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10 July 2023, Volume 4 Issue 7 Previous Issue    Next Issue

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Study on the application effect of different sealing solutions in the totally implantable venous access portamong tumor patients ZHU Wei, QIN Xiaoying, HUANG Peipei, XIANG Xiaoyan, LU Qi, CHEN Lijiao, CUI Zhiping, ZHANG Ye 2023, 4 (7):  581-586.  doi: 10.3761/j.issn.2096-7446.2023.07.001 Abstract ( 312 )   Save Objective To compare the application effects of different sealing solutions in totally implantable venous access port among tumor patients. Methods A randomized sampling was used to select 414 patients who were maintained infusion port in outpatient department of a tertiary Grade A hospital in Zhejiang Province from December 2018 to December 2022. They were divided into three groups，A，B，and C，with 138 cases in each group，using a random number table method. Patients were treated with 5 ml 0.9% sodium chloride for positive pressure sealing during intermittent maintenance in group A，and 5 ml heparin（10 U/ml） for positive pressure sealing in group B，and 5ml heparin（100 U/ml） positive pressure sealing in group C. To observe coagulation function and catheter blockage in patients among three groups. Results There were statistically significant differences in prothrombin time and activated partial thrombin time among the three groups（P<0.05）. There was no significant difference in D-dimer quantity and platelet count（P>0.05）. The pair comparison of prothrombin time among the three groups showed that there was no statistical significance between group A and group B（t=-34.409，P>0.05），but there were statistically significant differences between group A and group C（t=-179.308，P<0.001） and between group B and group C（t=-144.899，P<0.001）. The pairwise comparison of activated partial thromboplastin time among the three groups showed that there was no statistical significance between group A and group B（t=1.406，P>0.05）， but there were statistically significant differences between group A and group C（t=-35.493，P<0.05） and between group B and group C（t=-36.899，P<0.05）. Conclusion Among cancer patients with totally implantable access port during intermittent maintenance period，the use of heparin solution（100 U/ml） can prolong prothrombin time andactivated partial thromboplastin time. It is recommended that clinical nursing staff seal the tube with 0.9% sodium chloride or heparin solution（10 U/ml） in outpatient patients undergoing intermittent maintenance. Related Articles | Metrics

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Development and psychometric testing of a questionnaire measuring knowledge，belief and practice of prone position ventilation for patients with ARDS among ICU medical staf LI Yajun, WU Qiang, ZHANG Jing, CHEN Lianfang, LI Xiuchuan 2023, 4 (7):  587-593.  doi: 10.3761/j.issn.2096-7446.2023.07.002 Abstract ( 260 )   Save Objective To develop a questionnaire measuring the knowledge，belief，and practice of prone position ventilation for patients with ARDS among ICU medical staff，and to conduct reliability and validity testing. Methods Based on the knowledge，belief，and behavior theory model，an initial questionnaire was formed through literature study，theoretical analysis，expert interviews，Delphi expert consultation，and preliminary surveys. From October to November 2022，426 ICU medical staff from 7 tertiary comprehensive hospitals in Anhui Province were selected as the research subjects for reliability and validity testing. From January to February 2023，another 455 ICU medical staff from 7 tertiary comprehensive hospitals were selected as the survey subjects for confirmatory factor analysis. Results The final questionnaire consisted of three dimensions：knowledge，belief，and behavior，with a total of 41 items. The cumulative variance contribution rate of the three factors in exploratory factor analysis was 65.319%，and all fitting indicators in confirmatory factor analysis were within an acceptable range （χ2/df=2.504，RMSEA=0.058， RMR =0.014，IFI =0.933，CFI =0.933，PGFI =0.740，PNFI =0.846，PCFI =0.883）. Questionnaire Cronbach’s α coefficient was 0.982，the retest reliability was 0.995，and the split half reliability was 0.950. Conclusion This questionnaire has good reliability and validity，and is suitable for investigating the current status of ICU medical staff’s knowledge，belief，and practice of prone ventilation in ARDS patients. Related Articles | Metrics

