisfaction in observation group was 1 261.25, which was higher than control group 440.86, and the difference was statistically significant (Z=-38.107, P < 0.01). Conclusions Color Doppler ultrasound guidance in the puncture of new internal fistula in deep arteriovenous of hemodialysis patients has important clinical application value. It can significantly improve the success rate of one-time new internal fistula puncture, reduce the occurrence of adverse events due to puncture failure, and reduce patient′s pain, which is worthy of clinical promotion. Key words: Doppler ultrasound; Arteriovenous fistula; Applied

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

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

Objective To explore the application of PDCA nursing management in central venous catheter of elderly patients with malignant tumor patients. Methods Totally 120 cases of elderly cancer patients with PICC were divided into the observation group (from January 2015 to December 2015, n=60) and the control group (from January 2014 to December 2014, n=60) according to the time of admission from January 2014 to December 2015. Patients in the observation group were given PDCA nursing management, while patients in the control group were given routine nursing management. The PICC related infections, adverse nursing events occurrence and the nursing effect of two groups were compared. Results The PICC related infection, mechanical phlebitis, unplanned extubation rate, catheter slippage rate and catheter blockage rate of the observation group were lower than those of the control group (P<0.05). The compliance, the success rate of one-time puncture and the satisfaction rate of the observation group were higher than those of the control group (P<0.05); the indwelling catheter time was longer than the control group (P<0.05). The nurse communication ability, responsibility, PICC operation skills, service attitude, writing standards, PICC accident and other nursing quality score in the observation group were higher than the control group (P<0.05). Conclusions PDCA nursing management can effectively improve the nursing quality of elderly patients with malignant tumor who had PICC; reduce the PICC related infections and nursing accidents; prolong the time of indwelling catheter in patients; and improve the patient′s satisfaction rate. Key words: Elderly; Peripheral central venous catheter; Infection; Malignant tumor; PDCA nursing management

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.

Objective To analyze the nursing effect of central venous catheter (CVC) infusion combined with empathy nursing on AIDS patients. Methods A total of 129 AIDS patients who were hospitalized for infusion at Beijing You'an Hospital, Capital Medical University from June 2014 to June 2016 were selected as the control group. Another 129 AIDS patients from August 2016 to August 2018 were selected as the observation group. The control group was given ordinary infusion needle infusion and conventional psychological nursing, and the observation group was given CVC infusion combined with empathic nursing. The clinical nursing effect of the two groups of patients was analyzed. Results The infusion fluency rate, vascular damage rate, nurse puncture rate, and occupational exposure rate in the observation group were 91.47% (118/129), 10.85% (14/129), 0, 0, and the control group was 82.94% (107/129), 20.93% (27/129), 6.20% (8/129), 6.20% (8/129), the difference between the two groups was statistically significant (χ2 values were 4.188-8.224, P <0.05 or 0.01). After 3 months of intervention, the anxiety and depression (Self-rating Anxiely Scale/Self-rating Depression Scale) scores of the observation group were 47.87 ± 5.43 and 45.02 ± 5.61, which were significantly lower than the control group, which were 51.15 ±6.97 and 49.11 ± 6.48. The difference was statistically significant (t values were 3.320, 4.268, P <0.01). After 3 months of intervention, the treatment compliance rate in the observation group was 92.24% (119/129), which was significantly higher than 83.72% (108/129) in the control group, and the difference was statistically significant (t value was 4.419, P <0.05). After 3 months of intervention, the CD4+ T lymph count and HIV viral load in the observation group were (378.25 ± 49.04)/μl, (2.86 ± 0.53) igIU/ml, and the control group were (342.17 ± 43.47)/μl, (3.13 ± 0.66) igIU/ml, the improvement effect of the observation group was significantly better than that of the control group (t values were 3.559, 2.853, P <0.01). Conclusion CVC infusion combined with empathic nursing can significantly improve the anxiety and depression of AIDS patients, improve treatment compliance and infusion fluency, reduce vascular damage rate, related infection rate, nurse puncture rate and occupational exposure rate, and good nursing effect. Key words: AIDS; Empathy care; Central venous catheter; Compliance; Anxiety depression

