Objective:To analyze the status quo and influencing factors of accidental prolapse of peripherally inserted central catheter (PICC) in children, so as to provide references for formulating preventive measures.Methods:Using the convenient sampling method, a total of 1 268 pediatric patients who underwent catheterization at Intravenous Catheter Nursing Studio of Beijing Children's Hospital, Capital Medical University from January to December 2021 were selected as the research objects to analyze the incidence of PICC accidental prolapse. Logistic regression was used to analyze the influencing factors of PICC accidental prolapse.Results:Of the 1 268 children included in this study, 29 were excluded from follow-up and 1 239 children were eventually included. A total of 1 339 PICCs were implanted in 1 239 children, and the incidence of PICC accidental prolapse was 5.60% (75/1 339). Logistic regression analysis showed that whether the children had skin rash, time, location and catheter indentation time were the influencing factors for the occurrence of PICC accidental prolapse ( P<0.05) . Conclusions:The incidence of children's PICC accidental prolapse is at a high level, which is affected by many factors. Nursing staff should formulate effective preventive measures according to the influencing factors of PICC accidental prolapse, reduce the occurrence of children's accidental catheterization and extend the retention time of PICC.

Objective:To investigate the effects of high-flux versus low-flux hemodialysis on end-stage renal disease in older adults and evaluate its effects on myocardial injury indexes and micro-inflammatory response indexes. Methods:Seventy-two patients with ESRD who received treatment in Affiliated Hospital of Shaoxing University from January 2019 to January 2020 were included in this study. They were randomly assigned to receive either low-flux hemodialysis (control group, n = 36) or high-flux hemodialysis (observation group, n = 36). All patients received 6 months of treatment. Micro-inflammatory response indexes and renal function indexes pre- and post-treatment, and reverse reactions were observed in each group. Results:Serum interleukin-6, tumor necrosis factor α, and high-sensitivity C-reactive protein levels post-treatment in the observation group were (7.16 ± 1.32) ng/L, (2.10 ± 0.36) pg/L, (2.20 ± 1.06) mg/L respectively, which were significantly lower than those in the control group [(10.45 ± 1.42) ng/L, (5.22 ± 0.65) pg/L, (3.84 ± 1.57) mg/L, t = 10.19, 25.19, 5.19, all P < 0.001]. Serum parathyroid hormone, B-type natriuretic peptide, and cardiac troponin T levels post-treatment in the observation group were (520.36 ± 95.65) pmol/L, (0.45 ± 0.10) μg/L, (15.05 ± 6.37) ng/L, respectively, which were significantly lower than those in the control group [(830.25 ± 102.35) pmol/L, (0.85 ± 0.13) μg/L, (30.25 ± 6.59) ng/L, t = 13.27, 14.63, 9.95, all P < 0.001]. The total response rate was significantly higher in the observation group than in the control group [75.00% (27/36) vs. 47.22% (19/36), χ2 = 3.85, P < 0.05]. The overall incidence of adverse reactions was significantly lower in the observation group than in the control group [19.44% (7/36) vs. 41.67% (15/36), χ2 = 4.18, P < 0.05). Conclusion:High-flux hemodialysis can highly improve the control effect of micro-inflammatory responses and alleviate myocardial injury in older adult patients with end-stage renal disease. High-flux hemodialysis is more effective and safer than low-flux hemodialysis.

Objective:To retrieve, evaluate, and summarize the best evidence for peripherally inserted central catheter (PICC) related thrombosis in children.Methods:Guideline websites, relevant society websites, and databases at China and abroad were searched for guidelines, evidence summaries, expert consensuses, and systematic reviews related to thrombosis before and after PICC catheterization in children published up to June 30, 2021 based on evidence-based nursing. The quality of the literature was independently evaluated by 2 researchers with reference to Appraisal of Guidelines for Research and Evaluation InstrumentⅡ and the criteria of the Joanna Briggs Institute (JBI) in Australia (2016) . Data were extracted from the literatures that met the standards through expert demonstration, and the evidence was graded and recommended according to the JBI evidence pre-grading system (2014 edition) .Results:A total of 11 articles were included, including 4 guidelines, 1 systematic review, 1 expert consensus, and 5 evidence summaries. 27 pieces of evidence were summarized from 7 aspects: organizational management, catheter selection, blood vessel selection and puncture, location of catheter tip, physical prevention, drug prevention, and evaluation.Conclusions:This paper summarizes and analyzes the best evidence for PICC-related thrombosis in children and provides an evidence-based reference for the clinical application and practice of PICC-related thrombosis in children.

