Table of Content

10 May 2023, Volume 4 Issue 5 Previous Issue    Next Issue

Research Paper

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Development and application of a decision support manual for intravenous thrombolysis in patients with acute ischemic stroke YAO Ting, DOU Min, ZHANG Lixiang, MA Han 2023, 4 (5):  389-393.  doi: 10.3761/j.issn.2096-7446.2023.05.001 Abstract ( )   PDF (868KB) ( )   Save Objective To investigate the effect of decision aid manual in obtaining informed consent for intravenous thrombolysis in patients with acute ischemic stroke. Methods Patients with acute ischemic stroke who received intravenous thrombolysis in a tertiary class A hospital in Anhui Province from June 2019 to May 2021 were selected as study subjects by convenient sampling. They were divided into two groups according to admission time. 118 patients in the experimental group（June 2020 to May 2021）received informed consentmethod based on the decision-aid manual. 71 patients in the control group（June 2019 to May 2020）received the traditional informed consent method. The time from admission to signing the informed consent form by the family,the time from the visit of neurologist to signing the informed consent form,door-to-needle time（DNT）,and the achievement rate of DNT≤45 min were compared between the two groups. Results The time from admission to signing informed consent,time from neurologist's visit to signing informed consent,time from door to needle,and DNT≤45 min attainment rate in the experimental group were better than those in the control group, and the differences were statistically significant（P<0.001）. Conclusion The application of the decision aid manual in the informed consent conversation for intravenous thrombolysis in acute ischemic stroke patients shortened the time to obtain informed consent from the patient and the DNT time,and improved the timeliness of treatment for acute ischemic stroke patients. References | Related Articles | Metrics

Special Planning-Emergency Trauma Nursing

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Application of prehospital-inhospital information alert form for trauma patients in emergency handoffs DING Chuanqi, WANG Zhongying, LÜ Xuebing, ZHANG Xuefeng, WANG Sa, XU Caijuan, ZHAO Xiaogang, JIN Jingfen 2023, 4 (5):  394-398.  doi: 10.3761/j.issn.2096-7446.2023.05.002 Abstract ( )   PDF (907KB) ( )   Save Objective To explore the application of the “age,time,mechanism of injury,injuries,signs,treatment” （ATMIST）information alert form in prehospital-hospital handover of trauma patient. Methods We conveniently selected trauma patients from emergency department in a tertiary class B hospital in Zhejiang Province,108 trauma patients who received the traditional prehospital-hospital handover（June to July 2022）were included in the control group,and 93 trauma patients who received the ATMIST information alert form handover（August to September 2022）were included in the experimental group. The time of second handover,time to early trauma team activation,and healthcare provider satisfaction were compared between the two groups. Results The secondary handover time in the experimental group was 3（2,5）min,which was significantly lower than that in the control group 5（3,6）min（Z=-2.147,P=0.030）. The initiation of trauma care time in the experimental group was 0（-1,0）min,which was significantly earlier than that in the control group 0（0,0）min（Z=-2.161,P=0.031）. 93.33% of the healthcare workers considered it necessary to adopt the standardized information alert form,and 96.67% of the healthcare workers were satisfied with the ATMIST information alert form. Conclusion ATMIST information alert form was applied to prehospital-hospital early warning of trauma patients,which can significantly shorten the time of in-hospital secondary handover of trauma patients and activate the trauma treatment team earlier,and improve the recognition and satisfaction of health care personnel are higher. References | Related Articles | Metrics

