One-time Puncture Success Rate Research Articles

Safety Analysis of Umbilical Vein Puncture Guided by B-Ultrasound in Prenatal Diagnosis

Objective: To explore the safety of umbilical vein puncture guided by B-ultrasound in prenatal diagnosis. Methods: Patients undergoing prenatal examinations in the Department of Obstetrics and Gynecology from February 2023 to February 2024 were selected as the observational subjects. A total of 90 cases were included. Umbilical vein puncture was performed under B-ultrasound guidance to observe puncture safety. Results: The one-time puncture success rate of umbilical vein puncture under B-ultrasound guidance in 90 patients was 97.78%, with an average puncture time of 8.43 ± 1.04 minutes. Fetal heart rate slowed down in 2 cases during umbilical vein puncture guided by B-ultrasound and in 3 patients after surgery, resulting in an incidence rate of 5.56%. Logistic nonlinear multifactor analysis indicated that puncture time and the number of successful punctures were correlated. Additionally, fetal cardiovascular system abnormalities emerged as an independent risk factor for fetal heart rate slowdown, with a statistical value of P < 0.05. Conclusion: The one-time success rate of umbilical vein puncture guided by B-ultrasound for prenatal diagnosis is high. Early identification of high-risk groups and the implementation of targeted measures can reduce puncture adverse events and ensure the safety of prenatal diagnosis.

Application of image overlapping in percutaneous nephrolithotomy.

To investigate the application of ultrasound and CT image overlap in percutaneous nephrolithotomy (PCNL). A total of 140 patients with complicated kidney stones requiring PCNL were prospectively enrolled, from January 2020 to December 2022. These patients were randomly divided into 2 groups, with 70 patients each in the research group and the control group. All participants underwent dual-source, non-contrast CT scan of both kidneys and pelvis before surgery. Preoperative three-dimensional CT reconstruction and simulated puncture were performed in patients from the research group. The best puncture path was determined through ultrasound and CT image overlap. Puncture guided by regular CT and ultrasound was conducted in patients from the control group. Differences in the surgical outcomes between the two groups were compared. Compared to the control group, the research group had higher stone clearance rate in stage I PCNL, success rate of one-time puncture, less percutaneous channels, less reduction of hemoglobin and shorter procedure time. Complications in stage I PCNL were comparable in the two groups, and there was no significant change in the final stone clearance rates between the two groups. An optimal puncture channel can be chosen using ultrasound and CT image overlap. PCNL can be achieved with precise puncturing, thus achieving coincidence between imaging and anatomy and reducing the amount of blood loss during stage I of PCNL. It also shortens the procedure time and improves stone clearance rate of PCNL.

Efficacy and safety of modified Hartel approach in the treatment of primary trigeminal neuralgia with radiofrequency thermocoagulation

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.

Effect of external application of Chinese medicine liquid on preventing phlebitis caused by intravenous indwelling needle: a retrospective study

ABSTRACT Object: To analyze the clinical effect of external application of self-made Chinese medicine liquid to prevent phlebitis caused by intravenous indwelling needle in our hospital. Methods: According to different nursing strategies, 600 patients were divided into control group and observation group. The observation group received external application of self-made Chinese medicine liquid in our hospital; the control group was treated with wet compress with 50% magnesium sulfate solution. Then the success rate of indwelling needle puncture, the incidence of phlebitis, the incidence of pain during intravenous drip and the patients' satisfaction with the effect of phlebitis prevention and treatment were compared between the two groups. Then, the success rate of indwelling needle puncture, the incidence of phlebitis, the incidence of pain during intravenous drip and the patients’ satisfaction with the effect of phlebitis prevention and treatment were compared between the two groups. Results: The success rate of one-time puncture was 93.33% in the observation group and 81.67% in the control group. Observation group average indwelling catheter time for (3.89±2.37) days, significantly higher than that of control group (3.00±1.82) days; the incidence of phlebitis in the observation group was 27.33%, lower than that in the control group (43.00%). The satisfaction rate of observation group was 94.00%, significantly higher than that of control group (80.00%). All the differences were statistically significant (P<0.05). Conclusion: Compared with magnesium sulfate wet compress, external application of self-made Chinese medicine liquid in our hospital can effectively prevent the occurrence of phlebitis caused by indwelling needle, especially relieve pain during intravenous drip in patients, with high patient satisfaction.

