Objective To compare the effectiveness and safety of central venous catheters inserted from the left side and right side during peripheral inserted central catheterizations (PICC). Methods Totally 458 adult patients undergoing PICC between May 2007 and May 2008 were enrolled in this study and divided randomly into right-sided group (n = 228)and left-slded group (n = 230). Chest X-ray was performed immediately after catheterization to identify the initial tip locations. Other parameters were evaluated during follow-up. Results The rate of difficult insertion was significantly lower in right-sided group than in left-sided group (14.9% vs 24. 8% , P =0.003). The rate of tip projection angle ＞40°was also significantly lower in right-sided group (2.2% vs 23.4% ,P = 0. 000). The rate of tips reaching the central veins was not significantly different between two groups (54.4%vs 53.0% , P = 0. 538). Compared with right-sided catheters, the tip positions in the left-sided group was significantly less frequently located in the inferior segment of superior vena cave in the central tip locations (6. 6% vs 21.0% , P =0. 001)and more commonly positioned in the nominate vein in non-central tip locations (66. 7% vs 48.1% , P = 0. 008). In addition, the catheter detaining time (P = 0. 617), incidence of local phlebitis after puncture (P = 0. 561), catheter obstruction rate (P = 0. 774), and catheter-related infection rate (P = 0. 854)showed no significant differences between two groups. The incidence of swollen limb was significantly lower inright-sided group than in left-sided group (4. 4% vs 8.3%, P = 0. 043). Conclusions Right-sided catheters provide better outcomes than left-sided catheters. PICC through the right elbow veins should be preferred in clinical practices.

Objective To explore the role of process management in preventing peripheral central venous catheter (PICC)-related bloodstream infections (CRBSI). Methods A standard process management policy was established for the uniform management of PICC in our hospital. The incidences of CRBSI before and after the implementation of this policy were compared. Results The incidences of CRBSI was 6.0‰ (48/79 793 ) every 1000 catheter-days before process management and 2.9‰ (29/99643) after process management (P =0.000).Conclusion Standard process management can effectively prevent and control CRBSI caused by PICC.

Objective To explore the clinical significance of serum cystatin C (Cys C) combined with brain natriuretic peptide(BNP)in more earlier,more accurate diagnosis of contrast-induced nephropathy(CIN)after coro-nary angiography or percutaneous coronary intervention .Methods 358 patients undergone coronary angiography or percutaneous coronary intervention were enrolled in this study , and the data were collected .The serum creatinine (Scr),Cys C and BNP were tested before operation .The serum Cys C and BNP were tested 8h,16h,24h after opera-tion.The serum Scr was tested 24h,48h,72h after operation.All patients were diagnosed and grouped with CIN by ser-um Scr.The results were compared between the CIN group and control group ,diagnosis efficiency of Cys C ,BNP and combine with them was analyzed .Results CIN occurred in 16 cases of 358 enrolled patients , the incidence was 4.47%.The levels of Scr increased beyond 24h after operation in the CIN group .The levels of serum Cys C and BNP had no significant difference at 8h after operation compared to preoperation (P>0.05),and significantly rosed at 16h and 24h after operation(P<0.01)than before in the two group,[16h Cys C:(1.63 ±0.49)mg/L vs(0.91 ±0.33) mg/L,24h Cys C:(3.45 ±0.83)mg/L vs(0.91 ±0.33)mg/L,16h BNP:(215.96 ±55.72)ng/L vs(102.40 ± 32.23)ng/L,24h BNP:(352.41 ±61.08)ng/L vs(102.40 ±32.23)ng/L,all P<0.01].The levels of serum Cys C and BNP had no significant difference at 8h after operation in CIN(P>0.05),and significantly rosed at 16h and 24h after operation in CIN( P<0.01)than the corresponding levels in the control group [16h Cys C:(1.63 ±0.49)mg/L vs(0.93 ±0.38)mg/L,24h Cys C:(3.45 ±0.83)mg/L vs(0.92 ±0.34)mg/L,16h BNP:(215.96 ±55.72)ng/L vs(149.32 ±43.74)ng/L,24h BNP:(352.41 ±61.08)ng/L vs(164.82 ±49.62)ng/L,all P<0.01].The diagno-sis efficiency of serum Cys C combined with BNP at 16h after operation had high degree of accuracy .Conclusion In this study,the serum Cys C and BNP are better biomarker for early diagnose of CIN ,witch can diagnose CIN earlier than Scr .Combine of the two biomarker can more earlier ,more accurate diagnose CIN .

