Effect Of Cluster Nursing On Prevention Of Catheter-related Thrombosis In Patients With Femoral Vein Catheterization For Artificial Liver

Objective : To evaluate the effect of cluster nursing on preventing catheter-related thrombosis in patients with femoral vein catheterization for artificial liver.To provide clinical nursing staff with scientific and standard nursing methods,reduce the incidence of femoral venous catheter-related thrombosis after artificial liver therapy.Methods:In the case control study,patients with liver failure who were treated with femoral vein catheterization and artificial liver in the department of infectious diseases,the second affiliated hospital of chongqing medical university were selected as the study subjects.The patients were enrolled into the control group from January to June 2018 and the intervention group from July to December 2018.On the basis of comprehensive liver protection treatment in internal medicine,combined with artificial liver therapy with femoral vein catheterization,the treatment mode was selected as Plasma exchange+Dual Plasma molecular absorptionsystem(PE+DPMAS).A total of 128 patients in the control group and 175 patients in the intervention group were collected.The control group was given routine nursing for the prevention of deep venous thrombosis(DVT).The intervention group was given cluster nursing.To evaluate the limb pain of patients with femoral vein catheterization;The limb circumference of both groups was measured 10 cm above the patella and 10 cm below the patella.Vascular ultrasound determined whether deep venous thrombosis occurred after femoral vein catheterization in the two groups.The changes of laboratory test indexes that could predict thrombosis before and after femoral vein catheterization were measured.The size of d-dimer and the number of patients with high d-dimer before and after femoral vein catheterization were evaluated.The differences of platelet,fibrinogen and d-dimer between patients with thrombosis and those without thrombosis were compared.To evaluate the knowledge of preventing deep venous thrombosis after femoral vein catheterization in the two groups;Results:1.The data of age,gender,culture,blood transfusion history,smoking history,drinking history,diabetes mellitus or hypertension,catheterization site,catheterization days,ADL score,fall score and MELD score between the two groups were not statistically significant(P >0.05).There were also no statistically significant differences between the two groups in terms of precatheter platelet,international standardized ratio,fibrinogen,d-dimer and other indicators(P > 0.05).2.In the control group,10 cases of limb pain and 22 cases of swelling occurred on the side of catheter,while 12 cases of catheter-related thrombosis occurred,with an incidence of 9.38%.In the intervention group,limb pain occurred in 3 cases,swelling in 16 cases,and catheter-related thrombosis in 3 cases,with an incidence of 1.71%.The difference between the two groups was statistically significant(P < 0.05).3.After femoral vein catheterization,platelets,international standardized ratio,fibrinogen,d-dimer and other indicators in the two groups were compared again,and the differences were not statistically significant(P > 0.05).4.PLT,FIB and d-d values of patients with thrombosis and those without thrombosis were compared.The d-dimer of patients with thrombosis after femoral vein catheterization was higher than that of patients without thrombosis,and the difference was statistically significant(P < 0.05).5.The median score of the control group on knowledge of thrombosis prevention was 20 points,and the median score of the intervention group was 33 points.The difference between the two groups was statistically significant(P < 0.05).Conclusion:1.Intensive care can effectively reduce the incidence of catheter-related thrombosis in patients undergoing artificial liver therapy through femoral vein catheterization.2.Indicators that can predict thrombosis in patients: platelet,international standardized ratio,fibrinogen,d-dimer,etc.In patients with liver failure,the size of the value cannot be well correlated with clinical thrombotic events.Whether patients have deepvein thrombosis needs to be determined by medical staff in combination with clinical symptoms and doppler ultrasound results of patients in clinical work.3.Elevated d-dimer may occur before and after femoral vein catheterization in patients with liver failure,but patients with elevated d-dimer may not develop deep venous thrombosis,which only suggests that high blood coagulation and high risk of thrombosis may occur before and after femoral vein catheterization in patients with liver failure.4.Cluster nursing focuses on health education for patients and encourages patients to take the initiative to change bad living habits,which can improve patients' knowledge level of thrombosis prevention.