Effect of electric function training instrument for arteriovenous fistula on vascular index of fistula and puncture success rate in patients with autogenous arteriovenous fistulization

ABSTRACT Objective. To explore the effect of electric function training instrument for arteriovenous fistula on vascular index of fistula and puncture success rate in patients with autogenous arteriovenous fistulization (AVF). Methods. 60 patients received AVF in the Fourth Hospital of Hebei Medical University from June 2020 to June 2021 were selected as the study subjects, and they were divided into the treatment group (TG, n = 30) and the reference group (RG, n = 30) according to the random number table method. The patients in the RG received routine pressure training by clench fist and tourniquet after surgery, and the TG used electric function training instrument for arteriovenous fistula on the basis of routine clench fist, then comprehensively evaluating the clinical application value of this study protocol by comparing the vascular index of fistula and puncture success rate of the two groups. Results. The depth of cephalic vein to skin at T2 and T3 in the TG was notably lower than the RG (P < 0.05), and the vessel diameter of cephalic vein at T3 in the TG was visibly higher than the RG (P < 0.05), with no overt difference in the rate of fistula complication, one-time puncture success rate and the incidence of puncture injury in both groups (P > 0.05). The score of functional exercise compliance of fistula in the TG was clearly higher than the RG (P < 0.001). Conclusion. The study results suggest that the use of electric function training instrument for arteriovenous fistula after AVF is more effective, so it has certain clinical application value.

Ultrasound-guided percutaneous nephrolithotomy without indwelling ureteral catheter in older adults with upper urinary calculi: A retrospective study.

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.

Clinical study on the treatment of primary trigeminal neuralgia by robot-assisted percutaneous balloon compression.

C-arm-guided percutaneous puncture balloon compression alone has risk factors of puncture failure, complications, and poor prognosis. Robot-assisted PBC can effectively increase the one-time puncture success rate and improve the safety of the procedure. However, evidence on the superiority of robot-assisted PBC over C-arm-guided PBC alone remains relatively limited. Retrospective analysis The clinical data of 60 patients with trigeminal neuralgia aged 60 years or older in the Department of Neurosurgery of the Fourth Hospital of Harbin Medical University from January 2021 to October 2021. There were 29 males and 31 females, and the patients' ages ranged from 60 to 79 years, with an average of 71.63 ± 5.12 years. Two groups were divided according to the surgical method, the C-arm guidance-only group (30 cases, n = 30) and the robot-assisted group (30 cases, n = 30). The success rate of first puncture, total operation time, number of "pear-shaped" balloons, number of C-arm x-ray scans, and immediate postoperative relief rate were recorded in both groups, and follow-up was performed to evaluate the postoperative results and complications. The overall evaluation of postoperative results and complications was performed. Intraoperative balloon compression was successfully completed in all 60 patients, and the first puncture success rate was higher in the robot-assisted group than in the simple C-arm group, with a significant difference between the two groups (P < 0.001). In terms of intraoperative balloon morphology, the number of "pear-shaped" balloons was higher in the PBC than in the C-arm-only PBC group, with a significant difference between the two groups (P < 0.005). The degree of immediate postoperative remission in the robotic group was 0 VAS score, which was not statistically significant in both groups (P > 0.05). By the final follow-up, the mean VAS score of the robot-assisted group was lower than that of the simple C-arm group, and both were statistically significant (P < 0.05); complications of masticatory muscle weakness or abnormal facial sensation occurred in both groups after surgery, but the number of cases in the robot-assisted group was less than that of the simple C-arm group. Robot-assisted PBC is better than PBC with a C-arm x-ray machine in terms of first puncture success rate, number of intraoperative balloon "pear-shaped" cases, number of C-arm x-ray scans and short-term efficacy.