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The introduction and preliminary clinical application of Hand Burn Severity Assessment Tool ZHANG Juan, CAI Juan, LI Haifen, YAO Miao 2023, 4 (5):  399-404.  doi: 10.3761/j.issn.2096-7446.2023.05.003 Abstract ( )   PDF (1006KB) ( )   Save Objective The evaluation tool of Hand Burn Severity（HABS）was introduced and its severity classification was identified after clinical application,and its clinical guiding significance was analyzed. Methods Forward translation,back translation and cross-cultural adaptation of HABS were conducted based on the Brislin translation model. Convenience sampling method was applied to select 40 patients with hand burn from June to August 2020 for pre-survey. The Chinese Hand Burn Severity（C-HABS）assessment tool was developed and the consistency among raters was judged. From September 2020 to December 2021,335 patients with hand burn were formally recruited to analyze the severity classification of hand burn,and C-HABS usability evaluation form was used to determine the clinical effect and practical guiding significance. Results In the preliminary application results,the Kappa value between the two raters was 0.695>0.60,which indicated a strong consistency level among raters. A total of 342 application forms of C-HABS evaluation tool were administered for official application,and 335 questionnaires were actually collected,with effective response rate of 97.95%. C-HABS scoring criteria：0~11 was rated as mild burn;12~21 moderate burn;22~28 severe burn;29~36 extremely severe burn. There were 96% of the 50 staff from Burn Department agreed that the C-HABS assessment tool considered hand anatomy;84% thought that the assessment result of hand burn was more accurate;90% of them thought that the quantitative evaluation of C-HABS hand burn was more instructive in clinical practice. Conclusion C-HABS assessment tool can quantify and grade the severity of hand burn patients,which is helpful for early identification of risks,timely initiation of emergency rescue,and effective implementation of inter-agency transport and hierarchical diagnosis and treatment. References | Related Articles | Metrics

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Cluster analysis of research hotspots in traumatic shock XIAO Yaru, CHENG Jing, WANG Hui, HUANG Sufang, LIU Yu, DENG Juan, WANG Lu, LI Zheying 2023, 4 (5):  405-413.  doi: 10.3761/j.issn.2096-7446.2023.05.004 Abstract ( )   PDF (1693KB) ( )   Save Objective This study analyzed the publications,research hotspots and trends of traumatic shock at home and abroad,so as to provide reference for relevant personnel in this field to carry out academic research on traumatic shock. Methods Related literatures on traumatic shock were retrieved from Web of Science（WOS）core collection database and CNKI database. Retrieval date was as of October 1,2022. VOSviewer 1.6.18 was used for visual cluster analysis. Results A total of 2 860 literatures were retrieved from CNKI and 832 literatures from WOS database. Shock and Trauma Surgery Journal ranked first in the number of publications of WOS and CNKI. Rutgers State University New Brunswick and Daping Hospital of Third Military Medical University ranked first in the number of publications respectively. The research hotspots of traumatic shock in CNKI focused on traumatic hemorrhagic shock,early treatment and nursing of traumatic shock,while the research hotspots of traumatic shock in WOS focused on traumatic hemorrhagic shock,basic research of traumatic shock and first aid. Conclusion The number of published papers on traumatic shock is basically on the rise,and basic research on traumatic shock is still a hot field. In the future,researchers can carry out more studies on basic research,early fluid resuscitation,efficient pre-hospital first aid,remote rapid treatment and comprehensive nursing intervention in this field. References | Related Articles | Metrics

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The investigation on the knowledge,attitude and behavior of doctors and nurses using Injury Severity Score in Gansu trauma centers MA Xiaoyan, ZHANG Li 2023, 4 (5):  414-419.  doi: 10.3761/j.issn.2096-7446.2023.05.005 Abstract ( )   PDF (963KB) ( )   Save Objective To investigate the status quo of knowledge,attitude and behavior of doctors and nurses using Injury Severity Score（ISS）in trauma centers of Gansu Province,and analyze the influencing factors. Methods From July to August 2021,404 doctors and 443 nurses from 24 trauma centers in Gansu Province were included by stratified cluster sampling method,and a cross-sectional survey was conducted using the self-made ISS knowledge and practice questionnaire for medical staff in trauma centers. Results ISS scored（7.15±1.89）points in applied knowledge dimension,（35.53±5.01）points in belief dimension and （30.14±7.34）points in behavior dimension. Multiple linear regression analysis showed that educational background,working years,previous understand of ISS and training related to ISS were the influencing factors for the total score of ISS application knowledge,attitude and behavior（P<0.01）. Conclusion The doctors and nurses in the trauma center do not have a comprehensive understanding of ISS knowledge,and their attitude is positive,but their behavior needs to be improved. Managers should improve the training system,pay attention to the combination of theory and practice,and strengthen the training of doctors and nurses in ISS application knowledge and behavior,so as to improve their knowledge,attitude and practice level of its application. References | Related Articles | Metrics

