To explore the nursing measures to reduce the infection of indwelling catheter.
Chronic renal failure develops into uremia in the late stage. In order to maintain life, hemodialysis [1] has become the most important means of diagnosis and treatment. Stable and reliable vascular access is an important prerequisite for effective hemodialysis. The most ideal hemodialysis access is arteriovenous fistula, but many patients are limited by peripheral vascular conditions, so they can't perform autologous arteriovenous fistula surgery. The application of femoral vein indwelling intubation technology can provide a good vascular access for renal failure patients before or after the establishment of arteriovenous fistula, and carry out effective hemodialysis. If the femoral vein indwelling catheter is not properly cared during hemodialysis, a series of complications will occur, mainly catheter infection [1].
1 data and methods
1. 1 general information
From March 2007 to March 20, 2007, 90 patients with femoral vein catheterization in our hospital were randomly divided into two groups: experimental group (45 cases), male 30 cases (66.67%) and female 20 10/5 cases (33.33%); The age was 4 1 ~ 77 years old, with an average of (59.6438+0? 18.7) years old, including chronic nephritis 18 cases, diabetic nephropathy 15 cases, gouty nephropathy 7 cases and hypertensive nephropathy 5 cases; There were 45 cases in the control group, including 28 males (62.22%) and 65,438 07 females (37.78%). The age ranged from 42 to 76, with an average of (58.8? 17.5), chronic nephritis in 20 cases, diabetic nephropathy 14 cases, gouty nephropathy in 5 cases and hypertensive nephropathy in 6 cases. There was no significant difference in sex, age and etiology between the two groups (P > 0.05). 0.05), which is comparable.
1.2 nursing methods
1.2. 1 Nursing methods of the experimental group
1.2. 1. 1 pre-catheterization care: Because patients and their families know little about catheterization, they are afraid, nervous and worried. Nurses should be calm and patient, communicate with patients 3-5 times a day, explain their illness to patients, eliminate their nervousness and alertness, and treat treatment with an optimistic and positive attitude.
1.2. 1.2 urethral catheterization care: (1) Put the patient in supine position, with knee joint slightly flexed, hip raised, hip joint straight and slightly rotated outward; (2) protecting the privacy of patients; (3) Intubation shall be performed in strict accordance with aseptic requirements, with gentle movements, so as to minimize the intubation time; (4) When skin disinfection is carried out, sufficient disinfectant dosage and sufficient disinfection time should be ensured, and patients with more hair at the puncture site should be cut off rather than shaved off, and the skin preparation range should be >; 8cm, reducing the cause of infection.
1.2. 1.3 Post-catheter care: (1) Workers wear sterile gloves to disinfect the catheter mouth, rinse the catheter with 20ml physiological saline, then inject heparin sealing solution with the same volume as the catheter, then tighten the sterilized heparin cap, wrap the catheter mouth with sterile dressing and fix it properly; (2) Closely observe whether the skin at the puncture site is red, swollen, bleeding and other symptoms. Once it is found that there is massive bleeding during extubation, rescue measures should be taken in time; (3) Ask the patient to rest as much as possible, and avoid scratching the puncture site, urinating and turning over in life; (4) Remove the dressing at the catheter every day and disinfect it with Aner iodine twice. Diameter of each disinfection range >; 5cm, pay attention to keep the dressing dry and hygienic; (5) When changing medicine, be careful, strictly abide by aseptic operation procedures, and move gently.
1.2.2 Nursing methods of the control group
Patients in the control group were given routine femoral vein indwelling intubation nursing.
1.3 evaluation criteria of curative effect
Determine the criteria of catheter infection: redness, swelling and pain at the puncture site; The same bacteria appeared in local blood culture and peripheral blood culture of catheter, and the number was much higher than that in peripheral blood culture. The quantitative culture colony count of each catheter section is >:100 cfu; The patient has symptoms such as fever, lethargy and chills. Efficacy standard: marked effect: hemodialysis is smooth, breathing is stable, blood pressure is normal, and patients have no adverse reactions. Effective: hemodialysis is smooth, dyspnea is relieved, and blood pressure is close to normal. Invalid: the patient's femoral vein indwelling catheter fell off, shortness of breath, and the patient obviously felt unwell.
1.4 statistical method
SPSS l5.0 software was used for analysis, and the measurement data were expressed by ratio. T test was used for comparison between the two groups. P & lt0.05 indicates that the difference is statistically significant.
2. Results
2. Comparison of1patients with catheter infection
After the nursing, the catheter infection was compared between the two groups. There were 5 cases in the experimental group, and the infection rate was11.11%. In the control group, 19 cases were infected, and the infection rate was 42.22%. After t test, P
Observe the therapeutic effect of two groups of patients after nursing. In the experimental group, 39 patients' spirits improved obviously, hemodialysis went smoothly, blood pressure and other indicators returned to the normal range, and the total effective rate reached 86.67%. In the control group, 2 1 patient recovered to the normal range, and the total effective rate was 46.67%. After t test, P
discuss
Hemodialysis is an important means to maintain life for patients with severe renal insufficiency, and the basis of hemodialysis is good vascular access [2]. Femoral vein catheterization has the characteristics of simplicity, rapidity, safety, high success rate, few complications, long indwelling time, cheaper price than artificial blood vessels and better dialysis effect, so femoral vein catheterization is widely used in acute renal failure, chronic renal failure, immature internal fistula and food. However, indwelling catheters also have some disadvantages. Because the indwelling catheter is used for a long time, the probability of catheter infection is positively related to its use time, and reducing catheter infection has become an important goal of indwelling catheter nursing [3]. When conventional nursing is applied to indwelling catheter care with a relatively long period, the quality of nursing is difficult to guarantee, which leads to a high probability of catheter infection. Therefore, femoral vein indwelling catheter should focus on the causes of infection, comprehensively improve the nursing level, and strive to reduce the catheter infection rate [3].
To sum up, there are many reasons for the infection of femoral vein indwelling catheter. Intensive nursing care for patients with femoral vein indwelling catheter can effectively reduce the probability of catheter infection, prolong the service time of catheter, alleviate the pain of patients and improve the quality of life.
References:
[1] Mei Changlin, Ye Chaoyang, Rong Hao. Practical dialysis manual [M]. Beijing, People's Health Publishing House.53-59, 2009.
[2] Wang Leyan. Application of continuous quality improvement in prevention of central venous catheter-related infection in maintenance hemodialysis patients [J]. chinese journal of blood purification Journal, 2008,4 (4):188.
Ouyang Xialing. Infection associated with hemodialysis catheter [J]. Foreign medical transplantation and blood purification, 2005,5 (3): 4-7.
Cheng Xiaomei, Zhou Meizhen. Nursing care of double-lumen catheter with polyester ring for hemodialysis [J]. Zhejiang Journal of Integrated Traditional Chinese and Western Medicine, 2006, 16 (5): 329.
Gao tongfeng Nursing care of femoral vein indwelling catheter [J]. Modern Nursing, 2003,9 (11): 862.
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