Objective:To explore the pain perception and cognition of children with malignant tumor and their parents during the disease treatment.Methods:Using the convenient sampling method, a total of 179 children with malignant tumors and their 179 parents who were admitted to the day ward of Hematology and Oncology Center of Beijing Children's Hospital, Capital Medical University from June 2017 to February 2019 were selected as the research objects. The children and their parents were surveyed by using the self-developed Pain Questionnaire for Children with Malignant Tumor and the Pain Questionnaire for Parents of Children with Malignant Tumor. A total of 179 questionnaires were distributed, 179 valid questionnaires were recovered, and the effective recovery rate was 100.0%.Results:The incidence of pain during treatment in 179 parents and 179 children was 100.0% (179/179) and 98.3% (176/179) , respectively. The average scores of 179 parents and 179 children who considered the most severe pain during disease treatment were respectively (5.82±2.30) and (5.41±2.09) , and the average pain scores were (4.04±1.90) and (3.95±1.66) , respectively. There were statistically significant differences in pain perception between children and their parents during lumbar puncture/thecal injection, bone puncture, PICC catheter placement, indwelling needle puncture and venous blood collection ( P<0.05) . A total of 77.1% (138/179) of parents and 65.4% (117/179) of children had concerns about the use of analgesics, respectively. Conclusions:There is a high consistency between the severity of pain experienced by parents and the children's feelings during treatment. However, the parents feel that the unbearable treatment-related pain during the treatment of the disease is higher than that of children, and they are more passive than children in the attitude of receiving analgesics. Medical staff can listen to their parents' opinions during pain assessment, pay attention to education of parents before treatment-related operations, take measures to reduce or even avoid the occurrence of treatment-related pain and strengthen the training of pain relief measures.

Objective:To retrieve and summarize the best evidence of peripherally inserted central catheters (PICC) related bloodstream infection prevention and to evaluate the evidence, so as to provide reference for clinical implementation of preventive measures for catheter-related bloodstream infection.Methods:National Institute for Health and Care Excellence (NICE) , National Guideline Clearinghouse (NGC) , Guidelines International Network (GIN) , Scottish Intercollegiate Guidelines Network (SIGN) , Australian Joanna Briggs Institute (JBI) Evidence-based Health Centre Database, UpToDate, BMJ Best Practice, Cochrane Library, China National Knowledge Infrastructure (CNKI) , Wanfang and related professional websites such as Infusion Nursing Society (INS) , Medlive and official website of the National Health Commission were searched for all clinical decisions, guidelines, expert consensus, evidence summary and systematic reviews related to the prevention of PICC catheter-related bloodstream infections. The retrieval time limit was from the establishment of the databases to May 2021. Four researchers evaluated the quality of the literature, and two researchers extracted and summarized the evidence.Results:A total of 9 articles were included, including 1 clinical decision, 1 standard of practice, 4 guidelines and 3 evidence summaries. Finally, 29 pieces of evidence were included from 5 dimensions, including organization management, infusion tool selection, catheterization maintenance and use, health education and extubation.Conclusions:The summary of the best evidence for the prevention of PICC related bloodstream infection covers a wide range of areas. Managers and clinical medical staff should apply the evidence according to the specific medical situation to reduce the occurrence of clinical PICC catheter-related bloodstream infection.

