Objective We observed influence of different handgrip exercise on the changes of blood flow velocity and blood vessel diameter of basilic vein before and after the PICC placement and discuss the best model for handgrip exercise.Methods 60 patients with PICC were chosen and divided into group A,B and C with 20 patients in each groups.Group A received routine guidance on unarmed handgrip exercise,group B used electronic handgrip,the frequency was 25 times/min,the time period was 2 min with 4 times a day,once every 4 hours,group C adopted the same model as that of group B and 6 times a day,once every 3 hours.The venous blood flow velocity and blood vessel diameter was measured by pulsed Doppler ultrasound one hour before the PICC placement and one hour,1 day,3 days,7 days,10 days,14 days,21 days after placement.Results The venous blood flow velocity before and after PICC placement had statistically significant differences at different time points (F=2.934,P ＜ 0.05).The effect of group B and C was better than that of the group A and group C showed the best effect.The blood vessel diameter before and after PICC placement had significant differences at different time points(F=3.940,P ＜ 0.05).There was significant differences in the blood vessel diameter 1h before and 1h after PICC placement.Conclusions Handgrip exercise can effectively promote the upper limb venous blood flow velocity in patients with PICC,but shows little effect on the blood vessel diameter.Using the electronic hand grip in weak tap position,25 times/min,2 min every time,and 6 times a day (once every 3 hours),can obviously promote the upper limb venous blood flow velocity.

Objective The objective of this study was to explore the construction of a comprehensive and systematic quality management system for pharmacy intravenous admixture service (PIVAS) and form quality management method and model reflecting distinct gradations,specific responsibility and all staff participation,so that we can provide safe and effective intravenous solutions for the patients and guarantee the quality and safety of intravenous infusion and improve management quality.Methods According to Quality Management Standards of PIVAS published by Ministry of Public Health and JCI Standard,with the theory and methods of feed forward control and delicacy management,by establishing and completing three-grade-quality management organization,defining the quality control indicators,selecting and demonstrating with the application of expert meeting method and Delphi method,a scientific quality control system was formed.Statistics on unreasonable prescriptions,adverse drug reaction of intravenous infusion,defect of pharmacy intravenous admixture and satisfaction of medical staff and patients were compiled and evaluated throughout the implementation of the practice changes in 38 wards.Results Significant differences were observed in various indicators,comparing statistics collected during 6 months of the same season throughout the implementation of the practice changes.x2 value was 160.54,21.39 and 10.29 by comparison of unreasonable prescriptions,adverse drug reaction and number of drug preparation errors.The satisfaction degree of medical staff and patients improved evidently,x2 value was 14.34 and 26.76.Conclusions The construction and implementation of three-grade-quality management system adapt to high-risk,high strength,high sense of responsibility,process-oriented and intensive management of PIVAS.The impact on the continuous improvement PIVAS quality and assurance in safety of intravenous infusion is remarkable.