Endoscopic nasobiliary drainage (ENBD), a minimal invasive treatment technique that can relieve biliary obstruction quickly, reduce biliary pressure and clear biliary tract, is widely used in clinic. The study reviewed the application scope, features, methods of intubation and fixation, indwelling time, common complications and relevant nursing interventions of nasobiliary duct. The purpose of the study was to provide references for clinical nursing of nasobiliary duct, which was helpful to offer the high quality nursing service.

Objective:To investigate the level of discharge readiness and influencing factors of patients undergoing metabolic bariatric surgery (MBS) under enhanced recovery after surgery (ERAS) .Methods:Using the convenient sampling method, a total of 436 MBS patients admitted to Zhongnan Hospital of Wuhan University from July 2020 to June 2021 were selected as the research objects. Questionnaires were conducted using the General Information Questionnaire, the Chinese Version of Readiness for Hospital Discharge Scale (RHDS) and the Chinese Version of Quality of Discharge Teaching Scale (QDTS) . Multiple linear regression analysis was used to analyze the influencing factors of hospital discharge readiness in MBS patients. A total of 436 questionnaires were distributed, of which 425 were actually valid, and the effective recovery rate of the questionnaire was 97.48%.Results:The total score of discharge readiness of 425 MBS patients was (89.44±14.79) , and the total score of discharge guidance quality was (137.11±55.21) . Multiple linear regression analysis showed that the per capita monthly income of households, living conditions, educational background, whether complicated with chronic diseases and the quality of discharge guidance were the influencing factors of the level of discharge readiness of MBS patients ( P<0.05) , which explained 39.1% of the total variance. Conclusions:Under the ERAS model, the level of discharge readiness of MBS patients is not high. Medical staff should provide targeted intervention and support according to the patients' own conditions, establish an early family and social support system, develop a complete discharge plan, comprehensively carry out discharge education and follow-up and improve quality of discharge guidance and discharge readiness of patients.

This article interpretsthe expert consensus on venous catheter maintenance, including flushing and locking tube, dressing replacement and catheter maintenance, infusion connectors, catheter removal, education and training, infection control, etc. It is hoped that the expert consensus can provide a reference for clinical nurses to standardize the operations of intravenous catheter maintenance, thereby benefiting patients.

Objective:To explore the current situation of nursing human caring in hospital wards and analyze its influencing factors, so as to facilitate the development of nursing human caring practice.Methods:From July to November 2022, a total of 107 hospitals were surveyed through stratified convenience sampling method, and 4 072 ward nursing managers were recruited to finish the general information questionnaire and the ward nursing human caring status questionnaire. The general information included the region, class and type of the hospital, etc. The ward nursing human caring status questionnaire included 38 items in 5 dimensions of nursing human caring system and process, humanistic quality and training of nursing staff, humanistic environment and facilities, human caring procedures and measures, and human caring quality evaluation and improvement, with a full score of 190 points. Descriptive statistics were used to analyze the general data, independent samples t-test, ANOVA and correlation analysis were used to analyze the factors influencing the current status of nursing human caring in the ward, while multiple linear regression analysis was used to conduct a multivariate analysis. Results:The score of nursing human caring in hospital wards was 156.91±27.78. Whether the hospital had carried out nursing human caring pilot(demonstration) wards, whether the ward had previously been a hospital nursing human caring pilot(demonstration) nursing unit, the type of ward, and whether nursing managers had participated in human caring training were the influencing factors of the implication of nursing humanistic caring in wards( P<0.05). Conclusions:The practice of nursing human caring in hospital wards is at a good level, but needs to be further strengthened. Nursing managers should take systematically strategies to promote the development of nursing human caring practice.