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Research progress of the application of transorbital ultrasound in early warning evaluation of traumatic craniocerebral injury BAO Yiping, ZHOU Yaoying, YU Zhenliang, ZHOU Yang 2023, 4 (5):  419-423.  doi: 10.3761/j.issn.2096-7446.2023.05.006 Abstract ( )   PDF (922KB) ( )   Save Transorbital ultrasound technology is a non-invasive,safe,real-time and objective quantitative method to evaluate pupil function and optic nerve sheath diameter,can provide real-time dynamic image,which is an effective and safe evaluation method for traumatic craniocerebral injury. This paper reviews the application of transorbital ultrasound technology in the early warning and evaluation of traumatic craniocerebral injury,introduces the overview of transorbital ultrasound technology,the specific implementation plan of transorbital ultrasound technology in the early warning and evaluation of traumatic craniocerebral injury,and introduce the effect evaluation of early warning and judging the severity of the disease,then summarizes the experience. It is expected to provide a new nursing evaluation tool for severe patients of neurosurgery. However,the evaluation criteria needs to be further established and improved,and the correlation between optic sheath diameter and pupillary function needs to be further studied. References | Related Articles | Metrics

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Research progress of vacuum sealing drainage technology in wound treatment of venomous snakebite patients DENG Chunhong, TAO Pinyue 2023, 4 (5):  424-429.  doi: 10.3761/j.issn.2096-7446.2023.05.007 Abstract ( )   PDF (1049KB) ( )   Save Vacuum sealing drainage（VSD）is a widely used wound treatment method. In recent years,VSD has achieved good clinical effects in the treatment of venomous snake bites. This paper reviewed the overview and mechanism of VSD,the application mode,application effect,nursing measures and precautions of VSD in venomous snake bite,in order to provide reference for the wound treatment of venomous snake bite patients. References | Related Articles | Metrics

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Nursing care of a severe trauma patient with extravasation caused by intraosseous infusion CHEN Fang, YANG Minfei, CHEN Bin 2023, 4 (5):  430-432.  doi: 10.3761/j.issn.2096-7446.2023.05.008 Abstract ( )   PDF (697KB) ( )   Save To summarize the nursing experience of intraosseous infusion extravasation in a patient with severe trauma. Aiming at the critical condition of the patient,emergency rescue,atypical signs of humerus fracture leading to humerus intraosseous infusion extravasation,the key nursing measures included rapid identification of extravasation and emergency treatment,ultrasound-guided suction of exudate,accurate partial closure,alternate external application of drugs to reduce swelling,accurate assessment of limbs and identification of progress. After 7 days of active treatment and nursing,the swelling of the patient's limb subsided. After 2 months of follow-up after discharge,the patient recovered well. References | Related Articles | Metrics

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Emergency nursing care of a patient with blunt neck trauma combined with concealed tracheal injury PAN Yinzhi, YANG Minfei, YAO Xiaoyue 2023, 4 (5):  433-435.  doi: 10.3761/j.issn.2096-7446.2023.05.009 Abstract ( )   PDF (676KB) ( )   Save To summarize emergency nursing experience of a patient with blunt neck trauma combined with concealed tracheal injury. In view of the complex situation of the patient's airway and nursing difficulties requiring rapid management to ensure airway safety,we adopted dynamic assessment of airway and implemented ladder management of respiratory support;implemented emergency tracheotomy operation management including preoperative material preparation,intraoperative cooperation and postoperative nursing. After emergency treatment and care,the patient's condition was stable,and transferred to the ICU for further treatment. On the 10th day of admission,the patient was stable and discharged. The patient was followed up for 2 months after discharge and was in good condition. References | Related Articles | Metrics

Emergency Care Research

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Nursing of a child with primary ciliary dyskinesia and secondary pleural effusion and hemoptysis WU Tingting, RUAN Juanjuan, WEI Qingyu, SHAO Hanqing 2023, 4 (5):  436-440.  doi: 10.3761/j.issn.2096-7446.2023.05.010 Abstract ( )   PDF (860KB) ( )   Save To summarize the nursing experience of a child with primary ciliary dyskinesia and secondary pleural effusion and hemoptysis. For the child with problems such as obstructed airway clearance,difficulty to effectively remove respiratory secretions and secondary pleural effusion and hemoptysis,we adopted using the phased airway clearance technique,cooperating with the doctor to perform the thoracentesis,paying close attention to the changes of the child's conditions,preventing asphyxia caused by massive hemoptysis,and taking various forms of psychological care to help the child ameliorate anxiety. After 12 days of careful treatment and nursing,the child was discharged from hospital in a stable condition. Follow-up of one year after discharge showed that the child was in good condition. References | Related Articles | Metrics

