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
It has been known in the clinical practice that the therapeutic effect of acupuncture varies widely in different individuals, although the acupuncturist is using the same acupoint and the same mode of needle manipulat...It has been known in the clinical practice that the therapeutic effect of acupuncture varies widely in different individuals, although the acupuncturist is using the same acupoint and the same mode of needle manipulation. In addition, the effect of展开更多
目前,乳腺癌已经成为威胁女性生命安全的第一大疾病。患者经手术治疗后,还需要采用化疗进行辅助性治疗。经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）[1]是确保乳腺癌患者顺利、安全接受化疗的重要方式...目前,乳腺癌已经成为威胁女性生命安全的第一大疾病。患者经手术治疗后,还需要采用化疗进行辅助性治疗。经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）[1]是确保乳腺癌患者顺利、安全接受化疗的重要方式,也是护理工作的重点内容。展开更多
Currently, the modeling of cutting process mainly focuses on two aspects: one is the setup of the universal cutting force model that can be adapted to a broader cutting condition; the other is the setup of the exact c...Currently, the modeling of cutting process mainly focuses on two aspects: one is the setup of the universal cutting force model that can be adapted to a broader cutting condition; the other is the setup of the exact cutting force model that can accurately reflect a true cutting process. However, there is little research on the prediction of chatter stablity in milling. Based on the generalized mathematical model of inserted cutters introduced by ENGIN, an improved geometrical, mechanical and dynamic model for the vast variety of inserted cutters widely used in engineering applications is presented, in which the average directional cutting force coefficients are obtained by means of a numerical approach, thus leading to an analytical determination of stability lobes diagram (SLD) on the axial depth of cut. A new kind of SLD on the radial depth of cut is also created to satisfy the special requirement of inserted cutter milling. The corresponding algorithms used for predicting cutting forces, vibrations, dimensional surface finish and stability lobes in inserted cutter milling under different cutting conditions are put forward. Thereafter, a dynamic simulation module of inserted cutter milling is implemented by using hybrid program of Matlab with Visual Basic. Verification tests are conducted on a vertical machine center for Aluminum alloy LC4 by using two different types of inserted cutters, and the effectiveness of the model and the algorithm is verified by the good agreement of simulation result with that of cutting tests under different cutting conditions. The proposed model can predict the cutting process accurately under a variety of cutting conditions, and a high efficient and chatter-free milling operation can be achieved by a cutting condition optimization in industry applications.展开更多
Objective： To explore the preventive effect of applying hot compress with Chinese herbal salt packets（CHSP） to puncture vessels under aseptic conditions during peripherally inserted central catheter（PICC） on post...Objective： To explore the preventive effect of applying hot compress with Chinese herbal salt packets（CHSP） to puncture vessels under aseptic conditions during peripherally inserted central catheter（PICC） on postoperative phlebitis. Methods： A total of 720 hospitalized patients undergoing first PICC were assigned to treatment and control groups（360 cases each group） according to a random number table. The control group received conventional catheterization and nursing care. The treatment group was first given hot compress with CHSP（which consisted of honeysuckle 30 g, Semen brassicae 30 g, Salvia miltiorrhiza 30 g, Angelica dahurica 30 g, Semen raphani 30 g, Evodia rutaecarpa 30 g, and coarse salt 20 g） on the punctured vessel under aseptic conditions for 5–10 min before conventional catheterization. The main efficacy indices were the vessel diameters before and during catheterization and the success rate of a single catheter, and the secondary efficacy indiex was the incidence of superficial phlebitis within 1 week after catheterization. Results： The vessel diameter during catheterization of the treatment group was remarkably increased compared with the control group [（7.96±0.42） mm vs.（4.39±0.54） mm, P〈0.01]. The success rate of the single catheter of the treatment group was significantly higher than that of the control group [94.00%（329/350） vs. 73.72%（244/329）, P〈0.01]. The incidence of superficial phlebitis within 1 week after catheterization in the treatment group was lower than that in the control group（P=0.007）. There was no adverse event with CHSP. Conclusion： Hot compress with CHSP during PICC is applicable as it can effectively improve the success rate of a single catheter and reduce the incidence of superficial phlebitis after catheterization（Trial registration No. ChiCTR-ONC-17010498）.展开更多