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A qualitative study on the influencing factors of moral distress and coping experience among pediatric specialist nurses ZHENG Ying, SHEN Lijia, QIU Fei, YE Xian, SHEN Qianqian, XU Hongzhen 2023, 4 (7):  594-599.  doi: 10.3761/j.issn.2096-7446.2023.07.003 Abstract ( 180 )   Save Objective To understand the influencing factors and coping style of pediatric specialist nurses experiencing moral distress in their work，and to provide reference for alleviating the moral distress of pediatric nurses. Methods Phenomenological research method was used to conduct sem-structured interviews with 13 pediatric specialist nurses in Zhejiang Province from March to June 2022. Colaizzi phenomenological research analysis method was used to analyze the interview data. Results Two topics and eight sub-topics were formed after the interview contents were extracted，coded，cluster screened，interpreted and verified. The factors affecting the moral distress experienced by pediatric emergency and critical care nurses included the children level，the family level，the nurse level，and the working environment level. The coping style included increasing caring nursing behavior，trying to communicate effectively，self-psychological adjustment，and seeking organizational helps. Conclusion Pediatric specialist nurses suffer from moral distress caused by various influences，we should focus on the needs of children，promote doctor-patient communication，improve nursing position，increase team magnetism to ease the moral distress in the work of pediatric nurses. Related Articles | Metrics

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Nursing of a newborn with closed thoracic drainage by intravenous indwelling catheter under the support of extracorporeal membrane oxygenation WANG Yuan, ZHOU Hong, FU Jie, DING Liwen, JU Rong, WU Nana, CHEN Xia 2023, 4 (7):  600-603.  doi: 10.3761/j.issn.2096-7446.2023.07.004 Abstract ( 116 )   Save To summarize the experience of a newborn with closed thoracic drainage by intravenous indwelling catheter during the support of extracorporeal membrane oxygenation （ECMO）. Aimed at the nursing of closed thoracic drainage during ECMO support for the newborn with meconium aspiration syndrome （MAS），individualized nursing measures in the whole process were adopted，including nursing of closed thoracic drainage by intravenous indwelling catheter，response of bleeding event，airway care，infection prevention and control，pain intervention， combination of lung protection and prone position ventilation. After careful treatment and nursing，the patient was discharged steadily，and the follow-up of the patient was in good condition after discharge. Related Articles | Metrics

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Surgical nursing care of conjoined twins complicated with congenital heart disease of one infant undergoing separation operation ZHAO Hangyan, TOU Jinfa, SHI Mi, ZHU Jihua 2023, 4 (7):  604-606.  doi: 10.3761/j.issn.2096-7446.2023.07.005 Abstract ( 82 )   Save This paper reported the nursing experience of thoracoabdominal conjoined twins accompanied by congenital heart disease of one infant undergoing separation operation. Nursing points：refined managements were implemented after preoperative multidisciplinary joint simulation exercise and making personalized anesthesia plan to ensure the safety，such as hump position placement to support the joint part，multi-mode accurate temperature control，safe transition of operation before and after separation，infection prevention. The total operation time was 180 minutes，and the separation time for conjoined children was 11 minutes，the Apgar score of 1～5 minute was 9～10. After operation，the twins were sent to NICU for further treatment and nursing. After separation Twin A had some cardiac insufficiency symptom such as labored breathing and so on.We considered the pulmonary hyperaemia due to patent ductus arteriosus（PDA），so PDA ligation was performed on the 7th day after separation and postoperative oxygenation was improved gradually. Twin A had regular heartbeat without chest tightness and shortness of breath， and was discharged 40 days after separation. Twin A had pulmonary valve stenosis and underwent long-term corrective heart surgery. Twin B recovered and was discharged on the 8th day afters eparation. Related Articles | Metrics

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Postoperative nursing care of a child with pulmonary cystic fibrosis undergoing bilateral lung transplantation LIN Runqi, SUN Dongxu, WANG Zhi, ZENG Fei 2023, 4 (7):  607-609.  doi: 10.3761/j.issn.2096-7446.2023.07.006 Abstract ( 104 )   Save To review the nursing experience of a child with pulmonary cystic fibrosis caused by autosomal gene mutations and undergoing bilateral lung transplantation. Aiming at the characteristics of the child such as low weight and difficult perioperative management，we adopted goal-ori- ented volume management，and nurse-led cough reflex remodeling，effective posture drainage and progressive lung re- cruitment training management. Treatment and nursing of digestive tract complications，and immunosuppressive drug care were also implemented. After 24 days of hospitalization and nursing，the child was discharged smoothly. Related Articles | Metrics

