This study summarized the nursing experience of midline catheter insertion in 12 patients with a body mass index≥50,providing clinical references.Key nursing interventions included:pre-insertion patient positioning was adjusted to semi-Fowler's or sitting position based on respiratory status.The puncture sites were chosen at the middle or distal third of the upper arm with elbow flexion.The widened tourniquets and extended-length needles/catheter sheaths were used according to vascular depth and puncture angle.The modified pre-insertion length measurement and real-time ultrasound-guided vascular puncture were applied.The catheter with crisscross elastic bandage was secured post-insertion.All 12 patients successfully underwent catheterization,with devices removed after completing intravenous therapy and blood sampling.

To summarize the perioperative nursing experience of a patient with thoracic and abdominal aortic dissection aneurysm after Stanford type A aortic dissection surgery,who underwent intra-abdominal aortic aneurysm endovascular isolation,in situ fenestration branch covered stent placement,and artificial blood vessel bypass.The nursing points include regular evaluation of the intra-abdominal pressure of the patient,being on guard against the rupture of the dissection;specialist nurses participated in the preoperative multidisciplinary discussion;establishing an emergency plan for the rescue of ruptured aortic dissection;monitoring the vital signs of patients closely to prevent critical complications during surgery.After multidisciplinary treatment and meticulous care,the patient's surgery went smoothly and the postoperative recovery was good.The patient was discharged 8 days later.

This study summarized the nursing experience of midline catheter insertion in 12 patients with a body mass index≥50,providing clinical references.Key nursing interventions included:pre-insertion patient positioning was adjusted to semi-Fowler's or sitting position based on respiratory status.The puncture sites were chosen at the middle or distal third of the upper arm with elbow flexion.The widened tourniquets and extended-length needles/catheter sheaths were used according to vascular depth and puncture angle.The modified pre-insertion length measurement and real-time ultrasound-guided vascular puncture were applied.The catheter with crisscross elastic bandage was secured post-insertion.All 12 patients successfully underwent catheterization,with devices removed after completing intravenous therapy and blood sampling.

To summarize the perioperative nursing experience of a patient with thoracic and abdominal aortic dissection aneurysm after Stanford type A aortic dissection surgery,who underwent intra-abdominal aortic aneurysm endovascular isolation,in situ fenestration branch covered stent placement,and artificial blood vessel bypass.The nursing points include regular evaluation of the intra-abdominal pressure of the patient,being on guard against the rupture of the dissection;specialist nurses participated in the preoperative multidisciplinary discussion;establishing an emergency plan for the rescue of ruptured aortic dissection;monitoring the vital signs of patients closely to prevent critical complications during surgery.After multidisciplinary treatment and meticulous care,the patient's surgery went smoothly and the postoperative recovery was good.The patient was discharged 8 days later.

Objective To explore the current situation and influencing factors of caregiver readiness of elderly patients with chronic heart failure.Methods From March 2021 to April 2022,the convenient sampling method was used to select 335 caregivers of elderly patients with chronic heart failure who were hospitalized in 6 hospitals in Hangzhou as the survey subjects.The general information questionnaire,Caregiver Readiness Scale and Caregiver Burden Scale were used to investigate the caregivers of elderly patients with chronic heart failure.Results A total of 326 valid questionnaires were collected.The score of Caregiver Readiness Scale for elderly patients with chronic heart failure was(18.88±6.36),and 61.04%of the caregivers had mild to moderate burden.The results of multiple linear regression analysis showed that the caregiver's age,education level and cumulative care time were the positive influencing factors of the caregiver readiness,and the caregiver burden was the negative influencing factor of the caregiver readiness(P＜0.001).Conclusion The caregiver readiness of elderly patients with chronic heart failure is at a medium level.Caregivers who are older,more educated,have a longer cumulative caregiving time,and have a lighter caregiving burden are more prepared.Medical staff should pay attention to the motivation of caregivers,provide professional support from multiple aspects,and reduce the burden of care,increase readiness level.

This report presents the nursing care for a surgical patient with esophageal cancer who received immunotherapy before surgery and developed severe immune checkpoint inhibitor-related pneumonia and anastomotic fistula postoperatively.Key points of nursing:establishing a multidisciplinary case management team to develop personalized intervention programs;vigilantly monitoring disease progression,promptly identifying and treating immune checkpoint inhibitor-related pneumonia;early identification of anastomotic fistula and standardized management to reduce the risk of septic shock;assessing nutritional risks and providing sequential nutritional support;implementing a phased individualized pulmonary rehabilitation strategy based on Kanowski's health status score.After 88 days of comprehensive treatment and meticulous nursing care,the patient was discharged in a recovered state.Regular follow-up was conducted after discharge,and the patient recovered well.