经外周穿刺置入中心静脉导管（peripherally inserted central catheter,PICC）具有操作便捷、置管时间长、利于血管保护等优点;但也存在并发症,容易发生穿刺部位感染,甚至引起相关血行性感染[1-2],正确维护导管是预防导管相关感染的保...经外周穿刺置入中心静脉导管（peripherally inserted central catheter,PICC）具有操作便捷、置管时间长、利于血管保护等优点;但也存在并发症,容易发生穿刺部位感染,甚至引起相关血行性感染[1-2],正确维护导管是预防导管相关感染的保证[3]。笔者用碘伏湿敷与碘伏消毒后干纱布覆盖两种方法,对PICC穿刺部位感染进行治疗,展开更多
经外周静脉置入中心静脉导管（peripherally inserted central venous catheters,PICC）是指从外周静脉穿刺置入中心静脉获得静脉通路的导管,常用于肿瘤患者的化疗、长期静脉治疗及输注高渗性、有刺激性药物等[1]。因PICC具有留置时间...经外周静脉置入中心静脉导管（peripherally inserted central venous catheters,PICC）是指从外周静脉穿刺置入中心静脉获得静脉通路的导管,常用于肿瘤患者的化疗、长期静脉治疗及输注高渗性、有刺激性药物等[1]。因PICC具有留置时间长、操作安全、无痛、不限制患者日常生活等特点,已广泛应用于临床[2]。展开更多
经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）是经外周贵要静脉、肱静脉、正中静脉或头静脉穿刺置管,送管体达上腔静脉中下1/3处的中心静脉导管置入术,因其操作安全,留置时间长,目前被广泛应用于临床。...经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）是经外周贵要静脉、肱静脉、正中静脉或头静脉穿刺置管,送管体达上腔静脉中下1/3处的中心静脉导管置入术,因其操作安全,留置时间长,目前被广泛应用于临床。在穿刺和导管组合导入鞘置入过程中患者会感受不同程度的疼痛,随着以人为本整体护理观念的深入,展开更多
BACKGROUND Peripherally inserted central catheters(PICCs)are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy,nutrition,and other medications.However,PICC-related thrombo...BACKGROUND Peripherally inserted central catheters(PICCs)are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy,nutrition,and other medications.However,PICC-related thrombosis is a serious complication that can lead to morbidity and mortality in this patient population.Several risk factors have been identified for the development of PICC-related thrombosis,including cancer type,stage,comorbidities,and catheter characteristics.Understanding these risk factors and developing a predictive model can help healthcare providers identify high-risk patients and implement preventive measures to reduce the incidence of thrombosis.AIM To analyze the influencing factors of PICC-related thrombosis in hospitalized patients with liver cancer,construct a predictive model,and validate it.METHODS Clinical data of hospitalized patients with liver cancer admitted from January 2020 to December 2023 were collected.Thirty-five cases of PICC-related thrombosis in hospitalized patients with liver cancer were collected,and 220 patients who underwent PICC placement during the same period but did not develop PICC-related thrombosis were randomly selected as controls.A total of 255 samples were collected and used as the training set,and 77 cases were collected as the validation set in a 7:3 ratio.General patient information,case data,catheterization data,coagulation indicators,and Autar Thrombosis Risk Assessment Scale scores were analyzed.Univariate and multivariate unconditional logistic regression analyses were performed on relevant factors,and the value of combined indicators in predicting PICC-related thrombosis in hospitalized patients with liver cancer was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Univariate analysis showed statistically significant differences(P<0.05)in age,sex,Karnofsky performance status score(KPS),bedridden time,activities of daily living impairment,parenteral nutrition,catheter duration,distant metastasis,and bone marrow suppression be展开更多
BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients...BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.展开更多
经外周置入中心静脉导管（peripherally inserted central catheter,PICC）在近几年被广泛应用在早产儿、危重早产儿的静脉输液治疗中。通过一系列临床病例发现,PICC的应用会出现一定概率的风险,并且极有可能带来十分严重的后果,甚至是...经外周置入中心静脉导管（peripherally inserted central catheter,PICC）在近几年被广泛应用在早产儿、危重早产儿的静脉输液治疗中。通过一系列临床病例发现,PICC的应用会出现一定概率的风险,并且极有可能带来十分严重的后果,甚至是生命危险。PICC风险管理主要指的是从医务人员到患者,从药物、设备到环境等各个方面对PICC的护理进行管理,以降低风险。展开更多
The development and research of titanium cast alloy and its casting technology, especially its application in aeronautical industry in China are presented. The technology of molding, melting and casting of titanium al...The development and research of titanium cast alloy and its casting technology, especially its application in aeronautical industry in China are presented. The technology of molding, melting and casting of titanium alloy, casting quality control are introduced. The existing problems and development trend in titanium alloy casting technology are also discussed.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It has been known in the clinical practice that the therapeutic effect of acupuncture varies widely in different individuals, although the acupuncturist is using the same acupoint and the same mode of needle manipulation. In addition, the effect of