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Emergency nursing of a child with severe heat stroke caused by trapped in a closed compartment YE Danjuan, CHEN Lixia 2023, 4 (7):  610-612.  doi: 10.3761/j.issn.2096-7446.2023.07.007 Abstract ( 110 )   Save Summarize the emergency care experience of severe heart stroke in a 6-year- old child who was left in a closed car carriage. To solve the major problems such as thermal asphyxia，body fluid loss，repeated febrile convulsions，we implemented combined cooling technology，continuous core temperature monitoring，target-oriented capacity management to maintain the balance of water，electrolyte and acid-base，the management of artificial airway to effectively keep the airway unobstructed，case of repeated convulsive seizures，and family participatory care. After 6 h of emergency multidisciplinary emergency treatment and precision care，the child was successfully transferred to the emergency intensive care unit for further treatment，and later transferred to the other hospital for rehabilitation treatment. After a follow-up of one month，the child had a good prognosis. Related Articles | Metrics

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Perinatal nursing with umbilical artery thrombosis in late pregnancy ZHU Mengling, XIE Wanyang, GU Qiaoyi 2023, 4 (7):  613-615.  doi: 10.3761/j.issn.2096-7446.2023.07.008 Abstract ( 125 )   Save To summarize the prenatal clinical manifestations and perinatal nursing experience of 15 patients with umbilical artery thrombosis during late pregnancy. Nursing points：early identification of high-risk factors for umbilical artery thrombosis，strengthening monitoring of fetal heart and fetal movement，prevention of adverse drug reactions and deep venous thrombosis of lower limbs，implementation of personalized psychological nursing，and preparation for newborn rescue. After close monitorin，careful treatment and nursing，the 15 patients were discharged successfully，and the outcome of the mother and baby were good. Related Articles | Metrics

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The review of rhythmic stimulation for preterm infants in NICU ZHU Feng, DING Wenwen, WEI Li, QIN Jianfen, LIN Jiami 2023, 4 (7):  616-619.  doi: 10.3761/j.issn.2096-7446.2023.07.009 Abstract ( 115 )   Save The perception of rhythmic ability in premature infants affects their future development of social interaction and social ability，while the NICU environment cannot provide premature infants with the same frequency of rhythmic stimulation in the uterus. This article summarizes the significance and principle of rhythmic stimulation in NICU premature infants，the application and effect of single，dual and multiple rhythmic stimulation interventions in premature infants，in order to provide reference for medical staff to understand and implement rhythmic stimulation intervention in premature infants. Related Articles | Metrics

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Interpretation of group standards for skin care of adult incontinence GAO Yanhong, ZHAO Nuo, LIU Chunmei, WANG Ling, ZHOU Yujie, WANG Xia, GUO Tong, WEI Li, ZHANG Su, WANG Zhiwen, ZHANG Zhixia, HUANG Zheng, JI Huiru, GUO Shuli, JIANG Qixia, XU Honglian, HU Hongyang, ZHANG Hongmei, HU Ailing, SUN Hongling, FU Xiaojin, WU Xinjuan 2023, 4 (7):  620-624.  doi: 10.3761/j.issn.2096-7446.2023.07.010 Abstract ( 797 )   Save The unified and standardized skin care norms and procedures for incontinence patients provide clinical standard guidance for nursing staff，and are also the guiding basis for reducing the incidence of skin complications of patients. In 2022，the Third Medical Center of the General Hospital of the People’s Liberation Army collaborated with 16 hospitals nationwide to write the group standard of the Chinese Research Hospital Association “skin care norms for adult incontinence patient （T/CRHA 016-2023）”，which was released in January 2023. It mainly standardized the overall evaluation of skin care for adult incontinence patients，the selection of nursing products，the standard process and the key points of nursing. This article explained the important parts and items in this standard in detail to facilitate users’ understanding and promote the standardized practice of skin care for patients with clinical incontinence. Related Articles | Metrics

