Table of Content

10 November 2024, Volume 5 Issue 11 Previous Issue    Next Issue

Research Paper

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Application study of medical game guidance in the prevention of central venous catheter-related thrombosis in children WU Hanshu, ZHAO Xiaoshuang, SUN Hairui, GUAN Ruixin, ZHANG Baorong, ZHANG Dan 2024, 5 (11):  965-970.  doi: 10.3761/j.issn.2096-7446.2024.11.001 Abstract ( )   PDF (955KB) ( )   Save Objective To construct an activity program for upper limb large joints based on medical game guidance and evaluate the effectiveness of this program in reducing central venous catheter（CVC） associated thrombosis in children. Methods A total of 136 pediatric patients with cervical central venous catheter in the Pediatric Intensive Care Unit（PICU） of a tertiary Grade-A hospital in Changchun City from January 2022 to November 2023 were selected as the study objects by convenient sampling. According to the order of admission time,the children were divided into experimental group（n=71） and control group（n=65）. The control group was given routine nursing for thrombosis prevention,and the experimental group was given medical games to guide the movement of the large joints of the upper limbs based on routine nursing. Results The average blood flow rate after movement of the upper limb large joints in the experimental group was better than that of control group（P<0.05）,and the incidence of cervical thrombosis was lower than that of control group（P<0.05）. Conclusion The large joint movement of upper limb guided by medical games can effectively increase the blood flow rate of internal jugular vein and reduce the incidence of internal jugular vein thrombosis. References | Related Articles | Metrics

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Construction and application of transfer readiness intervention program for patients with severe acute pancreatitis in ICU HUANG Guangmei, CHEN Xueli, QUAN Mingtao, LUO Siyi, WU Long 2024, 5 (11):  971-977.  doi: 10.3761/j.issn.2096-7446.2024.11.002 Abstract ( )   PDF (1040KB) ( )   Save Objective To construct a transfer readiness intervention program for patients with severe acute pancreatitis in ICU and evaluate its effectiveness. Methods Based the literature study and the Delphi expert consultation,the transfer readiness intervention program for severe acute pancreatitis in ICU was developed. Using the convenience sampling method,66 patients with severe acute pancreatitis who were treated in the comprehensive ICU of a third-class A hospital in Guizhou Province from July 2021 to June 2022 were selected as research subjects and divided into experimental group and control group. The experimental group received the transfer readiness intervention program for ICU patients with severe acute pancreatitis,and the control group received routine transferal care. Transfer readiness,hospital anxiety and depression,length of ICU stay,unplanned readmission rate,and stress level of ICU patients‘ families were compared between the two groups. Results Total scores of transfer readiness and all dimensions,anxiety and depression,stress level of ICU patients‘ families,length of ICU stay and unplanned readmission rate were statistically different between the two groups（P<0.05）. Conclusion The transfer readiness intervention program of ICU severe acute pancreatitis can improve the readiness for transfer out of ICU,reduce the anxiety and depression,the stress level of patients‘ families,length of ICU stay and unplanned readmission rate. References | Related Articles | Metrics

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Study on the influencing factors and prognosis of delirium severity in intensive care units SONG Lifang, ZHANG Yinghui, WANG Cailin, ZHANG Liyu, WU Caihong, QIAO Xiaoxia 2024, 5 (11):  978-984.  doi: 10.3761/j.issn.2096-7446.2024.11.003 Abstract ( )   PDF (1099KB) ( )   Save Objective To investigate the severity of delirium in ICU,analyze its influencing factors,and explore the influence on the prognosis of patients. Methods A total of 410 patients admitted to the general ICU of a tertiary class A hospital in Taiyuan,Shanxi province from September 2022 to September 2023 were included,the patients were divided into subdelirium group,mild-moderate delirium group and severe delirium group. The related data were collected and the patients were followed up for 90 days after discharge. Multivariate logistic regression was used to analyze the factors influencing the severity of delirium. Kaplan-Meier method was used to plot the 90-day cumulative survival curve and Log-rank test was performed. Results The incidence of delirium was 36.77%. Subdelirium,mild to moderate delirium and severe delirium accounted for 32.20%,47.32% and 20.48%. Taking delirium as a reference,age was a risk factor for mild to moderate delirium,mechanical ventilation time was a risk factor for severe delirium. The use of benzodiazepines,procalcitonin,APACHE Ⅱ score,and gastrointestinal function grading were risk factors for the severity of delirium（P<0.05）. The 90-day mortality were significantly different among the patients with different delirium severity（P<0.05）. Conclusion The incidence of delirium in ICU patients was high,mainly mild to moderate delirium. Older age,higher APACHE Ⅱ score,longer duration of mechanical ventilation,higher procalcitonin levels,gastrointestinal dysfunction,and use of benzodiazepine were associated with more severe delirium. The severity of delirium affected the 90-day mortality after discharge. References | Related Articles | Metrics