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

Objective To explore the compliance , success rate of puncture of pediatric intravenous infusion and satisfaction of family .Methods One thousand and eight hundred children with pediatric intravenous infusion from June 2012 to July 2012 were chosen and divided into the control group and the intervention group according to the random number table , each with 900 cases.The control group received the routine nursing , and the observation group received the nursing work of improving pediatric intravenous infusion and the improved the nursing intervention technique .The compliance , puncture success rate and satisfaction of pediatric intravenous infusion were compared between the two groups .Results The rate of compliance was 90.00%in the observation group, and was significantly higher than 62.22% in the control group, and the difference was statistically significant （χ2 =190.99, P<0.05）.The success rate of puncture was 93.33% in the observation group , and was significantly higher than 67.78% in the control group, and the difference was statistically significant （χ2 =187.54, P<0.05）.The satisfaction of family was 98.89%in the observation group, and was significantly higher than 67.78% in the control group, and the difference was statistically significant （χ2 =194.61, P<0.05）.Conclusions The active nursing intervention can effectively improve the compliance , success rate of puncture of pediatric intravenous infusion and satisfaction of family . Key words: Nursing interventions; Pediatric intravenous infusion; Compliance; Puncture success rate; Satisfaction

Objective To explore the effects of cluster nursing and Traditional Chinese Medicine (TCM) nursing in patients with severe acute pancreatitis. Methods Totally 76 patients with severe acute pancreatitis admitted in Yantai Zhifu Hospital from January 2017 to December 2018 were selected by convenient sampling and divided into the control group (n=38) and the observation group (n=38) according to the random number table. Patients in the control group received routine nursing, while patients in the observation group received cluster nursing and TCM nursing on this basis. The nursing effect, quality of life, related hospitalization indicators, and nursing satisfaction rate were observed and analyzed between the two groups. Results The total effective rate of nursing in the observation group was 89.47% (24/38) , which was higher than 63.15% (24/38) in the control group (P<0.05) ; the the MOS Item Short From Health Survey score in the observation group was higher than that in the control group, and the hospitalization costs and length of hospital stay in the observation group were less than those in the control group , nursing satisfaction rate in the observation group was higher than control group, the differences were statistically significant (P<0.05) . Conclusions The implementation of cluster nursing and TCM nursing for patients with severe acute pancreatitis can enhance the nursing effect, reduce the treatment cost, and improve the quality of life of patients. Key words: Pancreatitis; Quality of life; Cluster nursing; Traditional Chinese Medicine (TCM) nursing; Nursing effect; Satisfaction

Objective To explore the application effect of multimode pain management in cancer pain in Geriatrics Department. Methods Using convenient sampling method, 80 cancer patients hospitalized in Geriatric Department from July 2017 to June 2018 were randomly divided into control group and observation group, with 40 cases in each group. Routine nursing care was given for the control group and multimode pain management was used in the observation group. The pain sensitive index, nursing satisfaction and cancer pain relief rate were compared between the two groups. Results The accuracy rate of pain evaluation, nursing satisfaction rate and cancer pain relief rate of the observation group were 80.0%, 95.0% and 87.5%, respectively, all higher than those of the control group, and the differences were statistically significant (χ2=6.765, 6.275 , 5.000; P<0.05) . Conclusions Multimode pain management can reduce the cancer pain of cancer patients and improve the satisfaction of nursing. Key words: Neoplasm; Pain; Aged; Multimode pain management; Pain sensitive index; Nursing satisfaction; Cancer pain relief rate

Objective To study the effect of ultrasonic guidance in radial artery catheterization. Methods From January 2017 to January 2018, 100 patients who received surgical treatment in Taizhou Central Hospital of Zhejiang Province and needed puncture and catheterization anesthesia during operation were randomly divided into control group (n=50) and observation group (n=50) according to digital table method.The control group adopted the traditional touch pulse method, while the observation group was guided by ultrasound.The first puncture success rate, the second puncture success rate, puncture time, puncture times, the vital sign index, incidence of adverse events, pain score, comfort score were compared between the two groups. Results The first puncture success rate (80%) and the second puncture success rate (100%) of the observation group were higher than 62% and 88% of the control group (χ2=3.934, 6.383, all P<0.05). The single puncture time [(59.85±8.31)s] and total puncture time [(107.14±35.37)s] of the observation group were shorter than those of the control group (t=5.766, 6.398, all P<0.05), and the puncture times [(1.27±0.54) times] of the observation group was less than that of the control group (t=5.689, P<0.05). After puncture, the heart rate [(73.79±2.46)times/min] and average arterial pressure [(96.75±6.76)mmHg] of the observation group were all lower than those of the control group (t=5.058, 4.635, all P<0.05). The total incidence of adverse events such as subcutaneous hematoma and arterial wall penetration in the observation group (4%) was lower than that in the control group (18%) (χ2=5.005, P<0.05). The pain scores at puncture and after puncture of the observation group [(1.53±0.71)points, (1.28±0.60)points] were lower than those of the control group (t=5.545, 6.233, all P<0.05). The comfort scores at puncture and after puncture of the observation group [(91.25±9.64)points, (97.31±11.37)points] were higher than those of the control group (t=6.147, 6.226, all P<0.05). Conclusion Ultrasonic guidance can effectively improve the puncture efficiency, reduce the fluctuation of vital signs, pain, reduce the adverse events during puncture, and make the patients feel more comfortable. Key words: Anesthesia; Punctures; Catheter insertion; Ultrasonography; Operation; Puncture success rate; Planar technique; Vital signs

