Table of Content

10 June 2023, Volume 4 Issue 6 Previous Issue    Next Issue

Research Paper

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Construction and application of perioperative pulmonary rehabilitation program in patients with severe scoliosis MA Yaojing, YU Qunfei, WANG Xinxin, REN Ying, XU Guoping, YUAN Zhe 2023, 4 (6):  485-492.  doi: 10.3761/j.issn.2096-7446.2023.06.001 Abstract ( )   PDF (1153KB) ( )   Save Objective To establish a pulmonary rehabilitation program for patients with severe scoliosis during perioperative period,and to discuss its clinical effect. Methods Literature analysis and expert consultation were used to construct the perioperative pulmonary rehabilitation program for patients with severe scoliosis. A total of 28 patients with severe scoliosis admitted from July 2021 to October 2022 to a tertiary Grade-A hospital in Hangzhou were selected as the experimental group and 30 patients with severe scoliosis admitted from January 2020 to June 2021 as the control group by convenient sampling method. The experimental group received perioperative pulmonary rehabilitation program for patients with severe scoliosis on the basis of routine nursing,and the control group received routine nursing. The differences of pulmonary ventilation function,6-minute walking test distance,and incidence of pulmonary complications between the two groups were compared. Results One week after surgery and one month after surgery,the percentage of forced expiratory volume in onet second of the predicted value,the percentage of forced vital capacity in the predicted value,the percentage of vital capacity in the predicted value and the 6-minute walking distance of the experimental group were higher than those of the control group,the differences were statistically significant（P<0.05）. One week after surgery,the incidence of pulmonary complications was statistically different between the two groups（χ2=40.069,P<0.001）. One month after surgery,no pulmonary complications occurred in both groups. No fall,acute motor injury or cardiovascular adverse events occurred in the two groups during pulmonary rehabilitation. Conclusion Perioperative pulmonary rehabilitation is beneficial to improve postoperative pulmonary ventilation function and short-term activity ability in patients with severe scoliosis,and reduce the incidence of pulmonary complications. In the future,follow-up time can be further extended to determine the long-term effect of perioperative pulmonary rehabilitation program on postoperative lung function changes in patients with severe scoliosis. References | Related Articles | Metrics

Special Planning—Emergency Information Construction

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Application of infusion process reengineering based on intelligent settlement and logistics information system in emergency department ZHANG Jinqiu, SHEN Xiulan, WANG Liping, ZHOU Zhiying 2023, 4 (6):  493-497.  doi: 10.3761/j.issn.2096-7446.2023.06.002 Abstract ( )   PDF (825KB) ( )   Save Objective To optimize the emergency infusion process and provide patients with efficient,comfortable and safe infusion services. Methods We optimized patient payment and delivery of medication process to reconstruct the emergency infusion process based on intelligent settlement system and hospital logistics information system. The convenience sampling method was used to select the infusion patients in the peak period of emergency treatment of a tertiary class A general hospital in Zhejiang Province from May to July 2021 as the control group,and the infusion patients in the peak period of emergency treatment from August to October 2021 as the experimental group. The experimental group adopted the reconstructed infusion process. Collect and compare the waiting time for infusion,the time from the beginning of skin test to medication,drug damage rate,and patient satisfaction between the two groups. Results A total of 236 emergency infusion patients were included in this study,including 121 patients in the experimental group and 115 patients in the control group. The time from the doctor's prescription to the patient's infusion puncture in the experimental group was 18.0（13.0,23.0）min,which was significantly shorter than that in the control group 29.0（19.0,49.0）min（Z=-6.889,P<0.001）. The time from the beginning of skin test to the application of medication in the experimental group was（36.32±6.31）min,which was shorter than that in the control group（55.50±5.72）min（t=-9.674,P<0.001）. No drug damage occurred in the experimental group. The satisfaction of patients in the experimental group was 93.4%,higher than that in the control group（Z=-7.197,P<0.001）. Conclusion Emergency infusion process reengineering shortened the waiting time of patients for infusion,ensured the safety of infusion medication,and improved patient satisfaction. References | Related Articles | Metrics