Therapeutic Effect of Ultrasound-Guided Peripherally Inserted Central Catheter Combined with Predictive Nursing in Patients with Large-Area Severe Burns.

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.

Clinical Application of Ultrasound Microscopy-Guided Pediatric Brachial Plexus Nerve Block Anesthesia.

In order to investigate the anesthetic effect and safety of the ultrasound-guided brachial plexus block in pediatric upper limb surgery, this study retrospectively analyzed the anesthetic effect of the ultrasound-guided brachial plexus block in pediatric upper limb surgery. From January 2016 to December 2017, 82 children undergoing upper limb surgery in hospital A were selected and randomly divided into two groups by the coin method, with 41 children in each group. Ultrasound-guided brachial plexus block anesthesia and conventional anatomic localization brachial plexus block anesthesia were performed. The anesthetic drug dosage of sensory block at anesthesia completion time and motor block at onset time was compared between the two groups; the one-time puncture success rate and incidence of anesthesia complications were compared between the two groups (local anesthesia poisoning, nerve injury, pneumothorax, hematoma, and phrenic nerve palsy). The results showed that the anesthesia completion time in the study group was slightly longer than that in the control group. The sensory and motor block occurred earlier in the study group than in the control group. Low doses of narcotic drugs are used. The one-time puncture success rate of the study group was higher than that of the control group. The incidence of anesthesia complications was lower than that of the control group. The one-time puncture success rate was 92.8% in the study group and 75.7% in the control group. Ultrasound-guided brachial plexus block anesthesia has a significant effect in pediatric upper limb surgery, which can improve the anesthetic effect and reduce the incidence of complications, and is worthy of clinical promotion.

Application of ultrasound-guided central venous catheterization at various sites in infants with shock

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.

Construction of Neonatal PICC Nursing Quality Evaluation System.

Objective In order to improve the quality of neonatal care, this study analyzed the construction of PICC and scientifically evaluated the quality of PICC. Methods A total of 100 neonatal patients admitted to the Pediatric Medical Intensive Care Unit of the People's Hospital in Laizhou City of Shandong Province between January 2015 and December 2018 were selected for nursing intervention. They were randomly divided into 50 cases in the observation group and 50 cases in the reference group. In the observation group, 50 were neonatal patients who received and completed PICC catheterization care, and in the reference group, 50 were neonatal patients with traditional conventional puncture care, PICC nursing quality evaluation index system, and nursing quality standard were applied, and questionnaire survey and patient satisfaction survey were conducted in the treatment. The two groups were compared for the success rate of one puncture, catheter detachment, treatment of local bleeding, incidence of nursing risk during other treatment, and other related nursing quality results. Results The incidence of related medical and nursing risks in neonatal patients such as one-time puncture success rate, catheter detachment during treatment, and local bleeding was significantly lower than those in neonatal patients receiving conventional nursing methods. The incidence of nursing risk events during puncture was effectively reduced. It is shown in the comparison of adverse events in neonatal pediatric nursing in the fourth quarter of 2017 and 2018. In 2018, the proportion of adverse events in neonatal nursing is decreasing, the quality index of nursing is improving, and the satisfaction of patients' families and relevant personnel in treatment is increasing. Conclusion The construction and application of neonatal PICC nursing quality evaluation system can improve the success rate of one-time puncture, reduce the pain of newborns, improve the nursing quality evaluation system, scientifically and reasonably provide effective methods and basis for hospital PICC nursing, and play an important role in the development of pediatric nursing.

Effect of PDCA Evidence-Based Nursing Practice on Arterial Blood Gas Analysis in the Respiratory Department

<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.