Special Planning-Multidisciplinary Collaboration

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Effect evaluation of homogeneous nursing management for cross-disciplinary admission of emergency patients under the quadruple objective theory CAO Junhua, ZHOU Lili, YANG Minfei, WU Xiaoyan, ZHAO Jinfeng, HUANG Hongyan 2024, 5 (11):  985-990.  doi: 10.3761/j.issn.2096-7446.2024.11.004 Abstract ( )   PDF (1159KB) ( )   Save Objective Guided by the quadruple Objective theory,to establish a homogeneous nursing management method for cross-disciplinary admission of emergency patients,and evaluate its application effect. Methods A research group was established to conduct unified training on homogenization of cross-department management for emergency patients. The patients admitted to cross-departments from the emergency department of a tertiary hospital in Hangzhou from January to June 2022 were selected as the experimental group（n=915）,and the patients admitted from July to December 2021 was retrospectively analyzed as the control group（n=917） and received the routine nursing. The nursing quality and safety indicators,such as the hospital-wide emergency call system（999） and rapid response team（RRT） initiation,medication errors,bed falls,and pressure injuries,efficiency indicators such as the time to first doctor‘s order issued,the average length of hospital stay,and the satisfaction of patients and doctors with nurses,were compared between the two groups. Results Compared with the control group,the safety and quality indicators of nursing management including the 999 initiation rate and RRT initiation rate,medication errors,bed falls and pressure injuries were decreased in the experimental group. In terms of efficiency management,the time for the first order issued by the specialist in charge was shortened（P<0.001）. The average length of hospital stay for similar diseases decreased significantly（P=0.003）. The satisfaction of patients and doctors with nurses was significantly increased（all P<0.001）. Conclusion The application of quadruple Objective theory to construct a homogenized nursing management for emergency patients‘ cross-department treatment contributes to improving nurses‘ safety management and efficiency management,and the satisfaction of emergency patients and doctors with nurses. References | Related Articles | Metrics

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A qualitative study on the current status and influencing factors of ICU nurses‘ participation in the antimicrobial stewardship LIU Yan, LU Caiju, ZENG Ling, TANG Jinhua, ZOU Shengwei 2024, 5 (11):  991-996.  doi: 10.3761/j.issn.2096-7446.2024.11.005 Abstract ( )   PDF (1121KB) ( )   Save Objective To explore the current status and influencing factors of ICU nurses‘ participation in the antimicrobial stewardship to improve nurses‘ participation in the antimicrobial stewardship. Methods A semi-structured interview was conducted among ICU nurses in two districts of a tertiary class A hospital in Nanchang,Jiangxi Province from May to June 2023. The interview results were analyzed and summarized to understand the current situation and influencing factors of nurses‘ participation in the antimicrobial stewardship. Results a total of three themes were summarized：the current situation of nurses‘ participation in the antimicrobial stewardship（role diversity,low professional value identity）,the obstacles of nurses‘ participation in the antimicrobial stewardship（lack of professional knowledge,medical hierarchy and Objective medical conditions limitations）,the promoting factors of nurses‘ participation in antimicrobial stewardship（open mind of active participation,positive feedback from the team and scientific and technological innovation）. Conclusion In order to improve nurses‘ contribution to the antimicrobial stewardship,we should try to overcome the obstacles identified in this study,and strengthen the promotion factors,so as to meet the challenge of global antibiotic resistance. References | Related Articles | Metrics