<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 investigate the clinical course and outcome evaluation of preschool children peripheral venous transfusion management, and provide the basis for clinical nursing care of preschool children intravenous infusion. Methods Totals of 100 preschool children with outpatient intravenous infusion were divided into observation group and control group with 50 cases in each according to random number table, routine nursing measures adopted in control group, transfusion safety preventive nursing measures adopted in observation group. According to America Boston Children’s Hospital child venous transfusion clinical process and outcomes monitoring content, self-designed preschool children with intravenous infusion of risk assessment and preventive measures. Comparison of two groups of children with intravenous infusion of first puncture successful cases, venous medicine exosmosis and call for solution and satisfaction. Results The success rate of first puncture in observation group was 94.00%, significantly higher than 68.00% in control group of (χ2=10.981, P<0.05). Observation group with 6 cases with venous medicine exosmosis happened in different degree with the incidence rate was 12.00%, significantly lower than the control group of 20 cases with 40.00% (Z=-3.098, P<0.05). Observation group with intravenous infusion the call rate of 43.33% was significantly lower than 49.21% in control group (χ2=75.614, P<0.05). The parents of children with liquid timely satisfaction scores (4.27±0.56 vs 3.13±0.42), inspection maintenance scores (4.43±0.38 vs 3.16±0.64), solves the question ability scores (4.48±0.51 vs 3.11±0.60) in observation group were higher than that in control group, and the differences were statistically significant (t=2.828, 2.963, 2.977, respectively; P<0.05). Conclusions Preschool children in intravenous infusion safety management can significantly improve the success rate of first puncture, reduce the incidence of adverse reactions, satisfaction of parents of children with more high, which is worth the clinical promotion. Key words: Child, preschool; Nursing care; Out-patient; Intravenous infusion

Objective To investigate the application of new portable vein visualizer in venous indwelling needle puncture in children. Methods A total of 432 children from January 2016 to June 2016 in pediatric department were randomly divided into observation group (n=224) and control group (n=208) . Children in observation group received self-designed new portable vein visualizer in superficial venous indwelling needle puncture, while children in control group received traditional needle puncture. The one-time puncture success rate, puncture time, pain in children and family satisfaction were compared between two groups. Results The success rate of observation group (95.1%) was significantly higher than control group (73.1%) (χ2=39.881, P<0.05) . The puncture time of observation group was shorter (3.400±0.615) than control group (4.850±0.873) , with statistically significant difference (t=9.608, P<0.05) . The family satisfaction in observation group (96.1%) was significantly higher than control group (85.2%) (χ2=7.037, P<0.05) . Conclusions Application of new portable vein visualizer in superficial venous indwelling needle puncture in children improves the success rate, decreases the puncture time, reduces the pain of children and improves family satisfaction. Key words: Innovation and promotion; New portable vein visualizer; Design; Application

This study was aimed to explore the application value of ultrasound-guided peripherally inserted central catheter (PICC) combined with predictive nursing in the treatment of large-area severe burns. 88 patients with large-area severe burns who visited hospital were chosen as the research objects. They were randomly divided into the observation group and the control group, with 44 cases in each. The patients in the observation group were treated with ultrasound-guided PICC combined with predictive nursing, while those in the control group were treated with traditional PICC and nursing methods. Then, the anxiety of patients was compared between groups by the Self-rating Anxiety Scale (SAS), while the depression was compared by the Self-rating Depression Scale (SDS). The pain of the patients was analyzed by the McGill Pain Questionnaire (MPQ), and a self-made nursing satisfaction questionnaire was adopted to evaluate the nursing satisfaction. The surgery-related indicators of the patients were detected and recorded (the success rate of one-time puncture, the success rate of one-time catheter placement, incidence of complications, heart rate, blood pressure, etc.). The success rates of one-time puncture (93% vs. 86%) and of catheter placement (95% vs. 81%) in the observation group were significantly higher than those in the control group, P < 0.05. The pain scores of the observation group were much lower than those of the control group at each time period, P < 0.05. The number of patients with negative emotions such as anxiety and depression in the observation group was markedly less than that in the control group. The incidence of complications in the observation group was notably lower than that in the control group (4.5% vs 18%), P < 0.05. The nursing satisfaction of the observation group was significantly higher than that of the control group (93% vs 79.5%), P < 0.05. In conclusion, ultrasound-guided PICC and predictive nursing had high clinical application values in the treatment of patients with large-area severe burns.