Background and purpose Peripherally inserted central catheter (PICC) used in neurosurgical patients requires changes in patients' head positions. However, such changes can worsen pressure on the brain tissue, lead to sudden acute brain herniation and respiratory arrest, resulting in a higher chance of patient death. This paper addresses the aforementioned problems by introducing a new PICC catheterization method. Method In a retrospective study, the records of patients with PICC from April 2020 to April 2023 were reviewed, and they were divided into three groups based on the methods employed. The first group as the conventional group, involved changing patients’ body positions during catheterization. The second group, as the intracavitary electrocardiographic (IECG) group, utilized intracavitary electrocardiographic monitoring and involved changing patients’ body positions during catheterization. The third group as the intracavitary electrocardiographic with improved body positioning (IECG-IBP) group, catheterization was performed with guidance from intracavitary electrocardiographs and without changing the patients’ body positions. The ECG changes among patients undergoing different catheter delivery methods were then compared, as well as the rate of catheter tip misplacement. Result The study encompassed a total of 354 cases. Our findings reveal distinct P wave amplitude percentages among the groups: 0% in the conventional group, 88.46% in the IECG group, and 91.78% in the IECG-IBP group. Furthermore, the following catheter tip misplacement rates were recorded: 11.54% for the conventional group, 5.39% for the IECG group, and 5.47% for the IECG-IBP group. Significantly notable differences were observed in these two key indicators between the conventional group and the IECG-IBP group. Notably, the IECG-IBP group demonstrated a more favorable outcome compared to the IECG group. Conclusion In patients with neurosurgical diseases, especially those with tracheostomy and nuchal stiffness, the IECG-IBP PICC catheter insertion method can effectively reduce the patient's neck resistance, does not increase the patient's headache and dizziness symptoms, and does not reduce the success of one-time catheterization. Rate and does not increase the incidence of jugular venous ectopia.

目的:探讨PICC置管过程中运用腔内心电图尖端定位技术方法,研究影响特征性P波改变的相关因素,降低其干扰因素,提高特征性P波敏感率.方法:选取2020年11月至2023年8月行PICC置管术患者269例的临床护理资料,观察置管过程患者腔内心电图特征性P波显示率及其影响因素.结果:影响腔内心电图特征性P波因素中,单因素分析显示患者年龄、上腔静脉下段、尖端异位上腔静脉外相关(P<0.05);多因素Logistic回归分析显示患者年龄相关(P<0.05),排除0-10岁和90-100岁年龄段样本量过少外,随着年龄增加,腔内心电图特征性P波发生率成显著下降趋势.结论:腔内心电图PICC尖端定位技术,特征性P波表达影响因素与年龄、上腔静脉下段、尖端异位上腔静脉外相关.

BACKGROUND:Nurses certified in wound, ostomy, and continence (WOC) monitored an increasing incidence of hospital-acquired transnasal tube-related pressure injuries (TTPIs) in a tertiary hospital. Hospital-acquired pressure injuries are one of the most common preventable complications of hospitalization; however, the significance of TTPI prevention must be considered alongside the safety of tube fixation to prevent unplanned extubations (UEs), which are serious adverse events. Thus, exploring a quality improvement (QI) project to effectively reduce the risk of TTPIs while safeguarding tube safety is urgently needed. PURPOSE:To decrease the incidence of TTPIs. METHODS:Inpatients from 2017 to 2018 were set as the control group, using routine precautions. Inpatients from 2019 to 2020 were set as the experimental group, and a bundle of training and clinical practice interventions was implemented to compare the incidence of TTPIs and UEs between the 2 groups. RESULTS:After improvement, the incidence of TTPIs reduced from 1.20% to 0.69%, the incidence of UEs reduced from 2.40% to 1.63%, and the differences were both statistically significant (P < .05). CONCLUSION:The QI project reduced the incidence of TTPIs and UEs, thereby protecting the nasal skin/mucosal surfaces, safeguarding tube fixation, and ultimately improving the quality of clinical care.