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Development of an Assessment Questionnaire on Multi-drug Resistant Organism Infection Prevention and Control Behaviors among ICU Nurses and the test of its reliability and validity FAN Li, WANG Lizhu, LI Qian, LU Xiaodan, TANG Caihong 2024, 5 (11):  996-1003.  doi: 10.3761/j.issn.2096-7446.2024.11.006 Abstract ( )   PDF (1175KB) ( )   Save Objective To develop assessment questionnaire on Multi-drug Resistant Organism（MDRO） Infection Prevention and Control（IPC） Behaviors among ICU Nurses,and to evaluate the reliability and validity. Methods We formed a pretest questionnaire by literature review,group discussion,expert consultation and pre-survey based on COM-B Model（Capability,Opportunity,and Motivation-Behavior Model）. To analyze the reliability and validity of the questionnaire,we processed a survey among 285 ICU nurses in Intensive Care Unit of 22 hospitals in China from October to November 2023,participants were selected by convenience sampling. We processed a survey among 309 ICU nurses in Intensive Care Unit of 28 hospitals in China at February 2024,for confirmatory factor analysis. Results The assessment questionnaire on MDRO IPC behaviors among ICU nurses has 4 dimensions and 32 items. The content validity index（CVI） of each item in the questionnaire ranged from 0.833 to 1.000,with an average of 0.944. The total Cronbach‘s α coefficient,test-retest reliability and split-half reliability was 0.968,0.812,0.890,respectively. The exploratory factors analysis showed that the variance contribution rate of four factors were 17.243%,14.464%,15.208% and 22.663% separately,and the cumulative variance contribution rate was 69.578%. All fitting indicators in confirmatory factor analysis were within an acceptable range. Conclusion The assessment questionnaire on MDRO IPC behaviors among ICU nurses has good reliability and validity,and can be used as a tool for assessing the current status and influencing factors of MDRO IPC behaviors among ICU nurses. References | Related Articles | Metrics

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Multidisciplinary collaborative nursing care for critically ill pregnant and postpartum women treated with extracorporeal membrane oxygenation WANG Shuqin, LI Xuyan, ZHANG Chunyan, WAN Na, ZHANG Yu, TANG Xiao, WANG Rui, JIA Yanrui, SUN Bing 2024, 5 (11):  1004-1006.  doi: 10.3761/j.issn.2096-7446.2024.11.007 Abstract ( )   PDF (732KB) ( )   Save To summarize the nursing experience of using extracorporeal membrane oxygenation to treat 8 critically ill pregnant and postpartum women. We adopted multidisciplinary collaborative team to coordinate and manage difficult catheterization,implement the delivery plan and monitor the fetuses,implement the precise anticoagulation and prevention of bleeding,strengthen catheter fixation and monitoring of spontaneous breathing during conscious ECMO,and provide multidimensional psychological care. All 8 patients survived,and 3 fetuses survived. References | Related Articles | Metrics

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A scoping review of activating rapid response teams based on early warning scores TAO Siying, DENG Zuomei, KE Guijun, LIU Yuequan, ZHOU Kang 2024, 5 (11):  1007-1013.  doi: 10.3761/j.issn.2096-7446.2024.11.008 Abstract ( )   PDF (1078KB) ( )   Save Objective To undertake a scoping review of the application research on the activation of Rapid Response Teams（RRT） for early warning scoring,both domestically and internationally. Methods We conducted a systematic search for relevant literatures in the following databases：PubMed,Embase,Scopus,CINAHL,Web of Science,The Cochrane Library,CNKI,VIP,WanFang,and CBM. The search period limited from the establishment of the database to March 31,2024,and the literature was screened and information materials were extracted based on the inclusion criteria. Results A total of 24 articles were included,including 3 in Chinese and 21 in English. We summarized the early warning score initiation of RRT in four areas：identification of deterioration,initiation of RRT,response to RRT,and evaluation metrics. Identification of deterioration involved timing of assessment and selection of scoring tools. RRT initiation scenarios included RRT initiator and immediate initiation criteria. The response profile of the RRT included the composition of the RRT and the response time. The evaluation metrics related to the clinical outcome of the patient and the current status of RRT initiation. Conclusion RRT initiated based on early warning scores can identify signs of deterioration in patients and intervene in a timely manner,which has a positive effects on improving the clinical outcomes of patients,but its application in China is still in the preliminary stage of exploration,and further research and practice are needed to improve and optimize it. References | Related Articles | Metrics