Objective:To investigate the complication and compliance of different supine time and the degree of obedience in children with leukemia after intrathecal chemotherapy.Methods:A total of 553 children with leukemia after intrathecal chemotherapy from April 1, 2017 to March 28, 2019 in Beijing Children′s Hospital Affiliated to Capital Medical University were selected. Children who received intrathecal injection from April 1, 2017 to December 31, 2017 were selected as control group(274 cases), from January 1, 2018 to March 28, 2019 were selected as research group(279 cases). The children in research group were supine 2 hours but control group were supine 4 hours after intrathecal. The complications that occurred after injection and within one week after injection and compliance were observed.Results:Finally, 457 children included in this study, there were 235 cases in research group and 222 cases in control group. The number of cases of limb numbness and local pressure reddening in the research group and the control group were 18, 20 and 31, 34, respectively, with statistically significant differences between the two groups( χ2 values were 4.74, 5.07, P<0.05). After intrathecal injection, the patients' compliance with the time of supine removal was completely acceptable to the research group, relatively acceptable, acceptable, and required efforts to adhere to the number of cases were 65, 83, 42, 45, respectively, while the control group were 34, 50, 76, 62, respectively, the differences were significant ( χ2 value was 30.04, P<0.05). Conclusions:Supine for 2 hours after intrathecal injection can reduce the incidence of complications and improve compliance, which is safe and feasible. So, supine for 2 hours after intrathecal injection is recommended.

Objective To explore the occurrence of pain in the treatment of children with malignant tumors and their perception and cognition of pain, and provide a reference for strengthening pain management and formulating clinical nursing measures. Methods Totally 179 children with malignant tumors admitted in the daytime wards of a Class Ⅲ Grade A children's hospital in Beijing from June 2017 to October 2018 were selected and investigated with the self-made pain questionnaire for children with malignant tumors. Totally 179 questionnaires were distributed and collected in this study, accounting for an effective recovery rate of 100％. Results The incidence of pain in the 179 children was 98.3％ (176/179). The severest pain score was (5.41±2.09), and the average pain score was (3.95±1.66). Pain involved the abdomen, lower limbs, oral mucosa, bones and joints, waist, back, upper limbs, chest, perianal mucosa, neck, head and face, perineum, ear, nose, throat and eyes. Totally 83.8％(150/179) of the children informed the medical staff in time when the pain occurred, hoping to get analgesic treatment; 35.2％ of the children were willing to receive analgesics. In the 179 Children, the children believed that 84.6％ of the pain was related to the treatment procedure; 46.6％ (82/179) was related to the disease itself; and the most unbearable treatment procedure was lumbar puncture/ intrathecal injection. Conclusions Children with malignant tumors have a higher incidence and severity of pain during the treatment of the disease, and the pain is widespread. Most children hope to receive analgesic treatment, but they do not have enough knowledge about analgesics. Medical staff should pay attention to the pain of children with malignant tumors, strengthen pain management, and take measures to reduce and even avoid treatment-related pain.