BACKGROUND Tube indwelling is a key procedure in modern medicine. Careful tube setup is necessary to prevent unplanned extubation. The training for tube fixation is time- and resource-consuming, and optimal modes of training are currently being sought. Previous studies have compared workshops and flipped classroom models separately using conventional teaching strategies, but no study has examined a combination of both teaching models in nursing training. AIM To compare the effectiveness of workshops vs workshops combined with the flipped classroom model for improving tube fixation training for nursing students. METHODS This was a prospective cohort study. In this study, 149 nurses who joined our hospital in 2019 underwent training using workshops combined with the flipped classroom model (experimental group), while 159 nurses who joined the hospital in 2018 received only workshop-based training (control group). The combination of workshops with the flipped classroom training model was divided into two modules: pre-class and in-class training. The participation of nurses in the training activities, on-site assessment of training, nurses’ evaluation of their training, and related indicators of tube quality management were evaluated. RESULTS The average age of nurses in the control group was 22.94 ± 0.94 years and that of nurses in the experimental group was 25.42 ± 3.23 years (P < 0.01). The qualified rate of after-class assessments for the experimental and control groups was 100.00% (average score: 94.01 ± 2.78 points) and 91.82% (average score: 84.24 ± 2.94 points), respectively (P < 0.01). Most nurses in the experimental group completely agreed that the combined training was helpful to cultivate clinical thinking and independent learning ability and to master knowledge of tube fixation. In addition, the training content within the pre-class teaching video, pre-class tube atlas, pre-class main instructor guidance, in-class demonstration, and in-class practice was very informative. The experimental group had higher evaluation scores than the control group (4.88 ± 0.38 vs 4.67 ± 0.64; P < 0.01). Comparison of tube quality management before and after training in 2018 to 2019 revealed that the unplanned ureteral tube removal rate dropped from 0.25‰ to 0.06‰, the unplanned chest tube removal rate dropped from 1.07‰ to 0.78‰, and the unplanned gastric tube removal rate dropped from 0.36‰ to 0.17‰. The incidence rate of pressure ulcers caused by the tube decreased from 0.78‰ to 0.45‰. CONCLUSION The combination of workshop and flipped classroom training is effective in improving tube fixation training of nurses, cultivating nurses’ active learning abilities and clinical thinking, and improving the safety of the procedure.

Background: Not only has the placement rate of enteral feeding tubes during operations for esophageal cancer increased, but also has number of patients who choose to continue enteral feeding at home instead of removing the feeding tube at discharge. The impacts of home enteral nutrition (HEN) after esophagectomy in esophageal cancer patients are analyzed. Methods: A systematic review was conducted in accordance with PRISMA and Cochrane guidelines. English and Chinese databases, including PubMed, Embase, Web of Science, The Cochrane Library, Scopus, CBM, CNKI, and Wan Fang were searched from inception to December 7, 2019. Randomized controlled trials evaluating the short-term outcomes of HEN following esophagectomy in cancer patients were included. The risk of bias of the included studies was appraised according to the Cochrane risk of bias tool. The summary of relative risk/weighted mean difference (WMD) estimates and corresponding 95% confidence interval (95% CI) were calculated using fixed- and random-effects models. Results: Nine randomized controlled trials involving 757 patients were included in the meta-analysis. Compared with oral diet, HEN was associated with significantly increased body weight (WMD 3 kg, 95% CI 2.36-3.63,P < .001), body mass index (WMD 0.97 kg/m(2), 95% CI 0.74-1.21,P < .001), albumin (WMD 3.43 g/L, 95% CI 2.35-4.52,P < .001), hemoglobin (WMD 7.23 g/L, 95% CI 5.87-8.59,P < .001), and total protein (WMD 5.13 g/L, 95% CI 3.7-6.56,P < .001). No significant differences were observed in prealbumin and gastrointestinal adverse reactions. Physical (WMD 8.82, 95% CI 6.69-10.95,P < .001) and role function (WMD 12.23, 95% CI 2.72-21.74,P = .01) were also significantly better in the HEN group. The nausea/vomiting (WMD -5.43, 95% CI -8.29 to -2.57,P = .002) and fatigue symptoms (WMD -11.76, 95% CI -16.21 to -7.32,P < .001) were significantly reduced. Appetite loss (WMD -8.48, 95% CI -14.27 to -4.88,P = .001), diarrhea (WMD -3.9, 95% CI -7.37 to -0.43,P = .03), and sleep disturbance (WMD -7.64, 95% CI -12.79 to -2.5,P = .004) in the HEN group were also significantly less than the control group. Conclusions: HEN improved nutrition status, physical and role function, and reduced nausea/vomiting, fatigue, appetite loss, diarrhea, and sleep disturbance compared with an oral diet in esophageal cancer patients postsurgery. HEN did not increase adverse reactions.