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Research progress and enlightenment on nursing training of rapid response team CHEN Shan, FAN Luo, JI Li, JING Chenyang, HE Guobao 2024, 5 (11):  1014-1018.  doi: 10.3761/j.issn.2096-7446.2024.11.009 Abstract ( )   PDF (834KB) ( )   Save Rapid response team（RRT） is increasingly used and implemented in healthcare systems around the world. The deficiency of nursing staff education is one of the obstacles to the development and proper use of RRT. Training RRT nurses can not only improve their enthusiasm for activating RRT,correctly identify patients with deteriorating conditions,but also manage critically ill patients more effectively. The purpose of this paper is to review the progress of RRT training at home and abroad,to provide experience and enlightenment for conducting RRT work,and to explore a nurse-led RRT training program suitable for China. References | Related Articles | Metrics

Emergency Care Research

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Nursing of a patient with pheochromocytoma multisystem crisis who suffered from sudden cardiac arrest ZHU Guoping, WEI Jianhua, WENG Fengxia, ZHANG Ping 2024, 5 (11):  1019-1021.  doi: 10.3761/j.issn.2096-7446.2024.11.010 Abstract ( )   PDF (585KB) ( )   Save To summarize the nursing experience of a patient with pheochromocytoma multisystem crisis who suffered from sudden cardiac arrest. In view of the low incidence of the disease,the rapid progression of the disease,and the need for early diagnosis,multidisciplinary members were initiated for joint participation in evaluation and diagnosis and treatment. In view of the problems of arrhythmia,acute pulmonary edema and nervous system injury,a rescue team was quickly established,extracorporeal membrane oxygenation was implemented,and brain function was dynamically monitored. After 17 days of treatment and nursing,the patient‘s condition was stable and he was successfully transferred back to the Department of Urology for surgical treatment. References | Related Articles | Metrics

Critical Care Research

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Perioperative nursing care for a child with hypertrophic obstructive cardiomyopathy caused by Ogden syndrome DING Yaping, JIN Yuyu, NI Yan, ZHU Jihua 2024, 5 (11):  1022-1024.  doi: 10.3761/j.issn.2096-7446.2024.11.011 Abstract ( )   PDF (565KB) ( )   Save To summarize the perioperative nursing experience of hypertrophic obstructive cardiomyopathy due to Ogden syndrome in a child. In response to the nursing challenges of complex surgery and high incidence of complications in the pediatric patient,the key points of preoperative nursing focused on reducing cardiac load. Postoperative nursing emphasized optimizing volume load and preventing low cardiac output syndrome,using cardiac pacemakers to assist in maintaining heart rhythm and preventing arrhythmias,dynamically monitoring pericardial drainage fluid and being vigilant for bleeding and pericardial tamponade,providing pain relief to improve comfort and prevent exacerbation of left ventricular outflow obstruction,and facilitating passive and active exercises to promote early cardiac recovery. After 10 days of meticulous nursing care,the patient successfully passed the critical period and was transferred to the cardiac surgery department for further specialized treatment before discharge. References | Related Articles | Metrics

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Nursing care of a patient with secondary bronchopleural fistula after autologous lung transplantation SUN Yanyan, LI Zhe, ZHENG Yuanyuan, WU Ting 2024, 5 (11):  1025-1027.  doi: 10.3761/j.issn.2096-7446.2024.11.012 Abstract ( )   PDF (619KB) ( )   Save To summarize the nursing experience of a patient with secondary bronchopleural fistula（BPF） after autologous lung transplantation. In view of the problems of severe complications of bronchopleural fistula after autologous lung transplantation and lack of evidence based nursing plan,the high risk screening of BPF before operation and the establishment of a multidisciplinary team were adopted. Early warning of secondary BPF after surgery should be implemented. A series of perioperative targeted nursing care were established,such as targeted airway management plan,precise control of blood glucose fluctuation range,and goal-oriented integrated nutrition management. Individualized psychological support and counseling were implemented. After 29 days of active treatment and nursing,the patient was discharged smoothly. References | Related Articles | Metrics