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Nursing care of a patient with internal carotid pseudoaneurysm rupture and bleeding after pituitary adenoma surgery CHEN Aiqin, CHEN Hongyan, ZHOU Qin 2023, 4 (7):  625-627.  doi: 10.3761/j.issn.2096-7446.2023.07.011 Abstract ( 114 )   Save To summarize the nursing experience of a patient with secondary internal carotid pseudoaneurysm rupture and bleeding after pituitary adenoma surgery. For the nursing issues of massive nasal bleeding after surgery，we developed and initiated emergency plans，maintained blood pressure stability，strengthened specialized nursing and nurse-patient communication. Through emergency rescue and careful nursing，the patient recovered and was discharged 21 days after operation. Related Articles | Metrics

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Emergency nursing care of acute myocardial infarction patients with sudden cardiac arrest during coronary intervention WANG Xueping, YE Weiguo, ZENG Xiaokang, ZHONG Jinze, ZHANG Debao, WU Peipei, XIA Liuqin 2023, 4 (7):  628-630.  doi: 10.3761/j.issn.2096-7446.2023.07.012 Abstract ( 185 )   Save To summarize the emergency nursing experience of sudden cardiac arrest in 13 patients with acute myocardial infarction during emergency percutaneous coronary intervention. According to the characteristics of patients such as rapid disease progression，repeated cardiac arrest，unstable circulation and etc.，strict disease monitoring，early recognition of the symptoms of cardiac arrest，and rapid implementation of high-quality cardiopulmonary resuscitation were adopted. The nurses initiated the hospital emergency response system， multidisciplinary emergency team was set to carry out advanced life support treatment，and cooperated with doctors to quickly build extracorporeal membrane oxygenation therapy. We also paid attention to nursing measures such as safe transfer and effective handover in the hospital. Among the 13 patients，8 were discharged after condition was improved，3 gave up treatment and 2 died. Related Articles | Metrics

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Early identification and nursing care of children with severe anti-N-methyl-D-aspartate receptor encephalitis PAN Lili, ZHANG Yi, WANG Xiuling 2023, 4 (7):  631-634.  doi: 10.3761/j.issn.2096-7446.2023.07.013 Abstract ( 117 )   Save To summarize the nursing experience of 18 children with severe anti-N-methyl-D-aspartate receptor （NMDAR） encephalitis. In view of the complex and diverse symptoms of the children in this group，the rapid progress of the disease，severe neurological dysfunction，feeding difficulties and other problems，the following nursing measures were implemented，including the assessment of the condition to help doctors diagnose the disease as soon as possible，early identification and management of central ventilation deficiency，rapid evaluation of the severity of epileptic persistent state and multidisciplinary management，choosing the proper way and method of enteral nutrition and maintenance of the nutrition feeding tube，phased rehabilitation nursing and whole process management of rituximab. All the patients were recovered and discharged，and their condition were stable in outpatient follow-up. Related Articles | Metrics

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Nursing care of an infant with mediastinal Kaposiform hemangioendothelioma combined with Kasabach Merritt phenomenon SHI Jiamei, SUN Routing, DING Yaping, XIA Shanshan 2023, 4 (7):  635-638.  doi: 10.3761/j.issn.2096-7446.2023.07.014 Abstract ( 75 )   Save To summarize the nursing experience of an infant with Kaposiform hemangioendothelioma of mediastinum combined with Kasabach Merritt phenomenon. In response to the stubborn low platelet count in the child，close observation of bleeding tendency was taken，with a focus on preventing intracranial hemorrhage. In view of the mass located in mediastinum，we improved the warning level of illness and identify serious complications early. Predictive pain care was carried out for the pain. In view of the combined application of immunosuppressive regimen，we strengthened medication nursing，implemented parents’ participatory nursing and improved the ability of out-of-hospital care. The patient’s platelet count increased，blood coagulation function was corrected 40 days after admission，and he was discharged smoothly. After three months，the patient was followed up in a stable condition. The mediastinal mass was smaller than before. Related Articles | Metrics