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Development and application of semi-automatic generation system of ECG monitoring alarm setting CHEN Juanhong, ZHANG Shuai, QUAN Yinyin, XIE Jing, SHEN Zhuqing, YAO Huiping 2023, 4 (6):  498-501.  doi: 10.3761/j.issn.2096-7446.2023.06.003 Abstract ( )   PDF (729KB) ( )   Save Objective To develop a semi-automatic generation system for ECG monitoring alarm settings,and to discuss its application effect in ICU monitor alarm management. Methods A research and development team was established to develop a semi-automatic generation system for ECG monitoring alarm settings. In May 2022,it was applied in the ICU of a tertiary hospital in Zhejiang Province. The accuracy of monitor alarm settings and clinical nurse's satisfaction with this system after the system application（May to October,2022）were compared with that before the system application（January to March,2022）. Results After the application of the semi-automatic generation system for ECG monitoring alarm settings,the accuracy rate of monitor alarm settings was 99.18% and 98.14%,which were significantly higher than that before the implementation（93.05%）,and the differences were statistically significant（P<0.05）. The satisfaction score of 59 nurses was （104.96±12.09）. Conclusion The use of the semi-automatic generation system for ECG monitoring alarm settings is helpful to improve the accuracy rate of clinical monitor alarm settings. Nurses are highly satisfied with the semi-automatic generation system for ECG monitoring alarm settings. References | Related Articles | Metrics

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Management practice of ambulance transport for patients with extracorporeal membrane oxygenation based on 5G technology HONG Hui, ZHANG Rui, WANG Yuwei, CAO Qiaodan, WANG Lizhu 2023, 4 (6):  502-506.  doi: 10.3761/j.issn.2096-7446.2023.06.004 Abstract ( )   PDF (1009KB) ( )   Save To summarize the management experience of 5G ambulance successfully transporting critically ill patients with extracorporeal membrane oxygenation support. Through the basic work of transfer,preparation before transfer,and management of the transfer process based on 5G technology,4 cases of critically ill patients with extracorporeal membrane oxygenation were successfully transferred to a higher-level hospital,and were successfully treated. References | Related Articles | Metrics

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Application of the virtual reality technology in adult ICU patients：a scoping review DONG Jing, ZHUANG Yiyu, ZHANG Junru 2023, 4 (6):  506-514.  doi: 10.3761/j.issn.2096-7446.2023.06.005 Abstract ( )   PDF (1341KB) ( )   Save Objective To conduct a scoping review to identify the specific intervention,results and limitations of virtual reality（VR）technology in adult ICU patients,so as to provide the guidance for future research and clinical application. Methods A literature search was performed in the CNKI,Wanfang database,VIP,CBM,Cochrane Library,PubMed,Embase,Web of Science,CINAHL,Scopus,Proquest and IEEE Xplore to identify relevant studies. The retrial limit was from database establishment to March 11,2023. The studies were screened and data was extrated independently by two researchers. Results Totally 23 studies were included,including nine randomized controlled trials,two quasi-experimental studies and two observational studies. Virtual reality（VR）technology provided relaxation and rehabilitation intervention for adult ICU patients. The results showed that VR interventions had positive effects on the motor function rehabilitation of patients,and had a potential effect on the prevention of delirium. However,due to the limitations of sample size,intervention periodicity,environment,whether it can improve cognition,psychology,sleep and pain was still controversial. No serious adverse events were reported and the acceptability of VR technology intervention in patients was good. Conclusion Virtual reality technology is feasible and has a positive effect on adult ICU patients. Future research should combine the advantages of “Internet plus nursing service”,take patients as the center,combine technological innovation and humanistic nursing,to formulate standardized evaluation standards and explore more comprehensive and personalized intervention strategies. References | Related Articles | Metrics