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Nursing care of a patient with erythroderma after traumatic liver rupture operation LIN Weixi, XU Juehua, LIU Shuai 2023, 4 (5):  440-443.  doi: 10.3761/j.issn.2096-7446.2023.05.011 Abstract ( )   PDF (735KB) ( )   Save To summarize the nursing experience of a patient with erythroderma after hepatectomy for traumatic hepatic rupture. In view of the patient's problems such as skin damage,severe swelling and fluid seepage,difficulty in venous catheter puncture and fixation,multi-drug-resistant bacteria combined with fungal infection,a multidisciplinary nursing collaboration team was quickly established to select appropriate intravenous catheters,do pipeline maintenance,prevent bacterial invasion of damaged wounds,take good skin care,and actively control infection. Scientific individualized nutrition management and lower extremity deep vein thrombosis treatment and nursing were implemented. We strengthened disease knowledge education and implemented cognitive reconstruction and negative emotion management strategies to improve patients' anxiety and depression. After 67 days of careful treatment and nursing,the patient's condition was improved and he was discharged. The patient was followed up for 3 months after discharge and recovered well. References | Related Articles | Metrics

Critical Care Research

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Nursing care of children with adrenalleukodystrophy undergoing hematopoietic stem cell transplantation ZHOU Hongqin, CHEN Xiuping, ZHU Jihua, ZHANG Chaolang, CHEN Xiaofei, CHE Yueping 2023, 4 (5):  444-446.  doi: 10.3761/j.issn.2096-7446.2023.05.012 Abstract ( )   PDF (744KB) ( )   Save To summarize the nursing experience of 2 children with adrenoleukodystrophy undergoing hematopoietic stem cell transplantation. According to their characteristics of progressive motor and swallowing function deterioration,and malnutrition after hematopoietic stem cell transplantation,a multidisciplinary treatment and nursing team was established to carry out nutritional risk screening and evaluation as soon as possible. We observed the changes of the disease closely,and identified the complications such as intestinal graft-versus-host disease and delayed hemorrhagic cystitis as early as possible,gave psychological support to children and parents to relieve anxiety. Individualized rehabilitation exercise and multidisciplinary joint follow-up plan was made to promote the early recovery of diseases. After careful treatment and nursing,2 children were discharged from hospital with normal bone marrow function. References | Related Articles | Metrics

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Postoperative nursing of patients with severe degenerative scoliosis undergoing staged minimally invasive surgery YU Qunfei, REN Ying, MA Yaojing, GUO Zhiting, XU Guoping 2023, 4 (5):  447-450.  doi: 10.3761/j.issn.2096-7446.2023.05.013 Abstract ( )   PDF (681KB) ( )   Save To summarize the nursing of staged minimally invasive surgical strategy in 12 patients with severe degenerative scoliosis.Aiming at the problem of psoas muscle strength decline,postoperative pain,high incidence of paralytic intestinal obstruction and restrictive ventilation disorder after stage Ⅰ surgery in this group of patients,guided psoas muscle strength exercise combined with microwave therapy was adopted. The principles of timing,fixed assessment tools,dynamic assessment and reassessment after intervention were followed to evaluate the pain changes of patients,and three-step multimodal drug intervention was implemented as soon as possible. Personalized exercise prescription was formulate and applied,a multi-channel prevention program was used for preventing paralytic ileus. A progressive breathing training program was developed and individualized psychological nursing and rational medication were used. After careful treatment and nursing,the length of hospital stay was from 10 to 14 days,and all patients were cured and discharged. References | Related Articles | Metrics

