ObjectiveTo discuss two fixation methods of nasotracheal intubation on the occurrence of nasal pressure sores in patients with maxillofacial surgery.MethodsThree hundred cases of patients under general anesthesia more than 4 hours with the nasal endotracheal intubation were randomly assigned into control group and experiment group with 150 cases in each group.In control group,medical tape was used to fix the endotracheal tube to dorsum,wrapping around the joint of endotracheal tube and threaded pipe.In experiment group,Mepilex foam dressing was used to wrap over the bend of endotracheal tube,with gauze covering the joint of endotracheal tube and threaded pipe before fixing the endotracheal tube to dorsum.Finally,the occurrence of pressure sores from the end of surgery to postoperative 1day were compared between the two groups.ResultsThe incidence of patients with first stage pressure sores was 4.7% in control group while none in experiment group.The incidence of nasal pressure sores was much lower in experiment group than that in control group (P<0.05).ConclusionsThe use of Mepilex foam dressing can reduce the pressure and friction between the endotracheal tube and the dorsum,which effectively prevents nasal pressure sores caused by endotracheal intubation.Therefore when having surgery with nasal general anesthesia and nasotracheal intubation and lastsing over 4 hours,the use of application covering the bend of endotracheal tube can prevent nasal pressure sores.

Objective:To investigate the effect of care bundles on prevention of nasal medical device-related pressure injury in patients with nasotracheal intubation undergoing oral and maxillofacial surgery under general anesthesia.Methods:This was a retrospective study. Using the convenient sampling method, patients with a surgical time more than 4 hours and a surgical grade of 3 or 4, with nasotracheal intubation undergoing oral and maxillofacial surgery under general anesthesia from Hospital of Stomatology, Sun Yat-sen University were selected. A total of 96 patients from July to December 2019 were in the control group, and 99 patients from July to December 2020 were selected as the observation group. The control group was treated with routine nursing measures, the observation group was subjected to a nursing care bundle. The incidence of nasal pressure injury was observed after the operation, 24, 48, 72 hours after the nasotracheal intubation was removed, and patients′ satisfaction score was compared.Results:The incidence of nasal pressure injury in the control group was 6.25% (6/96). None of the patients in the observation group had any pressure injury, which was significantly lower than the control group (Fisher exact probability method, P=0.013). The satisfaction scores in the observation group was significantly higher than that in the control group (26.88 ± 1.94 vs 24.71 ± 3.33), the difference was statistically significant ( t=-5.54, P<0.01). Conclusions:The care bundle can effectively prevent the occurrence of nasal pressure injury in patients undergoing oral and maxillofacial surgery with nasotracheal intubation and improve patient satisfaction.

Objective To discuss failure mode and effects analysis (FMEA) in reducing the surgical patient’s postoperative indwelling pathologic specimens error rate and effective control of the specimen quality inspection application .Methods We established the FMEA team and set “reduce postoperative indwelling pathologic specimen error rate” as the theme.According to the process of drawing , analysis, calculation of risk assessment code (RAC) and risk priority number (RPN), evaluation the results, etc, we investigated all the postoperative indwelling pathologic specimen situations and analyzed the cause of error specimen lien .Then corresponding countermeasures were made and applied .At last, we checked the effect .Results After the implementation of FMEA , the postoperative indwelling pathologic specimen error rate for the surgical patients decreased from 13.11% to 0.00%.Conclusions FMEA is very effective in reducing the surgical patient ’ s postoperative indwelling pathologic specimens risk and is worthy of generalizing .