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Analysis on current situation and risk factors of unplanned return to the rescue room in patients under observation in emergency department WANG Fang, ZHENG Danli, HUANG Sufang, XIE Yunli, FENG Mei, XIE La, YANG Ying, DENG Juan, XIAO Yaru 2023, 4 (7):  639-643.  doi: 10.3761/j.issn.2096-7446.2023.07.015 Abstract ( 427 )   Save Objective To analyze the characteristics of emergency observation patients who unplanned return to the rescue room，and explore its risk factors. Methods A retrospective analysis was conducted on 2 735 patients in emergency observation room who were transferred from the rescue room of a tertiary Grade-A general hospital from January 1，2019 to December 31，2021. The rate of unplanned return to the rescue room was statistically analyzed，and the differences of clinical characteristics between the group of unplanned return to the rescue room and the non-return group were compared. The risk factors of unplanned return to the rescue room were analyzed by binary logistic regression. Results A total of 87 patients returned to the rescue room unplanned，the rate of unplanned return was 3.2%. Logistic regression analysis showed that age（OR=1.021），unexplained abdominal pain （OR=2.916），and trauma（OR=0.226） was associated with the unplanned return to the rescue room（P<0.05）. Conclusion Age and unexplained abdominal pain are risk factors for unplanned return to the rescue room. It is suggested to establish a standardized evaluation process for patients who are transferred to the observation room， especially elderly patients and patients with unexplained abdominal pain，so as to predict the risk of condition changes and reduce the incidence of unplanned return to the rescue room. Related Articles | Metrics

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The effect of prehospital process optimization on treatment delay in patients with ischemic stroke：a Meta- analysis GUO Zhiting, JIN Jingfen, LIU Yuanfei, FU Yujia, WANG Xuyang, GUO Erling, ZHANG Yuping 2023, 4 (7):  644-652.  doi: 10.3761/j.issn.2096-7446.2023.07.016 Abstract ( 120 )   Save Objective To investigate the effect of prehospital procedure optimization on treatment delay and clinical outcome of ischemic stroke. Methods We searched PubMed，Embase，Cochrane Library，Web of Science， China Biomedical Literature Database，Wanfang data knowledge service platform，China National Knowledge Infrastructure，VIP database to collect intervention studies or cohort studies related to pre-hospital workflow optimization. The search period was from the database establishment to November 2022. Two evidence-based trained researchers independently screened literature，extracted data，and evaluated quality according to inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.3 software. Results Twenty-four literatures with a total of 197 154 patients were included. The results showed that prehospital procedure optimization could improve the rate of reperfusion therapy in patients with ischemic stroke[OR=1.98，95%CI（1.57，2.49），Z=5.75，P<0.001］ and shorten the time from symptom onset to thrombolytic therapy[WMD=-21.64，95%CI（-33.32，-9.97），Z=3.63，P<0.001］， the time from ambulance call to thrombolytic therapy[WMD=-30.29，95%CI（-44.14，-16.45），Z=4.29，P<0.001］ and the time of intra-hospital thrombolytic therapy or intravascular therapy to improve the clinical outcome of patients [OR=1.99，95%CI（1.29，3.05），Z=3.12，P=0.002］，but had no significant effect on the improvement of entry time from symptom onset to emergency room[WMD=-6.88，95%CI（-16.62，2.86），Z=1.38，P=0.17］. Conclusion Prehospital procedure optimization can effectively improve the reperfusion treatment rate and prognosis of patients with ischemic stroke，but the improvement of prehospital time is small，suggesting that the prehospital process needs to be further optim Related Articles | Metrics

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Evidence summary for discharge follow-up of patients with cancer pain LI He, LU Fangyan, ZHANG Meiyun, CHEN Jiaping, SHI Xiaolan 2023, 4 (7):  653-659.  doi: 10.3761/j.issn.2096-7446.2023.07.017 Abstract ( 152 )   Save Objective To summarize the best evidence for discharge follow-up of patients with cancer pain，and to provide reference for clinical practice. Methods We searched UpToDate，Cochrane Library，Embase，PubMed， National Guideline Clearinghouse（NGC），National Institute for Health and Care Excellence（NICE），Guidelines Inter- national Network（GIN），Scottish Intercollegiate Guidelines Network（SIGN），Registered Nurses’ Association of Ontario （RNAO），National Comprehensive Cancer Network（NCCN），European Society for Medical Oncology（ESMO），CNKI， Wanfang Data，China Biology Medicine disc（CBM） and the VIP Database（VIP） for all evidence of discharge follow- up of patients in cancer pain，including clinical decision-making，guidelines，expert consensus，group standards， evidence summary，systematic reviews. The retrieval period was from the establishment of the database to April 2023. Two researchers independently evaluated the literatures and extracted the literatures that met the standards. Results Ten literature were finally included，including one clinical decision，one guideline，three systematic reviews，one government report，one group standard and three expert consensuses. Finally 25 items of best evidences were summarized and categorized into 8 dimensions：principles of follow-up，follow-up personnel and subjects，follow-up time and frequency，follow-up methods，follow-up contents，follow-up records，follow-up termination，and quality control. Conclusion Medical staff should be under the perfect system and process management in the follow-up ins- titutions，using evidence-based method combined the actual clinical situation and willingness of patients，and formed an effective follow-up strategy，thus improve the patients’ pain self-management ability，improve the quality of life. Related Articles | Metrics