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Research progress of machine learning in the early identification and nursing of neonatal sepsis SHU Limei, LI Qiufang, GU Huimin, XU Xinfen, JIANG Chuan 2023, 4 (6):  515-518.  doi: 10.3761/j.issn.2096-7446.2023.06.006 Abstract ( )   PDF (755KB) ( )   Save Machine learning algorithms are algorithms that study and analyze data to obtain regularities among the data and use the regularities to predict unknown data. Electronic medical records contain a large amount of data information about patients' diseases,which provides the data basis for the practice of machine learning in the field of medical and nursing. This article reviewed the application status of machine learning in the early identification and nursing of neonatal sepsis,including obtaining data such as demographic characteristics,vital signs,antibiotic use,etiological characteristics and treatment of the entire hospitalization period from the electronic medical record database,and developing predictive models through machine learning algorithms,in order to provide reference for clinic nurses to realize early identification of neonatal sepsis,implement nursing plans as early as possible,and provide nursing interventions. Machine learning modeling can be used for early identification and diagnosis of neonatal sepsis. Its accuracy and wide adaptability need to be further confirmed by prospective studies based on multi-center large-scale data. References | Related Articles | Metrics

Guideline and Standard

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Construction of clinical practice guideline for acute chest pain nursing Chest Pain Nursing Group of Chest Pain Branch of China International Exchange, Promotive Association for Medical, Health Care, Qilu Hospital of Shandong University（Writing Committee：ZHANG Min, WANG Wenjun, GUO Weiting） 2023, 4 (6):  519-525.  doi: 10.3761/j.issn.2096-7446.2023.06.007 Abstract ( )   PDF (1203KB) ( )   Save Objective To develop the "Clinical practice guideline for nursing of acute chest pain" to provide practical basis for the nursing of patients with acute chest pain from community medical care,pre-hospital emergency care to emergency department,specialized treatment and secondary prevention. Methods In strict accordance with the method of formulating evidence-based nursing practice guideline,the guideline protocol was written and registered on the international practice guideline registration platform. Under the supervision of the guideline guidance committee,the consensus expert group and the development working group jointly constructed the draft of the guideline,which was reviewed by the external audit expert group,revised and agreed to form a formal guideline. Results The guideline included 10 aspects,including pre-hospital first aid,safe transport,pre-examination and triage,pain management,oxygen therapy management,surgery management,drug management,cardiac rehabilitation,chest pain center construction,training and education,and 57 recommendations in total. ConclusionThe guideline is an evidence-based guideline based on the best evidence,combined with the professional judgment of clinical doctors and nurses,and the patient preference and value,which can provide practical basis for clinical nursing staff to care for patients with acute chest pain. Related Articles | Metrics

Emergency Care Research

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Nursing of a child with disseminated cryptococcosis infection complicated by massive gastrointestinal bleeding SHEN Qianqian, CHEN Xiaofei, CHEN Shuohui, ZHANG Yi 2023, 4 (6):  526-529.  doi: 10.3761/j.issn.2096-7446.2023.06.008 Abstract ( )   PDF (743KB) ( )   Save To summarize the nursing experience of a child with disseminated cryptococcosis with yellow skin as the first symptom and complicated by massive gastrointestinal hemorrhage. For the patients with systemic yellow skin accompanied by pruritus,severe toxic side effects of antifungal drugs,massive gastrointestinal hemorrhage and hypokalemic crisis and other complications,the skin management of severe liver disease,special medication care of antifungal drugs,emergency care of gastrointestinal massive hemorrhage and hypokalemic crisis were taken. After 91d of treatment and nursing,the patient's condition was improved and returned to the local hospital for further treatment. One month after discharge,the child's skin jaundice subsided. Eight months later,he was followed up again by phone and was in good health. References | Related Articles | Metrics

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Nursing care of a patient with diabetic peripheral neuropathic pain after osteomyelitis surgery LÜ Bifang, ZENG Fei 2023, 4 (6):  530-533.  doi: 10.3761/j.issn.2096-7446.2023.06.009 Abstract ( )   PDF (734KB) ( )   Save To summarize the nursing experience of a patient with diabetic peripheral neuropathic pain after osteomyelitis surgery. In view of the main problems of this patient with diabetic neuropathic pain after surgery,such as complex type of pain,severe degree of pain,unstable fluctuation of blood glucose,and wound infection,the main measures such as staged individualized analgesia,precise blood glucose management,infection control,nutritional support,and whole-course psychological nursing were taken. After careful treatment and nursing,the patient's pain score was controlled at 2-3 points,and he was discharged 15 days after operation. During 6 months of follow-up,the patient's pain was well controlled. References | Related Articles | Metrics

