Objective To strengthen the standardized management of totally implanted vascular access devices (TIVAD) in order to prevent and reduce the complications.Methods The unified TIVAD maintenance record form was adopted.The form contained the embedded and maintenance information.The maintenance and propaganda handbooks were handed out to the patients.The incidence of complications between before and after the application of the maintenance record form was analyzed statistically.Results The incidence of infection and obstruction fell from 2.1％(20/942) and 8.3％(78/942) to 1.0％(13/1 258) and 2.8％(35/1 258),the difference was statistically significant.Conclusions The application of TIVAD maintenance record form can reduce the occurrence of complications and prolong the service life of TIVAD.

Objective To explore the effect of rehabilitation training start time after mastectomy on the recovery of the affected limb function. Methods 90 patients who received modified radical mastectomy were divided into groups A, B and C randomly. All the patients accepted the unified rehabilitation program, but started 1, 3 and 10 d after the operation respectively. They were evaluated with the Japanese Orthopaedics Association (JOA) assessment for affected shoulder 1, 3 and 6 months after operation. Results The score of JOA was the least in the group C (P<0.01) 1 month after operation, and was the most in the group A 3 months after operation (P<0.01). At the end of the 6th month, there was no difference among these groups (P>0.05). Conclusion The rehabilitation training can be started as early as possible.

Objective To analyze the reasons of catheter fracture of implantable vascular access devices and to explore the prevention and handling measures. Methods A retrospective analysis was carried in 3 887 adult patients with implantable vascular access devices and 13 had catheter fracture. The clinical features and causes were analyzed and the successful handling measures were summarized. Results Of 3 887 cases, a total of 13 (0.33%) catheter fracture occurred. The incidence rate of catheter fracture via subclavian jugular venipuncture was 3.70%,(6/162) , via internal jugular venipuncture was 0.18% (7/3 725), via internal jugular venipuncture was significantly lower than that via the subclavian venipuncture (χ2=47.505,P=0.000). There had no statistical differences between the left and right of the two puncture ways(P=0.707,0.682). Conclusions Catheter fracture is one of the serious complications in the process of use and maintenance of implantable vascular access device. Choosing appropriate surgical method, strengthen maintenance education, specificating the operation procedure, closing observation and other measures can not only reduce the occurrence of the catheter fracture, but also can dealt with catheter fracture in time, which could ensure the safety of patients' life.

Objective To explore the application of levofloxacin tube sealing in patients with venous port infection.Methods A total of 40 patients with venous port infection were ran-domly divided into observation group and control group.The control group was treated with antibi-otics,and the observation group was treated with levofloxacin tube sealing and systemic antibiotics. When drug sensitivity test returned,the control group was treated with sensitive antibiotics,and the observation group was treated with levofloxacin tube sealing and sensitive antibiotics.Infection condition,extubation rate,comfort and satisfactory degree toward nursing were compared between two groups.Results Disappearing time of infection symptoms and extubation rate in the observa-tion group were significantly shorter and less than those in the control group (P <0.05),and cura-tive effect and satisfactory degree toward nursing were significantly higher than those in the control group (P <0.05).Conclusion Levofloxacin tube sealing can effectively improve the infection symptoms of patients with venous port and reduce the extubation rate.

Objective To explore the application of levofloxacin tube sealing in patients with venous port infection.Methods A total of 40 patients with venous port infection were ran-domly divided into observation group and control group.The control group was treated with antibi-otics,and the observation group was treated with levofloxacin tube sealing and systemic antibiotics. When drug sensitivity test returned,the control group was treated with sensitive antibiotics,and the observation group was treated with levofloxacin tube sealing and sensitive antibiotics.Infection condition,extubation rate,comfort and satisfactory degree toward nursing were compared between two groups.Results Disappearing time of infection symptoms and extubation rate in the observa-tion group were significantly shorter and less than those in the control group (P <0.05),and cura-tive effect and satisfactory degree toward nursing were significantly higher than those in the control group (P <0.05).Conclusion Levofloxacin tube sealing can effectively improve the infection symptoms of patients with venous port and reduce the extubation rate.

Objective To explore the effect of the brake type pillow on preventing the postoperative complication in breast cancer patients .Methods One hundred and sixty patients with modified radical mastectomy for breast cancer were divided into the control group and the observation group according to the random number table, each with 80 cases.The observation group received the brake type pillow , and the control group received the routine nursing .The incidence of postoperative subcutaneous drainage , the subcutaneous effusion , the skin flap necrosis and the paretic upper-limb edema were compared between two groups .Results The amount of postoperative subcutaneous drainage in the observation group was (276.59 ±163.10) ml, and was (431.72 ± 265.18) ml in the control group, and the difference was statistically significant (t=3.573,P<0.01).The incidence rate of subcutaneous effusion was 0.25%in the observation group , and was lower than 1.63%in the control group, and the difference was statistically significant (χ2 =8.901,P<0.01).The incidence rate of skin flap necrosis was 0.25% in the observation group, and was lower than 1.38% in the control group, and the difference was statistically significant (χ2 =6.782,P<0.01).No difference was found in the incidence of the paretic upper-limb edema between two groups (χ2 =0.592,P>0.05).Conclusions Application of the brake type pillow can reduce the subcutaneous drainage after the operation in breast cancer patients , and prevent the incidence of the subcutaneous effusion and the skin flap necrosis , and it is needed to further study to prevent the incidence of the paretic upper-limb edema .

