Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for diff...Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inapp展开更多
目的:探讨人文关怀联合心理指导在老年糖尿病患者中的护理效果及对血糖波动的影响。方法:选取2017年2月-2018年2月本院收治的老年糖尿病患者132例,随机分为对照组与研究组,各66例。对照组采用常规护理,研究组采用人文关怀联合心理指导...目的:探讨人文关怀联合心理指导在老年糖尿病患者中的护理效果及对血糖波动的影响。方法:选取2017年2月-2018年2月本院收治的老年糖尿病患者132例,随机分为对照组与研究组,各66例。对照组采用常规护理,研究组采用人文关怀联合心理指导。比较两组高密度蛋白(HDL-C)、低密度蛋白(LDL-C)、总胆固醇(TC)、甘油三酯(TG)水平、餐后2 h血糖(2 h PBG)、空腹血糖(FPG)水平、日内平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)、血糖水平标准差(SDBG)、汉密尔顿抑郁量表(HAMD)评分、老年焦虑量表(GAI)评分。结果:研究组护理后HDL-C水平高于对照组(P<0.05);研究组护理后LDL-C、TC、TG水平均低于对照组(P<0.05);研究组2 h PBG、FPG水平均低于对照组(P<0.05);研究组护理后MAGE、MODD、SDBG水平均低于对照组(P<0.05);研究组护理后HAMD评分、GAI评分均低于对照组(P<0.05)。结论:老年糖尿病的护理期间,人文关怀联合心理指导的护理效果甚好,值得在临床上广泛宣传与使用。展开更多
文摘Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inapp
文摘目的:探讨人文关怀联合心理指导在老年糖尿病患者中的护理效果及对血糖波动的影响。方法:选取2017年2月-2018年2月本院收治的老年糖尿病患者132例,随机分为对照组与研究组,各66例。对照组采用常规护理,研究组采用人文关怀联合心理指导。比较两组高密度蛋白(HDL-C)、低密度蛋白(LDL-C)、总胆固醇(TC)、甘油三酯(TG)水平、餐后2 h血糖(2 h PBG)、空腹血糖(FPG)水平、日内平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)、血糖水平标准差(SDBG)、汉密尔顿抑郁量表(HAMD)评分、老年焦虑量表(GAI)评分。结果:研究组护理后HDL-C水平高于对照组(P<0.05);研究组护理后LDL-C、TC、TG水平均低于对照组(P<0.05);研究组2 h PBG、FPG水平均低于对照组(P<0.05);研究组护理后MAGE、MODD、SDBG水平均低于对照组(P<0.05);研究组护理后HAMD评分、GAI评分均低于对照组(P<0.05)。结论:老年糖尿病的护理期间,人文关怀联合心理指导的护理效果甚好,值得在临床上广泛宣传与使用。