Critical Care Research

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Nursing care of frequent hypoglycemia caused by excessive secretion of insulin-like growth factor-2 in a patient with advanced liver cancer MAO Hangfei, XU Yihong, XU Hongxia 2023, 4 (6):  534-536.  doi: 10.3761/j.issn.2096-7446.2023.06.010 Abstract ( )   PDF (571KB) ( )   Save This article summarized the nursing experience of a patient who has advanced liver cancer with repeated hypoglycemia due to excessive secretion of insulin-like growth factor-2（IGF-2）. For patient with frequent severe hypoglycemia,stomatitis and gastrointestinal reaction after chemotherapy,emotion fluctuation during the illness and other problems,key nursing points included multi-disciplinary collaboration to find the causes of hypoglycemia and develop prevention and treatment plan to reduce the risk of hypoglycemia,continuous dynamic monitoring of blood glucose for 24 hours to identify hypoglycemia rules,maintaining the balance between nutrient intake and hypoglycemia,establishment of trust by non-violent communication with patients to help the patient positively cope with the disease informatized discharge education and follow-up to avoid hypoglycemic coma after discharge. After active treatment and nursing,the patient did not develop a hypoglycemic coma again,blood glucose was controlled,stomatitis was cured,nutrition intake improved,mentality was adjusted. The patient was discharged after stable condition. References | Related Articles | Metrics

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Nursing care of neonatal gastroschisis undergoing one-stage repair ZHANG Lu, CHEN Xiaofei, ZHU Shuzhen, HU Yan, CHEN Xiaochun, LIN Nan, WANG Qiuyue 2023, 4 (6):  537-539.  doi: 10.3761/j.issn.2096-7446.2023.06.011 Abstract ( )   PDF (570KB) ( )   Save To summarize the experience of multidisciplinary cooperative nursing in 8 cases of neonatal gastros-chisis undergoing one-stage repair. In view of the children in this group who needed immediate surgery after birth,and the exposure of intestine in vitro for a long time could easily lead to water and electrolyte disorders,swelling damage and infection,and hypothermia and other difficulties,a multidisciplinary collaborative team was established to achieve whole-process management. Combined with accelerated rehabilitation concept,we shortened preoperative preparation time,protected intestinal extrusions before the surgery to maintain constant body temperature and strengthen body fluid management,strengthened postoperative monitoring to avoid abdominal space syndrome,malnutrition and other complications. Staged health education and follow-up were carried out to promote their rapid recovery after surgery and improve the quality of life of children. After active treatment and careful nursing,all the children in this group completed the preoperative preparation within 3 hours after birth,the operation was successful,and the postoperative recovery was good. They recovered and were discharged. References | Related Articles | Metrics

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Nursing care of a patient with thrombocytopenia and bleeding after vertebral artery stent implantation LIU Jing, FENG Xiuqin, WANG Wei 2023, 4 (6):  540-542.  doi: 10.3761/j.issn.2096-7446.2023.06.012 Abstract ( )   PDF (540KB) ( )   Save To summarize the treatment and nursing experience of a patient with heparin-induced thrombocytopenia（HIT）and bleeding after vertebral artery stent implantation. In view of the problems of patients with HIT accompanied by bleeding,and the coexistence of bleeding and coagulation risks,we adopted dynamic monitoring of HIT inducing factors,developed an early monitoring plan for bleeding,strictly prevented adverse events of thrombosis,strictly implemented the platelet transfusion process and were alert to adverse reactions of blood transfusion,developed a follow-up plan by multidisciplinary collaboration. After 7 days of treatment and nursing,the patient recovered and was discharged. One month of follow-up after discharge showed that the patient was in good condition. References | Related Articles | Metrics