Application of 3D-printed navigation plate in pulsed radiofrequency therapy of dorsal root ganglion in thoracic postherpetic neuralgia

Objective: To evaluate the accuracy, efficacy and safety of 3D-printed personalized navigation template in the treatment of thoracic postherpetic neuralgia (PHN) with dorsal root ganglion pulsed radiofrequency (DRG-PRF). Methods: A total of 63 patients with thoracic PHN from March 2019 to December 2020 in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were enrolled and randomly divided into study group (n=31) and control group (n=32) by random number table method. The study group received DRG-PRF treatment assisted by 3D-printed navigation template, while the control group received DRG-PRF treatment guided by conventional CT. The one-time success rate of puncture, the incidence of puncture times ≥3, the number of punctures, puncture time, visual analogue scale (VAS) score and surgical complications between the two groups were compared. Results: The one-time success rate of puncture in study group was 84.9% (79/93), which was higher than that of control group [30.2% (29/96)] (P<0.001). The incidence of puncture times ≥3, the number of punctures, puncture time in study group were 4.3% (4/93), 1 (1, 1) and 2.9 (2.8, 3.0) min, respectively, which were lower than that of the control group [21.9% (21/96), 2(1, 3), 9.0 (4.5, 12.9) min, respectively] (all P<0.01). No difference was found in VAS score at each time point before and after surgery between the two groups (all P>0.05). There was one case of pleura puncture in the control group, but no other complications such as straying into vertebral canal, hematoma, spinal cord injury, limb movement disorder, infection were found in the two groups. Conclusions: 3D-printed personalized navigation template is an effective method to guide DRG-PRF for the treatment of thoracic postherpetic neuralgia. It can significantly improve the surgical efficiency of DRG-PRF, but has no significant effect on the surgical efficacy.

Comparison of formula‐based PICC catheterisation versus common method for the treatment of newborns

Whether PICC in newborns can improve its success rate and reduce the complications by using the formula method to calculate the depth of catheterisation. A total of 130 newborns were prospectively studied from December 2018 to December 2019. All newborns were randomly divided into two groups that use formula method and common method respectively. The PICC catheter length of the two groups was observed. The unplanned extubation rate, one-time puncture success rate, catheter indwelling time, complications, duration of hospital stays and pain scores were recorded during the whole research process and compared between these two groups. The formula method significantly improved the puncture success rate and reduced the secondary adjustment rate. The length of the catheter adjustment was significantly lower than the control group. The retention time also increased significantly. The incidence of PICC-related complications, including phlebitis, thrombosis, catheter-related infection and catheter displacement, was significantly reduced by using the formula method. The formula method in neonatal PICC catheter had great outcomes in terms of improving the success rate of one-time puncture and prolonging the indwelling time of catheter.

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

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

The clinical application of color Doppler ultrasound in guiding the puncture of new internal fistula in deep arteriovenous

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

Analysis of the Current Application of Peripheral Intravenous Catheter and Indwelling Failure in the Department of Hepatobiliary Surgery

Background: PIVC therapy is the most common hospital procedure. Its insertion and maintenance are easy to fail. Objective: To investigate the current application of peripheral venous catheter (PIVC) in the department of hepatobiliary surgery and the risk factors that lead to indwelling failure. Peripheral intravenous catheter therapy is one of the most common treatment procedures but has a relatively high failure rate during insertion and indwelling. Methods: A cross-sectional correlation study was adopted. Clinical data of patients receiving PIVC from March to June in 2019 in our hospital were collected. All patients were inserted with closed 24G IV catheters manufactured by BD Company, sealed with 50U/mL heparin saline and secured by 3M Tegaderm Film-Transparent film dressing. Estuation caused by any reasons within 72 hours that failed to complete the treatment was considered to be indwelling failure. Univariate analysis was performed to analyze the effect of gender and age on the indwelling time, and logistic regression was used to analyze the related factors of indwelling needle-induced complications. The methods were consistent with the STROBE criteria (Supplementary File 1). Results: 445 patients were enrolled and clinical data from 395 patients were analyzed eventually, with a total of 773 PIVC cases. The indwelling time varied from 0.5h to 329h (median time 49.00±0.86h). Indwelling site: back of the hand (61%), forearm (28%), joint (6%), upper arm (4%) and finger (1%). The success rate of one-time puncture was 92%. PIVC indwelling failure rate was 46% which appeared to be higher in females and older people. Complications included exudation (72%), phlebitis (8%), blockage (5%) and errhysis (4%). There were no statistically significant differences in the incidence of complications in each indwelling period (P>0.05). Logistic regression analysis showed that complications were independent risk factors for catheter indwelling failure (OR: 26.98, P<0.01). Conclusions: PIVC mostly performed on the back of the hand and its indwelling time was associated with patients’ gender and age in the department of hepatobiliary surgery. The occurrence of complications was an independent factor for PIVC failure.