文摘导管相关性静脉血栓（catheter-related thrombosis,CRT）是指导管置入期或被移除7d内,在导管外壁、导管所处静脉或其邻近静脉血管内壁的血凝块形成,其可由附壁血栓自导管延伸扩展至血管腔,是长期应用静脉导管最严重的并发症[1-2]。目前,中心静脉置管（peripherally inserted central catheaer,PICC）广泛应用于血液肿瘤患者,而近年研究表明血液肿瘤深静脉血栓发病率与实体瘤接近[3]。
基金supported by Hunan Provincial Natural Science Foundation of China (Grant Nos. 10JJ2040, 11JJ3055)National Major Science and Technology Special Projects of China (Grant No.2012ZX04011-011)+1 种基金Postdoctoral Science Funded Project of China (GrantNo. 20110490261)Hunan Provincial 12th Five-year Plan Key Disciplines of China (Grant No. 2012-42)
文摘Currently, the modeling of cutting process mainly focuses on two aspects: one is the setup of the universal cutting force model that can be adapted to a broader cutting condition; the other is the setup of the exact cutting force model that can accurately reflect a true cutting process. However, there is little research on the prediction of chatter stablity in milling. Based on the generalized mathematical model of inserted cutters introduced by ENGIN, an improved geometrical, mechanical and dynamic model for the vast variety of inserted cutters widely used in engineering applications is presented, in which the average directional cutting force coefficients are obtained by means of a numerical approach, thus leading to an analytical determination of stability lobes diagram (SLD) on the axial depth of cut. A new kind of SLD on the radial depth of cut is also created to satisfy the special requirement of inserted cutter milling. The corresponding algorithms used for predicting cutting forces, vibrations, dimensional surface finish and stability lobes in inserted cutter milling under different cutting conditions are put forward. Thereafter, a dynamic simulation module of inserted cutter milling is implemented by using hybrid program of Matlab with Visual Basic. Verification tests are conducted on a vertical machine center for Aluminum alloy LC4 by using two different types of inserted cutters, and the effectiveness of the model and the algorithm is verified by the good agreement of simulation result with that of cutting tests under different cutting conditions. The proposed model can predict the cutting process accurately under a variety of cutting conditions, and a high efficient and chatter-free milling operation can be achieved by a cutting condition optimization in industry applications.
基金Supported by the Zhejiang Science and Technology Program of Traditional Chinese Medicine(No.2015ZB043,2015ZA072)the Zhejiang Provincial Program for the Cultivation of HighLevel Innovative Health Talents(No.2014-108)
文摘Objective： To explore the preventive effect of applying hot compress with Chinese herbal salt packets（CHSP） to puncture vessels under aseptic conditions during peripherally inserted central catheter（PICC） on postoperative phlebitis. Methods： A total of 720 hospitalized patients undergoing first PICC were assigned to treatment and control groups（360 cases each group） according to a random number table. The control group received conventional catheterization and nursing care. The treatment group was first given hot compress with CHSP（which consisted of honeysuckle 30 g, Semen brassicae 30 g, Salvia miltiorrhiza 30 g, Angelica dahurica 30 g, Semen raphani 30 g, Evodia rutaecarpa 30 g, and coarse salt 20 g） on the punctured vessel under aseptic conditions for 5–10 min before conventional catheterization. The main efficacy indices were the vessel diameters before and during catheterization and the success rate of a single catheter, and the secondary efficacy indiex was the incidence of superficial phlebitis within 1 week after catheterization. Results： The vessel diameter during catheterization of the treatment group was remarkably increased compared with the control group [（7.96±0.42） mm vs.（4.39±0.54） mm, P〈0.01]. The success rate of the single catheter of the treatment group was significantly higher than that of the control group [94.00%（329/350） vs. 73.72%（244/329）, P〈0.01]. The incidence of superficial phlebitis within 1 week after catheterization in the treatment group was lower than that in the control group（P=0.007）. There was no adverse event with CHSP. Conclusion： Hot compress with CHSP during PICC is applicable as it can effectively improve the success rate of a single catheter and reduce the incidence of superficial phlebitis after catheterization（Trial registration No. ChiCTR-ONC-17010498）.