Quality and Safety

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Establishment and practice of fast nursing track for patients with dangerous upper gastrointestinal tract bleeding LÜ Jia, SHEN Xiaoling, HUANG Ganying, FU Rong, ZHANG Hua, YANG Huijie 2023, 4 (6):  543-547.  doi: 10.3761/j.issn.2096-7446.2023.06.013 Abstract ( )   PDF (733KB) ( )   Save Objective To construct a fast nursing track for patients with dangerous upper gastrointestinal tract bleeding and verify its clinical effects. Methods A multidisciplinary team was set up to analyze the failure of the diagnosis and treatment process of patients with dangerous acute upper gastrointestinal bleeding by using healthcare failure mode and effect analysis（HFMEA）combined with the monitoring results of quality control indicators,and to construct a fast track for nursing of patients with dangerous upper gastrointestinal bleeding. The effects of the previous process from May 2020 to April 2021 and the fast track for nursing care of patients with dangerous upper gastrointestinal bleeding from May 2021 to April 2022 were compared. Results The reporting time of hemoglobin was shortened from 21（17,26）min to 7（5,9）min（P<0.001）. The time from the initiation of blood transfusion pro-cess to the start of blood transfusion was shortened from 39（36,45）min to 25（20,30）min（P<0.001）. And the time from start-up of emergency endoscope to implementation was reduced from 50（42,60）min to 40（36,50）min （P=0.001）. The average length of stay in the emergency room was shortened from 236（178,255）min to 180（160, 200）min（P=0.009）. There was significant difference in length of hospital stay between the two groups（P=0.013）,but there was no significant difference in survival outcome（P=0.162）. Conclusion The fast track for nursing care of dangerous upper gastrointestinal bleeding can reduce the time of each key link in the treatment of dangerous upper gastrointestinal bleeding and shorten the length of hospital stay,and ensure the safety of emergency medical treatment. References | Related Articles | Metrics

Evidence Synthesis and Practice

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Summary of the best evidence on prehospital cooling care for exertional heat stroke XIAO Jinqun, MAO Yi, JIANG Zhihui 2023, 4 (6):  548-553.  doi: 10.3761/j.issn.2096-7446.2023.06.014 Abstract ( )   PDF (856KB) ( )   Save Objective To evaluate and summarize the best evidence of pre-hospital cooling care for exertional heat stroke（EHS）and provide basis for clinical pre-hospital cooling care. Methods We systematically searched BMJ Best Practice,UpToDate,Scottish Colleges Guideline Website,National Institute of Clinical Medicine,National Guideline Clearinghouse of USA,Joanna Briggs Institute Library,New Zealand Guidelines Collaborative,Registered Nurses' Association of Ontario,Canada Clinical Practice Guidelines,China Practical Guidelines Registration Platform,Nursing Consult,Cochrane Library,PubMed,China Biomedical Literature Database,CNKI,Wanfang and Yi Maitong for evidence on prehospital cooling care for exertional heat stroke,including guidelines,expert consensus,clinical decision-making and systematic review. The retrieval time limit was from the establishment of the database to December 31,2022. The literature quality evaluation and data extraction were performed by two researchers. Results A total of 10 articles were included,including one guideline,eight expert consensuses and one systematic review. Finally,21 pieces of best evidence were summarized from 4 aspects. Conclusion The summarized nursing evidence of EHS prehospital cooling can provide reference for clinical medical staff or emergency personnel,and help to reduce the organ damage rate and mortality caused by EHS. References | Related Articles | Metrics