Comparison between ultrasound-guided TIVAD via the right innominate vein and the right internal jugular vein approach

BackgroundTo compare the efficacy and safety of right internal jugular vein (IJV) approach and right innominate vein (INV) approach for US-guided totally implantable venous access devices (TIVADs), and to explore the advantages and disadvantages of the two approaches.MethodsSix hundred and nineteen adult patients had long-term infusion and chemotherapy needs and inconvenience of peripheral venous infusion. Right INV approach was used to implant 339 cases of TIVADs, and right IJV approach was used to implant 280 cases of TIVADs. The success rate of one-time catheterization and the incidence of complications in the two groups were retrospectively analyzed.ResultsAll patients were successfully implanted in TIVAD. The success rates of one-time puncture in INV group and IJV approach group were 98.53% (334/339) and 95.36% (267/280), respectively. There was significant difference between the two groups (P = 0.020). The incidence of perioperative complications and long-term complications in the right INV group were 1.18% (4/339) and 3.54% (12/339), respectively, while those in the right IJV group were 1.43% (4280) and 3.93% (11280). There was no significant difference in the incidence of perioperative or long-term complications between the two groups (P = 0.785, P = 0.799, respectively).ConclusionsUS-guided TIVADs via the right INV approach and the right IJV approach are both safe and reliable. The right INV approach improves the one-time puncture success rate, as long as the technique is properly operated, serious complications rarely occur.

Optical puncture combined with balloon dilation PCNL vs. conventional puncture dilation PCNL for kidney stones without hydronephrosis: a retrospective study

BackgroundAccurate puncture and dilation of the target kidney calices for percutaneous nephrolithotomy (PCNL) can be difficult. This study aimed to investigate the advantages of PCNL using optical puncture (i.e. the puncture is visualized on a screen as seen through the needle) combined with balloon dilation vs. conventional puncture methods.MethodsThis was a retrospective study of 58 consecutive patients with kidney stones without hydronephrosis and treated at the Minimally Invasive Urology Center of Zhejiang Provincial People’s Hospital between 10/2016 and 12/2017. Twenty-one patients underwent optical puncture combined with balloon dilation PCNL. Thirty-seven patients underwent conventional puncture instrument dilation PCNL (controls). Success rate, tubeless rate, blood loss, pain, and complications were compared between the two groups.ResultsThe one-time puncture success rate (95.2% [20/21] vs. 67.6% [25/37], P = 0.02) and the postoperative tubeless rate (81.0% [17/21] vs. 54.1% [20/37], P = 0.04) were higher in the optical puncture group compared with controls. The average postoperative hemoglobin reduction was smaller (1.13 ± 0.63 vs. 1.56 ± 0.59 g/dL, P = 0.01), the postoperative VAS score was lower (1.6 ± 0.9 vs. 2.5 ± 1.2, P = 0.004), the rate of postoperative analgesic use was lower (14.3% [3/21] vs. 40.5% [15/37], P = 0.04), and the postoperative mean hospitalization days was shorter (3.7 ± 0.9 vs. 4.4 ± 0.8, P = 0.005) in the optical puncture group vs. controls. There was no case of urinary sepsis, blood transfusion, perirenal hematoma, pleural injury, and visceral organ damage.ConclusionsOptical puncture combined with balloon dilation PCNL could be associated with good therapeutic effect and low frequency of complications for the treatment of kidney stones without hydronephrosis.

Design and application of new portable vein visualizer

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