Objective To compare the effects of mini-midline catheters that were placed in different sites.Methods The inpatients of a tertiary general hospital in Zhejiang Province from October 2023 to January 2024 were selected as the study subjects using a fixed point continuous convenience sampling method.The patients were divided into 2 groups by simple random grouping method.The experimental group had a mini-midline catheter placed in the upper arm,and the control group had a mini-midline catheter placed in the forearm.The incidence of catheter-related complications,the puncture success rate with one-attempt,the total procedure time,the time of the first occurrence of catheter-related complications,the rate of removal due to complications,and the indwelling catheter duration were compared between the 2 groups.Results A total of 121 patients were included,including 64 in the experimental group and 57 in the control group.The incidence rates of catheter-related complications in the experimental group and the control group were 29.69％and 66.67％;the times of the first occurrence of catheter-related complications were 167(122,220)h and 104(73,168)h;the rates of removal due to complications were 17.19％and 42.11％;the indwelling catheter duration was 171(124,258)h and 120(92,187)h;the differences between the 2 groups of these outcomes were statistically significant(P＜0.05).The puncture success rates with one-attempt in the experimental group and the control group were 96.88％and 96.49％;the total procedure times were 352(296,446)s and 370(295,430)s;the differences between the 2 groups of these outcomes were not statistically significant(P＞0.05).Conclusion Mini-midline catheters inserted in the upper arm can reduce the incidence of catheter complications and the rate of removal due to complications,prolong the time of the first occurrence of catheter-related complications and the indwelling catheter duration.

Objective To investigate the current status of off-label drug use(OLDU)management in tertiary hospitals of Guizhou province and to provide baseline evidence for developing a unified administration regulation for OLDU in Guizhou province.Methods In line with the relevant policies and regulations,a questionnaire including basic information about the person filling out the form,basic information about the hospitals,and information about OLDU was developed.The questionnaire was sent to 84 tertiary hospitals in Guizhou province through the Wenjuanxing.Results A total of 84 questionnaires were distributed and recovered,with a response rate of 100.00%.Of the 84 hospitals,77 had OLDU,of which 68(88.31%)had established a management system for OLDU.Among the 77 hospitals with OLDU,65(84.42%),42(54.55%),58(75.32%),36(46.75%),15(19.48%),and 21(27.27%)hospitals respectively,required approval from the Committee on Drug Administration and Pharmacotherapy before OLDU,restricted the qualifications of doctors prescribing OLDU,required informed consent from patients or their families before OLDU,recorded the matters and reasons in the medical records of patients treated with OLDU,followed up patients in their files and evaluated the reasonableness of the OLDU,and carried out special reviews for OLDU.Only 30(38.96%)hospitals have set up a catalogue of OLDUs,and 58(75.32%)hospitals have urgent needs to set up a unified provincial catalogue of OLDUs.Conclusion The pharmacy administration level of OLDU in tertiary hospitals of Guizhou province is relatively low,so there is an urgent need to establish a unified OLDU management system and medication catalog.

Objective:To explore the effects of infusion of irritant medications on the patients with midline catheter based on propensity score matching method and provide reference for medications infusion through midline catheter.Methods:Through a retrospective cohort study, the clinical data of 1 539 patients with midline catheter placement in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from March 2019 to October 2022 were retrospectively analyzed, and the patients were divided into irritant medications group ( n=1 120) and non-irritant medications group ( n=419) according to the characteristics of the medications they were infused with, and then compared the patients of the two groups with midline catheter-related complications and catheter indwelling time based on the propensity score matching. Results:Among 1 539 patients, there were 656 males and 883 females, aged 18-92 (59.30 ± 18.76) years old. Before propensity score matching, there were statistically significant differences in age: (58.09 ± 18.72) years old, (62.55 ± 18.50) years old; hypertension:496 cases, 210 cases; diabetes:266 cases, 129 cases; white blood cell count:7.50(5.50, 9.70) × 10 9/L, 7.00(5.10, 9.50) × 10 9/L between the irritant medications group and non-irritant medications group ( t=4.18, χ2=4.18, 7.92, Z=-1.98, all P<0.05). After propensity score matching, there were 412 patients in the irritant medications group and 412 patients in the non-irritant medications group, and there was no significant difference in the general data between the two groups (all P>0.05). After propensity score matching, the rates of oozing, bleeding, catheter occlusion, catheter-related thrombosis, catheter dislodgement and total catheter complications between the two groups showed no statistically significant difference (all P>0.05). The catheter indwelling time in the irritant medications group was 10.00 (5.25, 16.75) days, which was longer than that in the non-irritant medications group for 6.00 (4.00, 11.00) days, the difference was statistically significant ( Z=-7.25, P<0.05). Conclusions:Infusion of irritant medications has no effect on the outcome of midline catheter, but monitoring and catheter maintenance should be strengthened in order to reduce the occurrence of cutheter related complications.

Objective:To construct a postoperative exercise management program for elderly patients with lung cancer based on social cognitive theory, and to provide guidance for improving the postoperative exercise ability of elderly patients with lung cancer.Methods:Systematically searched UpToDate, PubMed, Web of Science, Cochrane Library, Medlive, Wanfang, CNKI and other databases for relevant literature on postoperative rehabilitation exercise for elderly patients with lung cancer, with the search time from the establishment of the database to February 13, 2023. Guided by social cognitive theory, a preliminary draft of the postoperative exercise management program for elderly patients with lung cancer was prepared based on the literature research, and the final draft was formed after revising the program content through expert meeting method.Results:The questionnaire recovery rate of expert meeting method was 12/12; the expert authority coefficient was 0.892; the importance coefficient of variation of each item was 0-0.150; the Kendall coordination coefficient was 0.262 ( P<0.001); the final exercise management program included 5 first-level items, 18 second-level items and 42 third-level items. Conclusions:The process of constructing the postoperative exercise management program for elderly patients with lung cancer has scientificity and reliability, and the content has rationality and comprehensiveness, which can provide guidance for improving the postoperative exercise rehabilitation of elderly patients with lung cancer.