Objective To explore the effects of individualized comprehensive intervention on complications during indwelling implantable venous access port (IVAP), so as to provide reasonable suggestion and theory evidence for reducing the incidence of IVAP complications. Methods We selected 400 breast cancer patients with IVAP. All of the patients were completely randomized divided into control group and experimental group. Patients of control group (n=200) received routine intervention including education before implanting IVAP and discharge instruction. On this basis of routine intervention, patients of experimental group (n=200) were treated with the individualized comprehensive intervention and enhancing continuous intervention out hospital aiming at common complications of IVAP. We compared patients' incidences of complications during IVAP between two groups. Results Patients' incidences of complications during IVAP in control group and experimental group were 27.0% and 7.5% respectively with a significant difference (P＜ 0.01). There were 12 patients with unplanned port drawing due to complications in control group and 3 in the experimental group with a significant difference (P＜ 0.05). Conclusions Individualized comprehensive intervention can effectively reduce the incidences of complications during IVAP, improve the utilization time and ratio of IVAP. Enhancing continuous intervention out hospital is also the important measure to decrease the incidence of severe complications.

Objective To explore the effect of maintenance of interval time on catheter blockage and infection for intravenous infusion port patients during the off-treatment time. Methods A total of 100 patients with implanted ports, who drew blood well every time, bolus fluently and had informed consent, were divided into experimental group and control group by random number table method on average. The maintenance carried once in the control group every 4 weeks, while it happened in the experimental group every 12 weeks. We compared the catheter blockage and infection between two groups. Results There had no catheter completely block,Ⅲ grade catheter block and infection in the two groups during the 72 weeks, but Ⅰand Ⅱ grade blockage happened. In the experimental group, there was 3 patients having I grade catheter block, and that of the control group was 2 with no statistically significant difference between two groups (χ2 =0. 211,P>0. 05). In the experimental group, there was 1 patients hadⅡgrade catheter block, and that of the control group was 2 with no statistically significant difference between two groups (χ2 =0. 344,P >0. 05). Conclusions The intravenous infusion port patients had no correlation between the length of maintenance and blockage with infection. The maintenance carried once every 4 weeks is easily accepted for patients.

Objective To explore the influence of extubation time of urinary catheter on post-operational urination and comfort degree of patients with orthopedic surgery, so as to and make clear the best extubation time of urinary catheter for them. Methods 900 patients treated with operation in Department of Orthopaedics in the Third Hospital of Hebei Medical University from April to June in 2016 were selected by convenience sampling and divided, according to extubation time of urinary catheter, into group A, B and C, each with 300 cases. For patients in group A, urinary catheters were removed in the morning the day after the operation(12~24 h after operation), while in group B, 6 h after, and in group C, 2 h after. Rate of successful urination after extubation of urinary catheter, bladder discomfort, incidence rate of acute urinary retention and comfort degree of indwelling catheter in the three groups were compared. Results Difference in rate of successful urination and incidence rate of frequent micturition, urgent urination, micturition pain and acute urinary retention of patients in the three groups showed statistic significance (P<0.05). It was shown in pairwise comparison that rates of successful urination in group A and B were higher than that in group C, while incidence rates of acute urinary retention were lower (P < 0.05), and that incidence rate of frequent micturition, urgent urination and micturition pain in group A was higher than that in group B and C (P<0.05). Difference in comfort degree of indwelling catheter in the three groups showed statistic significance (P < 0.05). Incidence rates of discomfort in degree Ⅱ in group B and C were less than that in group A, while incidence rate of discomfort in degree Ⅲ in group C was less than that in group A and B (P<0.05). Conclusions For orthopedic patients,the best extubation time of urinary catheter is 6 h after the operation, which helps to raise rate of successful urination, lower urethra irritative symptoms due to cathetering, and reduce bladder discomfort after extubation.

Objective To explore the correlation of MPV,NLR,PT,APTT and FIB with early pro-gression of ACI in patients with BAD.Methods A total of 303 ACI patients with BAD admitted in our department of neurology from October 2021 to September 2023 were consecutively recrui-ted,and according to their progression within 7 d of onset,they were divided into progression group(89 cases)and un-progression group(214 cases).The general clinical data,blood routine re-lated indicators(MPV,NLR)and coagulation related indicators(PT,APTT,FIB)were compared between the two groups.Multivariate logistic regression analysis was applied to identify the rela-tionship of above indicators with early progression of ACI in BAD patients.ROC curve was plot-ted to analyze the predictive value of the indictors for disease progression in these patients.Results The progression group had significantly advanced age,larger proportions of diabetes,hyperlipi-demia and stroke history,and increased levels of uric acid,LDL-C,homocysteine,MPV,platelet distribution width,NLR,D-dimer and FIB,and shorter TT,PT and APTT when compared with the un-progressed group(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that MPV,NLR,PT,APTT,and FIB were all independent influencing factors for early disease pro-gression of ACI in patients with BAD(P＜0.05,P＜0.01).ROC curve indicated that the AUC value of combined MPV,NLR,PT,APTT and FIB in detecting early disease progression was 0.859(95％CI:0.813-0.905).Conclusion Blood routine(MPV,NLR)and coagulation related indicators(PT,APTT,FIB)are closely associated with the early disease progression of ACI in BAD patients,and these indicators are of high value in predicting the early disease progression.