Objective:To evaluate the effect of acupoint stimulation on the prevention of anticipatory chemotherapy-induced nausea and vomiting by using Cochrane systematic review method.Methods:Wanfang database, China National Knowledge Infrastructure (CNKI) , VIP Chinese Science and Technology Journal Full-text Database, SinoMed, Cochrane Library, PubMed, EMbase, Elsevier, Springer, ClinicalKey for Nursing were searched by computer, which were supplemented by Internet retrieval, and the retrieval time was from set of these databases to November 2019. All randomized controlled trials and semi-randomized controlled trials that explored acupoint stimulation for the prevention of anticipated chemotherapy-induced nausea and vomiting were collected. The quality was evaluated by reference to Cochrane Handbook 5.1.0, and the data were analyzed with RevMan 5.0 software.Results:A total of 5 papers were included (544 adult tumor inpatients, 269 in the intervention group and 275 in the control group) , of which 2 were randomized controlled trials and 3 were semi-randomized controlled trials. All literatures were grade B in quality. There were 3 kinds of acupoint stimulation involved, which were auricular therapy, acupoint massage and acupoint application. Meta-analysis results showed that only the subgroup analysis of acupoint application (184 patients) showed that the intervention group was superior to the control group in terms of the control effect of chemotherapy-induced nausea and vomiting ( RR=1.12, 95% CI 1.03-1.23, P=0.01) . Other results showed no statistically significant difference between the intervention group and the control group, either in the Meta-analysis of all literatures, or in the subgroup analysis based on different types of nausea and vomiting, different time of occurrence, whether the intervention group combined with antiemetic drugs or auricular therapy intervention ( P>0.05) . In the Meta-analysis of adverse reactions, 3 literatures analyzed the occurrence of adverse reactions, among which 2 literatures did not observe adverse reactions, and 1 literature showed that the incidence of adverse reactions in the intervention group (22%) was lower than that in the control group (52%) . In the Meta-analysis of depression scores, two literatures (260 patients) evaluated depression scores, using random effect model. The results showed that the depressive symptoms score of the intervention group was lower than that of the control group ( MD=-11.72, 95% CI -19.82-3.62, P=0.005) . In the Meta-analysis of quality of life, 2 literatures evaluated the improvement of quality of life. Since the data could not be combined and only descriptive analysis was performed, the results suggested that auricular therapy could improve quality of life of patients. Conclusions:Acupuncture point stimulation is not yet considered to relieve anticipatory chemotherapy-induced nausea and vomiting, but it does not increase the risk of adverse reactions and it can reduce depressive symptoms.

Objective To study the changes of cytokines in aqueous humor of patients with proliferative diabetic retinopathy (PDR)after intravitreal bevacizumab (IVB) and the correlation of these cytokines.Methods Fifty-six patients(63 eyes) with severe PDR underwent pars piana vitrectomy (PPV) with IVB pretreatment in our hospital from April,2014 to February,2015 were collected.All the patients received IVB therapy from 3 days to 7 days before PPV.Aqueous humor samples were collected at the time of IVB and PPV treatment.The concentrations of vascular endothelial growth factor (VEGF),interleukin-6 (IL-6),interleukin-8 (IL-8) and monocyte chemotactic protein-1 (MCP-1) were measured by cytoinetric bead array (CBA).The changes of these cyto-kines after IVB were analyzed by using Wilcoxon rank sum test for paired data.The correlation between these cytokines was analyzed by using Spearman rank test.Results From 3 days to 7 days after IVB,the concentration of VEGF in aqueous humor was (6.57 ± 12.29)pg · mL-1,lower than the pre-operation of (278.71 ±340.20)pg · mL-1,the difference was statistically significant (P ＜ 0.05).The concentration of IL-8 was (385.60 ± 1099.47) pg · mL-1,higher than pre-operation of(298.87 ± 1005.79) pg ·mL-1,the difference was statistically significant (P ＜ 0.05).IL-6 and MCP-1 were increased after IVB,but the difference was not statistically significant (all P ＞ 0.05).VEGF,IL-6,IL-8 and MCP-1 had an obviously relationship between each two factors(all P ＜ 0.05).Conclusion Angiogenesis in patients with PDR are regulated by a variety of cytokines,and targeted reduction of VEGF may compensatory increase the concentration of other inflammatory cytokines.

This paper summarized nursing experience of 11 patients with refractory or relapsed neuroblastoma who developed CAR-T adverse reaction after receiving the transfusion.Nursing key points included:close monitoring of changes of vital signs,especially body temperature and blood pressure;observation of changes of skin,avoiding scratching when skin rash occurred,and daub calamine lotion was applied;strict recording input and output volume of 24 hours,ensuring patency of venous catheters and constant infusion of liquid,observing changes of urine volume and color;strengthening prevention of infection,strict operation of antiseptic technique,protective isolation when moving in laminar flow clean room;monitoring changes of face,breathing,blood oxygen and so on.Through careful treatment and nursing care,the treatment of children was ensured.