A Study Of Screening Venipuncture Difficulty Children By Evaluation Tool For Vascular Grade And Evaluating Effects Of Hirudoid

Objective(1) It is to disign the evaluation tool of the vascular grade which is suitable for children through the Delphi method.(2) It is to compare and analyse the effect of hirudoid to the ascular condition and the success rate of vein-puncturein in resolving difficult puncture through regularly using anisodamine and hirudoid in silk children with difficult puncture. It is also to provide the basis of the solution to the clinic puncture difficulty.Methods1. Design of children’s vascular grade evaluation toolThis research preliminary draws up criteria of children’s vascular grade through literature retrieval,step by step decomposition of target elements,expert interview.Initial criteria system will be Modified through the 2-round Delphi expert inquiry method. Data is inputed、analyzed and processed by using Excel2003,SPSS17.0,Yaahp0.6.0 and other software.It is to analyse the the composition of experts by descriptive statistic method. It is to be tested the reliability and representation of its experts’ opinion through indicators of the degree of concentration and coordination,positive coefficient,Authority coefficient. It is to be tested the reliability of indicators at all levels by Cronbach’s a coefficient and the validity of the index system is indicated by the content-validity ratio.2 Application of Hirudoid in children with veinpuncture difficultyIt is to study on 150 cases of sick children with veinpuncture difficulty in a children’s hospital of Zhengzhou from October 2015 to April 2016. Children were randomly divided into Hirudoid group, Anisodamine group and control group of 50 cases according to the kinds of diseases, age,gender, levels of vascular,vascular site,etc. Hirudoid group:It is to determine the site of the vascular and evenly spread hirudoid as the center. Range:diameter≥5cm,dosage:lcm/time*area,frequency:5 times/day, using time:3～10 days.The operator records the vessel grade, the time of puncture, the puncture tool(detainingneedle/PICC), and the success of statistics after 3min,5min,7min, 10min,15min,20min,30min, 1day,2days,3days,5days,7days and 10days using Hirudoid (Venipuncture should be carried out according to the criterion of intravenous infusion when the blood vessel has improved after assessment. Preventive use of Hirudoid is the end after venipuncture.).Anisodamine group:It is to determine the vascular site,put the sterile cotton yarn (diameter≥5cm) immersed in the Anisodamine (1ml:10mg) at the centre of the site,and remove the sterile cotton yarn After 10 minutes.Dosage:10ml(100mg),frequency:5 times/day, using time:3～10 days. The operator records the vessel grade, the time of puncture, the puncture tool (detaining needle/PICC), and the success of statistics after 3min,5min,7min, 10min, 15mn,20min,30min,1day,2days,3days,5days,7days and 10days using Anisodamine. (Venipuncture should be carried out according to the criterion of intravenous infusion when the blood vessel has improved after assessment. Preventive use of Anisodamine is the end after venipuncture.). Control group:The routine puncture method was used. It is to record the vessel grade,the puncture tool (detaining needle/PICC),the time of puncture, and the success of statistics.Results(1) Evaluation criterion of vascular grade in children was established After two rounds of inquires. Evaluation project contains 5 levels,7 items and 35 evaluating indicators. The recoveries of two rounds of inquiries are.50% and 100%.The coordination coefficient of index system is 0.3061. The coefficient of experts’authority was 0.8357, the overall reliability coefficient was 0.795,the content validity index was 0.809, The vascular grade evaluation tool is in accordance with the evaluation criteria of the Delphi method.(2) After intervention, The number of improved cases in the Anisodamine group(18) was more than the Hirudoid group(3)within a day. The difference was statistically significant(P<0.05); The number of improved cases in the Anisodamine group(18) was more than the Hirudoid group(6)within 2 days.The difference was statistically significant(P<0.05); The number of improved cases in the Anisodamine group(18) was more than the Hirudoid group(12)within 3 days.The difference was not statistically significant(P>0.05); The number of improved cases in the Hirudoid group(21) was more than the Anisodamine group(18)within 5 days.The difference was not statistically significant(P>0.05); The number of improved cases in the Hirudoid group(35,42) were more than the Anisodamine group(18)within 7-10 days.The difference were statistically significant(P<0.05).(3) The number of cases occurring local swelling and pain of blood vessels in Hirudoid group(7) was less than that in Anisodamine group (17) and in control group(16 cases),The difference was statistically significant (P<0.05)(4) The success rate of first time puncture in Anisodamine group, Hirudoid group and control group were 64.00%,84.00%,56.00%, and,those of second time puncture were72.00%,98.00%,68.00%,respectively.The success rate of two times puncture in Anisodamine group were all higher than those in control group,but The difference was not statistically significant (P>0.05).The success rate of two times puncture in Hirudoid group were all higher than those in Anisodamine group and in control group,the difference were all statistically significant(P<0.05).Time consumption of Indwelling needle and PICC indwelling catheter:Time consumption in Anisodamine group were (22.68+3.65)s,(8.94+3.55) min, respectively.Time consumption in Hirudoid group were (13.89±2.56) s,(5.21±1.78)min,respectively. Time consumption in control group were(31.89±4.45)s,(9.33±3.46),respectively. Time consumption in Anisodamine group were less than those in control group,but the difference were not statistically significant (P>0.05). Time consumption in Hirudoid group were less than those in Anisodamine group and in control group,the difference were statistically significant (P<0.05)Conclusions(1) The evaluation tool of the vascular grade was established needed by the research,and confirmed in accordance with the evaluation criteria of Delphi method.by verification.(2) Hirudoid can improve vascular conditions, boost the success rate of puncture, reduce time consumption of puncture in application of puncture difficulty...