Objective To explore the effectiveness of arterial crisis after replantation of limb treated by ultrasound guided Fogarty balloon catheter. Methods Between January 2012 and July 2016, 27 patients suffered from arterial crisis after replantation of limb were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic anticoagulant. There were 18 males and 9 females with the age of 19-51 years (mean, 32 years). The limb mutilation position was at knee joint in 3 cases, lower limb in 9 cases, ankle joint in 6 cases, elbow joint in 2 cases, forearm in 4 cases, and wrist joint in 3 cases. The arterial crisis happened at 2.5-18 hours (mean, 7.5 hours) after limb replantation surgery. Color doppler ultrasonography was used to diagnose the arterial thrombosis, finally the anastomotic thrombosis were found in 16 cases, non-anastomotic thrombosis in 7 cases, and combined thrombosis in 4 cases. All the thrombosis were deteced in the arteries with the length of 0.8-3.9 cm. Results No complication such as vascular perforation, rupture, air embolism, thromboembolism, wound infection, or sepsis happened after operation. Arterial crisis occurred again in 3 cases at 1.5-13.5 hours after limb replantation and treated by arterial exploration, 1 case was treated successfully; 2 cases had arterial occlusion and partial necrosis of limb, and got amputation treatment at last. The rest 24 cases survived with the incision healing by first stage. In the 24 cases, 1 case suffered from acute myonephropathic metabolic syndrome and corrected after hemodialysis; 1 case suffered from acute liver functional damage and corrected by comprehensive treatment of internal medicine. The 24 patients were followed up 7-38 months (mean, 11 months). At last follow-up, blood supply of the limb was good with normal skin temperature and improved sense of feeling, activity, and swelling. According to Chinese Medical Association of hand surgery to the upper extremity function assessment standard, the results were excellent in 12 cases, good in 8 cases, and fair in 4 cases with an excellent and good rate of 83.3%. Conclusion Ultrasound guided Fogarty balloon catheter treatment of posterior replantation of arterial crisis can accurately locate the thrombosis, get the thrombus fast and invasive minimally to avoid the blind and repeated thrombectomy, and obtain certain effectiveness.
Objective To explore the application effect of process optimization in perioperative venous access management. Methods A total of 205 general surgery patients in the Operating Room of Cheng Du Shang Jin Nan Fu Hospital, West China Hospital of Sichuan University from April to May 2018 were selected as the control group, and 205 general surgery patients from June to August 2018 were selected as the observation group. The traditional management process was used in the control group, and the process optimization management was performed in the observation group. The establishment of venous access and related complications between the two groups of patients, as well as the satisfaction of patients and staff before and after the process optimization were compared. Results There was no significant difference in gender, age, education level, operation type, anesthesia method, operation duration, or intraoperative intravenous infusion channels between the two groups of patients (P>0.05). There was no statistically significant difference in gender, age, educational background, job title, job nature, or working years of the staff participating in the satisfaction survey before and after the process optimization (P>0.05). The rate of repetitive venous puncture (15.61% vs. 58.05%) and the idelness ratio of the intraoperative indwelling needle approach (10.73% vs. 52.20%) in the observation group were lower than those of the control group, and the differences were statistically significant (P<0.05). There was no statistically significant difference in the incidence of tube blockage, detubation, or phlebitis/exudation between the two groups (P>0.05). After process optimization, patient satisfaction (22.91±3.43 vs. 17.44±4.90) and staff satisfaction (28.17±2.56 vs. 20.65±3.71) were higher than before optimization, and the differences were statistically significant (P<0.05). Conclusions The process optimization of venous access management for perioperative patients can effectively reduce the rate of venous repeated venipuncture and the idelness ratio of the intraoperative indwelling needle approach, reduce invasive operations on patients, reduce the ineffective work of nurses, avoid the waste of medical resources such as manpower and materials, and improve the satisfaction of patients and staff. It is worthy of promotion and application.