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Nursing care of a patient with multiple brain metastases from lung cancer and acute cerebral infarction accompanied by hemorrhag LÜ Zhanghong, YU Jiahui 2023, 4 (5):  451-454.  doi: 10.3761/j.issn.2096-7446.2023.05.014 Abstract ( )   PDF (788KB) ( )   Save To summarize the nursing experience of a patient with multiple acute ischemic cerebral infarction and hemorrhage caused by Trousseau syndrome and complicated with multiple tumor brain metastasis.In view of the mutation and rapid progress of the patient's condition,early identification of cerebral infarction related to Trousseau syndrome was adopted to improve the early warning ability of stroke and embolism risk. We strengthened the early warning and preventive measures of cerebral hemorrhage risk,and improved the ability to judge the risk of sudden death;monitored and regulated the stability of intracranial pressure and blood pressure to avoid aggravating cerebral infarction and cerebral hemorrhage;payed attention to the psychology of family members,communicated well and improve the function of family support system. We provided self-symptom monitoring based on case management mode,focused on nursing measures such as prevention of cerebral hemorrhage,enabled patients to get early detection,early warning,early diagnosis and early treatment. The patient was stable and discharge on the15th day of hospitali-zation. Two weeks of follow-up showed that the patient was in good condition without intracranial hemorrhage. References | Related Articles | Metrics

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Anticoagulation nursing of abnormal coagulation during extracorporeal model pulmonary oxygenation in a patient with systemic lupus erythematosus HE Zhili, WEI Zhengdeng, WANG Qiaojin, BAI Liping, GAO Mingrong 2023, 4 (5):  454-457.  doi: 10.3761/j.issn.2096-7446.2023.05.015 Abstract ( )   PDF (637KB) ( )   Save To summarize the experience of abnormal coagulation during extracorporeal membrane oxygenation in a patient with systemic lupus erythematosus complicated with pericardial tamponade. A multidisciplinary health care team was involved in the evaluation of anticoagulation risks and the formulation of anticoagulation protocols. An ECMO anticoagulant care team was set up to develop related anticoagulant nursing evaluation lists and procedures,monitor the anticoagulant effect. The evaluation and nursing of preventing thrombosis and lower limb ischemia were carried out throughout the whole process of treatment. After 17 d of treatment and nursing,the patient was stable and transferred back to the ward. References | Related Articles | Metrics

Quality and Safety

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The current status and influencing factors analysis of elderly non-urgent patients in emergency department YAO Xiaoyue, YANG Minfei, CHEN Fang, ZHANG Lanlan, SHEN Weidi, YANG Shilei 2023, 4 (5):  458-462.  doi: 10.3761/j.issn.2096-7446.2023.05.016 Abstract ( )   PDF (691KB) ( )   Save Objective To analyze the current situation of emergency room visits of elderly non-urgent patients and explore its influencing factors. Methods The clinical data of 34 133 elderly patients in 2020 were retrospectively analyzed. The patients were divided into two groups based on whether they were non-urgent patients. The differences of clinical indicators between the two groups were compared,and the influencing factors of emergency non-urgent elderly patients were analyzed by Logistic regression model. Results 29 206（85.57%）were non-urgent patients and 4 927（14.43%）were urgent patients. Binary Logistic regression analysis showed that medical departments were surgery（OR=2.118）,orthopedics（OR=4.671）and ENT departments（OR=6.472）,and other departments（OR=11.914）,patients who transferred by ambulance（OR=0.115）or other channels（OR=0.291）,summer visits（OR=0.783）or autumn visits（OR=0.568）were influencing factors for emergency visits in elderly non-urgent patients（P<0.05）. Conclusion The emergency visit rate of elderly non-urgent patients in ER is higher,triage personnel should pay attention to elderly patients who come to the hospital on foot,for non-medical treatment,and visits in summer and autumn,and can try to guide them to outpatient clinics or other treatment places to reduce emergency overcrowding. References | Related Articles | Metrics