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Research progress on risk prediction models of incontinence associated dermatitis in critically ill patients XU Xia, ZHANG Jiajia, DING Zhuyu, ZHANG Yan, XIAO Xueqi 2023, 4 (7):  660-663.  doi: 10.3761/j.issn.2096-7446.2023.07.018 Abstract ( 239 )   Save Incontinence-associated dermatitis（IAD） is a major skin problem worldwide. Risk prediction model can screen out high risk patients of IAD，so as to identify and intervene early. This paper reviewed the basic situation， construction method and prediction performance of risk prediction model of incontinence-associated dermatitis，so as to provide reference for clinical medical staff to implement skin prevention management. However，risk factors should be comprehensively included，and emphasis should be placed on the application of the model. Related Articles | Metrics

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Research progress of acute stroke screening scale ZHOU Liping, YE Huan, LOU Jiexiang, CHU Huilin, ZHU Chenping 2023, 4 (7):  664-669.  doi: 10.3761/j.issn.2096-7446.2023.07.019 Abstract ( 205 )   Save Stroke is the third leading cause of disability，and is one of the common diseases in Emergency Department. The management of acute ischemic stroke emphasizes early diagnosis，early treatment，early rehabilitation and early prevention of recurrence. Early identification in the pre-hospital or Emergency Department is the first step to initiate the stroke diagnosis and treatment. The acute stroke screening scales include the common stroke screening scale，the scale with large vessel occlusion and vertigo as the main symptom. This paper reviews the application of acute stroke patient screening scale in pre-hospital or Emergency Department，so as to provide scientific basis for the identification of acute stroke in emergency medical care. However，there is a need to further develop and improve the stroke screening scales for large vessel occlusion and vertigo as the main symptom in China. Related Articles | Metrics

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Design and application of a new special treatment vehicle for continuous renal replacement therapy WANG Lizhu, SHAO Qing, XIANG Yan, SHEN Lanying, XIANG Chenqi 2023, 4 (7):  670-672.  doi: 10.3761/j.issn.2096-7446.2023.07.020 Abstract ( 203 )   Save Objective To design and explore the application effect of a new special vehicle for continuous renal replacement therapy（CRRT） in critically ill patients. Methods This CRRT specialized treatment vehicle consists of a vehicle body with universal wheels，an operating platform，a garbage bin hanging area，and a sharp tool box placement area. The necessary items during the CRRT treatment process are placed in the CRRT treatment vehicle by the bedside. Patients who received CRRT from the Intensive Care Unit of a Grade-III hospital in Zhejiang Province from August 2022 to October 2022 were selected as the research objects. A total of 70 CRRT operations were performed. According to the random number table，the experimental group and the control group were 35 times respectively. The convenience of item retrieval，the satisfaction of responsible nurses and the satisfaction of quality control nurses were compared between the two groups. Results The convenience score of the experimental group was 4（4，5） points，while the control group was 3（2，3） points. The satisfaction score of the responsible nurses in the experimental group was 4（4，5） points，while the control group was 3（2，3） points. The satisfaction score of the quality control nurses in the experimental group was 4（4，4） points，while the control group was 2（2，3） points. The differences were statistically significant between the two groups（P<0.001）. Conclusion The new CRRT special treatment vehicle can effectively increase the convenience，and improve the satisfaction of nurses. Related Articles | Metrics