Quality and Safety

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Investigation on the practice and influencing factors of ICU nurses on family participatory sensory stimulation behaviors in patients with consciousness disorder TANG Dongmei, ZHANG Hong, ZENG Li 2024, 5 (11):  1028-1034.  doi: 10.3761/j.issn.2096-7446.2024.11.013 Abstract ( )   PDF (914KB) ( )   Save Objective To analyze the status quo and influencing factors of ICU nurses′ knowledge,attitude and practice（KAP） of family-involved sensory stimulation behaviors for patients with disturbance of consciousness. Methods A self-designed KAP questionnaire of family-involved sensory stimulation was used to investigate 293 ICU nurses from 8 general hospitals in 4 provinces and cities in May 2022. Independent sample t test,variance analysis and linear regression analysis were performed on the influencing factors of KAP. Results The average score of knowledge among 267 ICU nurses included in the analysis was（3.71±0.71）,the average score of recognition was （4.44±0.29）,and the average score of practical behavior was（3.58±0.40）. Univariate analysis showed that nurses with different professional titles,roles of nursing work,and relevant training had statistically significant differences（P<0.05）. The results of multiple linear regression analysis showed that factors affecting the KAP level of nurses towards family participatory sensory stimulation were whether they were in management roles such as teaching group leaders,held high professional titles,and received relevant training. Conclusion ICU nurses have a more positive attitude in family participatory sensory stimulation for patients with consciousness disorders,but the knowledge and practice level need to be improved. Professional titles,receiving relevant nursing training,and the role of nursing work may be the influencing factors of nurses involving in family participatory sensory stimulation. Nursing managers should pay full attention to the training needs of ICU nurses and improve the practice level of nurses in family participation sensory stimulation. References | Related Articles | Metrics

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Construction and practical evaluation of sub-specialty of nursing for gastrointestinal poisoning XIE Dongyi, JIANG Lili, ZHOU Yu, LI Guangzhou, ZHANG Li, HUANG Xihua, JI Xueli 2024, 5 (11):  1035-1039.  doi: 10.3761/j.issn.2096-7446.2024.11.014 Abstract ( )   PDF (742KB) ( )   Save Objective To explore the construction and application effects of sub-specialty nursing for gastrointestinal poisoning. Methods According to the specialty characteristics of gastrointestinal poisoning nursing and the principles of hospital treatment,a sub-specialty nursing group of gastrointestinal poisoning was established in January 2022,and the organizational structure,quality control methods,work contents,standard procedures and training programs were formulated. The changes of nurses‘ clinical comprehensive practice ability,specialty theory and specialty skills,time node parameters of nursing measures implementation and main outcome indicators of patients were compared before and after the establishment of subspecialty nursing group of gastrointestinal poisoning. Results The clinical comprehensive practice ability,specialty theory and specialty skills of nurses were significantly improved after the establishment of subspecialty nursing group of gastrointestinal poisoning（P<0.001）. For time node indicators of implementation of nursing measures for patients with acute gastrointestinal poisoning,the start time of ECG monitoring was shortened by about 2 min（P=0.005）,the blood sample collection time was shortened by about 5 min（P<0.001）,the start time of hemoperfusion was shortened by about 30 min（P=0.029）,the interval of perfusion was shortened by about 17 min（P=0.001）,and the start time of intravenous medication was shortened by about 2 min（P=0.005）,the beginning time of antidote use was shortened by about 36.5 min（P<0.001）. The collection time of urine sample,the start time of gastric lavage and the start time of catharsis all showed a shortening trend,but the differences were not statistically significant（P>0.05）. For the main outcome indicators of patients,the survival rate at 7 days was increased by about 8%（P=0.024）,and the survival rate at 28 days was increased by about 8%（P=0.045）. For secondary outcome measures,the length of stay in general ward was shortened by about 1 days（P=0.008）,and the length of stay in ICU was shortened by about 3 days（P=0.029）. There was a trend of shortening of the stay time in emergency room,but the difference was not statistically significant（P>0.05）. Conclusion The construction of sub-specialty nursing of gastrointestinal poisoning can effectively improve nurses‘ ability of specialized nursing practice and improve nursing quality of patients with gastrointestinal poisoning. References | Related Articles | Metrics