文摘经外周穿刺置入中心静脉导管（peripherally inserted central catheter,PICC）具有操作便捷、置管时间长、利于血管保护等优点;但也存在并发症,容易发生穿刺部位感染,甚至引起相关血行性感染[1-2],正确维护导管是预防导管相关感染的保证[3]。笔者用碘伏湿敷与碘伏消毒后干纱布覆盖两种方法,对PICC穿刺部位感染进行治疗,
文摘经外周静脉置入中心静脉导管（peripherally inserted central venous catheters,PICC）是指从外周静脉穿刺置入中心静脉获得静脉通路的导管,常用于肿瘤患者的化疗、长期静脉治疗及输注高渗性、有刺激性药物等[1]。因PICC具有留置时间长、操作安全、无痛、不限制患者日常生活等特点,已广泛应用于临床[2]。
文摘经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）是经外周贵要静脉、肱静脉、正中静脉或头静脉穿刺置管,送管体达上腔静脉中下1/3处的中心静脉导管置入术,因其操作安全,留置时间长,目前被广泛应用于临床。在穿刺和导管组合导入鞘置入过程中患者会感受不同程度的疼痛,随着以人为本整体护理观念的深入,
文摘BACKGROUND Peripherally inserted central catheters(PICCs)are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy,nutrition,and other medications.However,PICC-related thrombosis is a serious complication that can lead to morbidity and mortality in this patient population.Several risk factors have been identified for the development of PICC-related thrombosis,including cancer type,stage,comorbidities,and catheter characteristics.Understanding these risk factors and developing a predictive model can help healthcare providers identify high-risk patients and implement preventive measures to reduce the incidence of thrombosis.AIM To analyze the influencing factors of PICC-related thrombosis in hospitalized patients with liver cancer,construct a predictive model,and validate it.METHODS Clinical data of hospitalized patients with liver cancer admitted from January 2020 to December 2023 were collected.Thirty-five cases of PICC-related thrombosis in hospitalized patients with liver cancer were collected,and 220 patients who underwent PICC placement during the same period but did not develop PICC-related thrombosis were randomly selected as controls.A total of 255 samples were collected and used as the training set,and 77 cases were collected as the validation set in a 7:3 ratio.General patient information,case data,catheterization data,coagulation indicators,and Autar Thrombosis Risk Assessment Scale scores were analyzed.Univariate and multivariate unconditional logistic regression analyses were performed on relevant factors,and the value of combined indicators in predicting PICC-related thrombosis in hospitalized patients with liver cancer was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Univariate analysis showed statistically significant differences(P<0.05)in age,sex,Karnofsky performance status score(KPS),bedridden time,activities of daily living impairment,parenteral nutrition,catheter duration,distant metastasis,and bone marrow suppression be
基金the Chongqing Medical Scientific Research Project(a joint project of the Chongqing Health Commission and Science and Technology Bureau),No.2020FYYX046。
文摘BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.
文摘经外周置入中心静脉导管（peripherally inserted central catheter,PICC）在近几年被广泛应用在早产儿、危重早产儿的静脉输液治疗中。通过一系列临床病例发现,PICC的应用会出现一定概率的风险,并且极有可能带来十分严重的后果,甚至是生命危险。PICC风险管理主要指的是从医务人员到患者,从药物、设备到环境等各个方面对PICC的护理进行管理,以降低风险。
基金The paper is support by Foundation Key Project of Yunnan:The Study on inoculated theory and reliability of low carbonductile iron, NO. 1999E0004Z
文摘The development and research of titanium cast alloy and its casting technology, especially its application in aeronautical industry in China are presented. The technology of molding, melting and casting of titanium alloy, casting quality control are introduced. The existing problems and development trend in titanium alloy casting technology are also discussed.