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Evidence summary for pulse indicator continuous cardiac output monitoring WANG Lizhu, LI Qian, CHEN Yuaner, WANG Ziwei, XIANG Yan, QI Xuefeng, HU Yaling, LU Haifei 2023, 4 (6):  554-561.  doi: 10.3761/j.issn.2096-7446.2023.06.015 Abstract ( )   PDF (1071KB) ( )   Save Objective To summarize the evidence of PiCCO monitoring and provide evidence for improving the accuracy of clinical PiCCO measurement and standardization of operation. Methods We searched UpToDate,UK National Institute for Health and Care Excellence,American Society of Critical Care Medicine,American Association of Critical Care Nurses,British Association of Critical Care Nurses,PubMed,Embase,Wanfang database,China Knowledge Network and so on for studies related to PiCCO technical operations,including evidence summaries,clinical decisions,recommended practices,technical reports,clinical practical guidelines,systematic reviews,randomized controlled trials,quasi-experimental studies,diagnostic studies,and observational studies. The retrieval time limit was from January 1,1997,to April 30,2022. After methodological quality evaluation by two researchers,the evidence was extracted and summarized according to the theme. Results A total of 18 articles were included,including two expert consensus papers,one randomized controlled trial,nine quasi-randomized controlled trials,four cohort studies,and two diagnostic trials. 23 best evidences were obtained,including five topics,namely PiCCO pipeline management,indicator injection,calibration timing,parameter monitoring under specific conditions and personnel training. Conclusion It is necessary to strengthen the training of medical staff on PiCCO monitoring operation technology,follow the evidence-based nursing standards,select practical evidence according to the actual situation,improve the accuracy of PiCCO measurement and the standardization of operation,and promote the transformation of evidence-based knowledge to practice. References | Related Articles | Metrics

Review

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Research progress on risk prediction model of enteral nutrition feeding intolerance in adult ICU patients BAO Yiping, ZHANG Ling, YU Zhenliang 2023, 4 (6):  562-568.  doi: 10.3761/j.issn.2096-7446.2023.06.016 Abstract ( )   PDF (1031KB) ( )   Save Adult ICU patients have a high risk of enteral nutrition intolerance. It not only increases the difficulty of nursing,but also increases the risk of death and seriously affects the clinical outcome. This paper reviews the research on risk prediction models of enteral nutrition intolerance in adult ICU patients,introduces the risk prediction model overview,Logistic regression model,nomogram model,deep learning model,prediction value,function and application effects of risk prediction model,in order to provide reference for the correct selection and application of the model for clinical medical staff,and to optimize the management of feeding intolerance practice. References | Related Articles | Metrics

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The application progress of comprehensive assessment in elderly patients attending the emergency department LIANG Yi, YING Yanping 2023, 4 (6):  568-572.  doi: 10.3761/j.issn.2096-7446.2023.06.017 Abstract ( )   PDF (673KB) ( )   Save Comprehensive geriatric assessment refers to the identification of relevant risks of the elderly through multidisciplinary methods,and then targeted improvement,so as to maximize the maintenance of the functional status of the elderly and improve the quality of life. This paper reviews strategies to improve the effectiveness of comprehensive assessment in elderly patients attending emergency departments,including promoting multidisciplinary collaboration,strengthening training,and developing procedures. Comprehensive assessment is beneficial to early identification and intervention of health risk factors beyond the current chief complaint of elderly patients,but a more efficient and localized comprehensive assessment process for elderly patients in emergency setting still needs to be further improved. References | Related Articles | Metrics

Technology Innovation

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Design and application of machine bed restraint sheets for interventional surgery JIN Zhexia, CHEN Renbiao, ZHANG Yan, Wu Chunqiao, ZHAO Tian, DONG Jian 2023, 4 (6):  573-576.  doi: 10.3761/j.issn.2096-7446.2023.06.018 Abstract ( )   PDF (724KB) ( )   Save Objective To design the machine bed restraint sheets for interventional surgery and evaluate the application effects. Methods Machine bed restraint sheets for interventional surgery was composed of sheet body,straps,mobile straps,and extremity fixation straps. We conveniently selected 100 patients with acute ischemic stroke who underwent mechanical intracranial thrombectomy under general anesthesia in minimally invasive interventional department of a Grade-Ⅲ general hospital in Zhejiang Province. 50 patients from June to October 2022 were selected as experimental group and the restraint bed sheets were used. 50 patients from January to May 2022 were selected as control group without restraint. The time from catheter lab to femoral artery puncture and the incidence of intraoperative restraint-related adverse events were compared between the two groups. Results The time from catheter lab to femoral artery puncture of experimental group was（15.60±3.34）min which was shorter than that of control group（25.98±5.50）min. The difference was statistically significant（t=-11.406,P<0.001）. No restraint related adverse events occurred in both groups. Conclusion The machine bed restraint sheets are safety to operate,which can shorten the time from catheter lab to femoral artery puncture. References | Related Articles | Metrics