Evidence Synthesis Research

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Research on sleep in critically ill children：a bibliometric and visual analysis SHI Songsong, LI Yunyun, SUN Jiwen, ZHANG Wenlan, HE Jiaxin, SHEN Biyu 2024, 5 (11):  1040-1044.  doi: 10.3761/j.issn.2096-7446.2024.11.015 Abstract ( )   PDF (824KB) ( )   Save Objective This study aimed to analyze the research literature on sleep in critically ill children by bibliometrics,explore the research hotspots and frontiers of sleep in critically ill children,and provide references for future related research. Methods Articles on sleep in critically ill children were retrieved from the Web of Science Core Collection,and the visual analysis software CiteSpace was used for bibliometric analysis,including annual publication,journals,cited journals,countries,institutions,authors,cited authors,cited references,and keywords. Results A total of 223 articles published between January 2002 and June 2022 were analyzed. Advances in Neonatal Care published the most studies,while Pediatrics was the most cited journal. The United States and Johns Hopkins University ranked first with respect to country and institution in the field,respectively. Kudchadkar published the most research,and Als was the most cited author. The most co-cited reference was an article published by Levy. The hot spots research were “environment”,“brain”,“developmental care”,“electroencephalography”,the frontier research were “impact”,“exposure”,“noise”. Conclusion The overall trend of annual publications on sleep in critically ill children has increased slowly,with less cooperation among countries and institutions. Research hot spots and frontier trends of research on sleep in critically ill children mainly focused on the dangers of sleep deprivation,sleep monitoring tools,the influencing factors and interventions. References | Related Articles | Metrics

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Evidence summary for prevention and management of spinal cord injury after aortic surgery ZHUANG Feifei, SHI Yuxin, GUO Conghui, WU Rong 2024, 5 (11):  1045-1051.  doi: 10.3761/j.issn.2096-7446.2024.11.016 Abstract ( )   PDF (997KB) ( )   Save Objective To summarize the best evidence for prevention and management of spinal cord injury in patients after aortic surgery,so as to provide reference for clinical practice. Methods For the prevention and management of spinal cord injury in patients after aortic surgery,the clinical decisions,best practices,evidence summaries,guidelines,expert consensuses,systematic reviews,randomized controlled trials,and quasi-experimental studies were systematically searched in computer decision-supporting system,guideline websites,association official websites and databases. The search deadline was from database establishment to December 31,2022. Two researchers screened and evaluated the methodological quality of included literature,and extracted and summarized the evidence. Results Twenty-two articles were included in the study. Three dimensions with 20 items of evidence were summarized,including assessment and monitoring of spinal cord injury,risk factors identification,prevention and management strategies. Conclusion This study summarized the best evidence on the prevention and management of spinal cord injury after aortic surgery,which could provide evidence-based references for clinical and nursing practice. Most of the current evidence came from abroad,therefore,it is necessary to further carry out high-quality nursing researches in China. Through the application of the best evidence,scientific methods are expected to prevent and manage spinal cord injury after aortic surgery,and improve the quality of nursing and outcomes of patients. References | Related Articles | Metrics

Review

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Research progress and enlightenment of transfer checklist application in the transfer of patients with extracorporeal membrane oxygenation support BAO Hanru, LIANG Aiqun, LI Jing, PEI Kexi, GUO Jixiang, LUO Xiaoping, LI Ruiling 2024, 5 (11):  1052-1056.  doi: 10.3761/j.issn.2096-7446.2024.11.017 Abstract ( )   PDF (763KB) ( )   Save With the rapid development of extracorporeal membrane oxygenation （ECMO）,how to improve the efficiency while ensuring the safety of ECMO support has gradually become a key problem. As a cheap,efficient and convenient management tool,checklist has played a significant role in the field of nursing. This article reviews the development of patient transfer in patients with ECMO,the application status and effects of the checklist in the transfer of patients with ECMO,analyzes the existing problems of ECMO transfer checklist and prospects its future development,to provide reference for the further application of transfer checklist in the transfer of patients with ECMO and the development of ECMO transport in the future. References | Related Articles | Metrics