[求助]血管内导管相关感染的定义

楚楚

令人费解哈！:L 正常体重儿的肠外营养是危险因素，那么抗菌药物治疗超过十天是否是危险因素呢？低体重儿的抗菌药物治疗超过十天是危险因素，那么肠外营养是否是危险因素？还是这项研究对这两个人群没有进行相关研究？:look

缭绕

原帖由 楚楚 于 2007-7-30 11:34 发表

                               
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那么翻译有些误差，应该是出生体重高于正常儿，对吧？:pikhmn

俺的翻译是高出生体重儿接受静脉营养会增加感染的危险性。:lol

木瓜

原帖由 楚楚 于 2007-7-30 14:28 发表

                               
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令人费解哈！:L 正常体重儿的肠外营养是危险因素，那么抗菌药物治疗超过十天是否是危险因素呢？低体重儿的抗菌药物治疗超过十天是危险因素，那么肠外营养是否是危险因素？还是这项研究对这两个人群没有进行相关 ...

那两句话里没有涉及这么多内容呀！

楚楚

各位大虾，能否与大家分享一下您对这段话的理解？
四、预防血管内导管相关感染的一般措施
(二)穿刺点的选择
穿刺部位皮肤细菌密度是CRBSI重要危险因素。为了降低感染率，建议选择锁骨下静脉穿刺留置CVCs，尽量不选择颈部、下肢等处。虽然没有随机临床试验比较不同穿刺点的感染率，但选择颈内静脉穿刺时，导管相关感染率高于锁骨下和股静脉。
成人患者，股静脉置管时，发生导管细菌定植的几率较高。同时，与颈内、锁骨下静脉置管相比，股静脉置管发生深部静脉血栓的危险大，发生导管相关感染的可能性也高，所以，条件允许时，尽量避免选择股静脉作为穿刺点。
那么选择穿刺点的时候，到底是颈内静脉优于股静脉，还是股静脉优于颈内静脉？

icchina

原帖由 楚楚 于 2007-8-19 14:24 发表

                               
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各位大虾，能否与大家分享一下您对这段话的理解？
四、预防血管内导管相关感染的一般措施
(二)穿刺点的选择
穿刺部位皮肤细菌密度是CRBSI重要危险因素。为了降低感染率，建议选择锁骨下静脉穿刺留置CVCs，尽 ...

那么选择穿刺点的时候，到底是颈内静脉优于股静脉，还是股静脉优于颈内静脉？
感觉还是翻译和理解的问题。对照原文，可以这样说“成人中颈内静脉优于股静脉，儿童中感染发生率两者一样但股静脉引起的机械损伤要少些”。

Site of Catheter Insertion
The site at which a catheter is placed influences the subsequent risk for catheter-related infection and phlebitis. The influence of site on the risk for catheter infections is related in part to the risk for thrombophlebitis and density of local skin flora.
Phlebitis has long been recognized as a risk for infection. For adults, lower extremity insertion sites are associated with a higher risk for infection than are upper extremity sites (49--51). In addition, hand veins have a lower risk for phlebitis than do veins on the wrist or upper arm (52).
The density of skin flora at the catheter insertion site is a major risk factor for CRBSI. Authorities recommend that CVCs be placed in a subclavian site instead of a jugular or femoral site to reduce the risk for infection. No randomized trial satisfactorily has compared infection rates for catheters placed in jugular, subclavian, and femoral sites. Catheters inserted into an internal jugular vein have been associated with higher risk for infection than those inserted into a subclavian or femoral vein (22,53,54).
Femoral catheters have been demonstrated to have relatively high colonization rates when used in adults (55). Femoral catheters should be avoided, when possible, because they are associated with a higher risk for deep venous thrombosis than are internal jugular or subclavian catheters (56--60) and because of a presumption that such catheters are more likely to become infected. However, studies in pediatric patients have demonstrated that femoral catheters have a low incidence of mechanical complications and might have an equivalent infection rate to that of nonfemoral catheters (61--63). Thus, in adult patients, a subclavian site is preferred for infection control purposes, although other factors (e.g., the potential for mechanical complications, risk for subclavian vein stenosis, and catheter-operator skill) should be considered when deciding where to place the catheter. In a meta-analysis of eight studies, the use of bedside ultrasound for the placement of CVCs substantially reduced mechanical complications compared with the standard landmark placement technique (relative risk [RR] = 0.22; 95% confidence interval [CI] = 0.10--0.45) (64). Consideration of comfort, security, and maintenance of asepsis as well as patient-specific factors (e.g., preexisting catheters, anatomic deformity, and bleeding diathesis), relative risk of mechanical complications (e.g., bleeding and pneumothorax), the availability of bedside ultrasound, and the risk for infection should guide site selection.