Evidence Synthesis and Practice

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Evidence summary of frailty assessment in lung transplant patients GU Peipei, ZENG Fei, LIANG Jiangshuyuan, HU Xiaomin, GUO Luyao, ZHANG Jitao, CAI Lingyun, LU Juanjuan 2023, 4 (5):  463-468.  doi: 10.3761/j.issn.2096-7446.2023.05.017 Abstract ( )   PDF (858KB) ( )   Save Objective To summarize the best evidence of assessment of frailty in lung transplant patients and to provide evidence for improving the management of frailty in lung transplant patients. Methods We searched BMJ Best Practice, UpToDate,Canada Ontario Association of Registered Nurses,Nation Guidelines Clearinghouse in the United State,National Institute for Health Care Excellence in the United Kingdom,Australia Joanna Briggs Institute Evidence-Based Health Care Center Database,Cochrane Library,CINAHL,PubMed,CNKI,Wanfang Database and the website of the International Society of Heart Lung Transplantation for clinical guidelines,expert consensus,evidence summary and systematic review related to frailty in lung transplant patients and supplemented well-designed original studies.as well as well-designed original studies. The search period was from the establishment of database until September 2022. The quality of literature and the level of evidence were evaluated by the evaluation criteria and evidence grading system of JBI Evidence-Based Health Care Center. Results A total of 11 literatures were included,including 6 expert consensus papers,1 systematic review paper and 4 cohort studies. In total,14 pieces of best evidence of lung transplant patients' frailty assessment were obtained,including six aspects：assessment timing,evaluators,information sources,assessment sites,assessment tools and security. Conclusion It is suggested that lung transplantation centers develop specific risk assessment tools for screening patients with fraility based on fraility indicators. References | Related Articles | Metrics

Review

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Research progress of value-based nursing LUO Yating, WANG Sha, GAN Gang, DONG Xiaoqian, CAO Huan, LIU Min, DUAN Yinglong, XIE Jianfei 2023, 4 (5):  469-473.  doi: 10.3761/j.issn.2096-7446.2023.05.018 Abstract ( )   PDF (765KB) ( )   Save Value-based healthcare has become the focus of healthcare system reform. Nursing managers are facing multiple pressures such as cost and quality,which influence the value of nursing services. At present,value-based nursing research is still in its infancy,there is no accepted concept,and there is a lack of relevant measurement indicators and tools. This paper reviews the concept,research origin and significance of value-based nursing,and measurement indicators,analyzes application strategies of value-based nursing in clinical transformation. The connotation driving and clinical transformation of value-based nursing should be further sorted out to form a unified and standardized management in future research. References | Related Articles | Metrics

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Research progress of oral mucosal pressure injury in ICU patients with oral tracheal intubation LI Qian, WANG Lizhu, ZHU Yirong, FAN Fan 2023, 4 (5):  473-477.  doi: 10.3761/j.issn.2096-7446.2023.05.019 Abstract ( )   PDF (692KB) ( )   Save Oral mucosal pressure injury is the most common mucosal pressure injury in ICU,which can increase the pain of patients and seriously affect the quality of life of patients. This article reviews the epidemiology,assessment and staging,influencing factors and intervention measures of oral mucosal pressure injury,in order to provide reference for clinical medical staff to manage oral mucosal pressure injury in clinical practice and conduct further related research. References | Related Articles | Metrics

Technology Innovation

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Design and application of invasive blood pressure monitoring transducer fixture XU Juehua, LIU Shuai 2023, 4 (5):  478-480.  doi: 10.3761/j.issn.2096-7446.2023.05.020 Abstract ( )   PDF (567KB) ( )   Save Objective To design a transducer fixation device for invasive blood pressure monitoring and evaluate its application effect. Methods The transducer fixator was composed of adjustment belt,fixed base and bubble level. A total of 60 patients who underwent invasive blood pressure monitoring in intensive care unit from April 2021 to April 2022 were selected,and a retrospective control study was conducted. The pressure sensor was fixed by the bedside fixed rod in the control group,and the pressure sensor was fixed by the transducer fixation device in the experimental group for pressure measurement. The accuracy of blood pressure monitoring,the rate of transducer displacement or slip-off,skin injury and nurses' satisfaction were compared between the two groups. Results There was no significant difference between the two groups in the effect of different angle fixation methods on blood pressure（P>0.05）. The rate of transducer shedding in the experimental group was 0%,displacement was（0.80±1.45）cm and incidence of medical device-related pressure injury was 0%,which were significantly lower than those in the control group（P<0.05）. The overall satisfaction of nurses was better than that of the control group. Conclusion The invasive blood pressure monitoring transducer fixation device ensures the accuracy of pressure measurement,and is safe and convenient to use,with high satisfaction of nurses. References | Related Articles | Metrics