Objective To investigate the learning curve of peripherally inserted central catheter (PICC) switching operation, for providing a reference basis for the nurses switching operation. Methods The clinical data of 50 cases of switching operation by one nurse of stomach surgery in PICC outpatient service maintenance center were retrospectively analyzed from July to December in 2013. According to the order of operations, every 10 patients was a learning phase, and they were divided into five stages:group A with number 1 to 10, group B with number 11 to 20, group C with number 21 to 30, group D with number 31 to 40, group E with number 41 to 50. The time and score of switching operation were compared among 5 groups. Results The age of the participants was(49.78±14.87) years, and there were no significant differences in sex, age, tube parts, catheter indwelling time among 5 groups, P>0.05. The time of switching operation were (20.17± 0.82),(17.10± 0.47),(15.15± 0.23),(14.27± 0.15),(13.16± 0.09) min in group A, B, C, D, E. The score of switching operation were (80.00 ± 7.88), (91.60 ± 0.56), (93.10 ± 0.53), (93.20 ± 0.44), (93.90 ± 0.43) points in group A, B, C, D, E. There were significant differences in the time and score of switching operation among 5 groups, F=50.978, 23.787,P<0.01. Between two comparison groups, 20 cases, the time of switching operation appeared inflection point (P<0.05), 10 cases, the score of switching operation appeared inflection point (P<0.05). The time of switching operation of the first 20 cases was (19.04±0.51) min,and which of the later 30 cases was (14.45±0.09) min. The score of switching operation of the first 10 cases was (80.00±7.88) points, and which of the later 40 cases was (92.95±1.72) points. Conclusions After a learning curve of 20 switching operation, nurses can overcome the learning curve and master the skills of dressing change of PICC proficiently.

Objecive To evaluate and compare the efficacy of injecting tissue glue and lauromacrogol in modified sandwich method combined with synchronous ligation for patients with esophageal and gastric variceal.Methods 42 cases of patients with esophageal and gastric variceal were randomly divided into synchronous treatment group (22 cases) and sequential treatment group (20 cases). Both group received modiifed sandwich method for gastric varices (lauromacrogol-tissue adhesive-lauromacrogol). Synchronous treatment group meanwhile received synchronization ligation for esophageal varices, but sequential treatment group received sequential ligation after one week. The hemostasis rate, effective rate of varices, rebleeding and complications rate were analyzed.Results There were no signiifcant difference in hemostasis rate, effective rate and rebleeding rate between two groups. The incidence of complications, such as chest and abdominal pain, fever, transient bacteremia were equal between these two groups. No patients had ectopic embolism. The number of ligation device in synchronous treatment group was more than sequential treatment group (8.19 ± 2.01 vs 7.81 ± 1.78,P > 0.05), and the rate of esophageal varices disappearance was inferior to sequential treatment group (59.09% vs 70.00%), however, there were no statistical difference (P > 0.05).Conclusion Endoscopic injection of tissue glue and lauromacrogol synchronization ligation is safe and effective for esophageal and gastric variceal with low complication rates. This method could reduce gastroscopy times and medical expenses, and is worthy of further investigating.