楚楚

不同手术的SSI的感染率存在差异，其中“颈部切口比腹部切口抵抗力高”，从这一点是否进一步证明了颈内静脉优于股静脉？
    那么您医院选择颈内静脉多，还是选择股静脉多？虽然选择锁骨下静脉发生导管相关性血流感染的危险性最低，但由于技术和设备的原因，临床选择锁骨下静脉的情况仍然不多。您医院呢？

楚楚

根据原文：
Skin Antisepsis
In the United States, povidone iodine has been the most widely used antiseptic for cleansing arterial catheter and CVC- insertion sites (72). However, in one study, preparation of central venous and arterial sites with a 2% aqueous chlorhexidine gluconate lowered BSI rates compared with site preparation with 10% povidone-iodine or 70% alcohol (73). Commercially available products containing chlorhexidine have not been available until recently; in July 2000, the U.S. Food and Drug Administration (FDA) approved a 2% tincture of chlorhexidine preparation for skin antisepsis. Other preparations of chlorhexidine might not be as effective. Tincture of chlorhexidine gluconate 0.5% is no more effective in preventing CRBSI or CVC colonization than 10% povidone iodine, as demonstrated by a prospective, randomized study of adults (74). However, in a study involving neonates, 0.5% chlorhexidine reduced peripheral IV colonization compared with povidone iodine (20/418 versus 38/408 catheters; p = 0.01) (75). This study, which did not include CVCs, had an insufficient number of participants to assess differences in BSI rates. A 1% tincture of chlorhexidine preparation is available in Canada and Australia, but not yet in the United States. No published trials have compared a 1% chlorhexidine preparation to povidone-iodine.
这个蓝字部分应该是“2%葡萄糖酸氯已定“吧？但译文为”2%氯已定酊制剂“，是不是译错啦？
某导管的使用说明：推荐使用溶于聚烯吡酮的碘消毒剂，不建议使用以丙酮或酊剂作为溶剂的碘消毒剂，其它消毒剂是否也不能以酊剂作为溶剂呢？ 期待您的解答！:run

楚楚

我一直以为自已人缘还行，直到今天我才发现人缘很差，几乎到了众判亲离的地步！！:'( :'( 经常自言自语没人理咱:L :L
可我还是有点不死心，今天再努力一次。碘酒为什么又叫碘酊呢？我看了它的成分，里面没有酊呀！
有没有人帮我呀？

爱在sky

好东西！我已经下载了

zzxygb619

碘和碘化钾的乙醇溶液就称为碘酊，如果不加乙醇就不能称为碘酊了。

safihu

这个指南和这个指南。。。。。。。https://bbs.sific.com.cn/viewthread.php?tid=321

福娃

感谢楚楚斑竹、杰丝提供的美味知识大餐，我即刻就餐，并消化、吸收，增强体质，谢谢！

楚楚

原帖由 zzxygb619 于 2007-9-26 12:44 发表

                               
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碘和碘化钾的乙醇溶液就称为碘酊，如果不加乙醇就不能称为碘酊了。

根据《现代医院消毒学》（主编：杨华明、易滨）：碘酊俗称碘酒，用于临床消毒或灭菌的碘酊含有效碘浓度为2%-2.5%(W/V)，配方及配制方法如下：碘20g，碘化钾15g，蒸馏水480ml，乙醇（95%)或异丙醇加至1000ml。
我的问题是：酊是一种剂型？还是一种化学物质？

福娃

我觉得是一种剂型，从边旁来看，我猜是酒精和其他（可能是蒸馏水）的混合物。

楚楚

酊：医药上用酒精和药物配制而成的液剂。
我认为酊既是一种剂型，也含有化学物质即酒精。使用含有酒精的消毒剂消毒时要注意不消毒穿刺点，避免酒精进入血液导致过敏反应等，因此“某导管的使用说明：推荐使用溶于聚烯吡酮的碘消毒剂，不建议使用以丙酮或酊剂作为溶剂的碘消毒剂”。
是否对呢？请大家参与讨论！:o

木瓜

看外文相关文献时经常会碰到septicemia，bacteriemia，sepsis，bloodstream infection，他们之间的联系和区别大家知道吗？

福娃

我认为不对，首先：1.对酒精过敏并不意味要进入血液才产生过敏，对酒精过敏的病人往往表现出的是皮肤症状；2.酒精是易挥发的液体，操作时先消毒穿刺点皮肤，而后，待干，再行穿刺，通过穿刺点而将酒精带入的情况微乎其微，除非穿刺点上的酒精象水滴；3.对酒精过敏的病人往往对碘也过敏。所以，我认为消毒剂本身使用说明注意事项上应标明“对酒精或碘过敏的人禁止使用”就行了。:)

楚楚

3.对酒精过敏的病人往往对碘也过敏。

这一点我不敢认同，我就是例子呀，我对酒精过敏，但对碘并不过敏。

另外某品牌的PICC产品使用说明书上明确说明进行深静脉置管时，对穿刺部位先使用70-75%的酒精消毒三遍，再使用活力碘消毒三遍，它为什么要特意这样强调呢？:L :L

桃子妖妖

是不是生产某品牌PICC产品的厂家对它自己的东东很不放心啊？;P :P

tangyan

下载学习了，谢谢老师