村山 陵子

超音波検査装置(エコー)は,非侵襲,非拘束,リアルタイムに皮下組織のアセスメントが可能である.それを活用し,末梢静脈カテーテル留置の際にエコーで観察しながら穿刺,および留置を可能とするカテーテル留置技術を考案した.しかし観察する際に用いるプローブやエコーゼリーによって清潔野が確保しにくく,感染の恐れを伴うことが課題であった.そこで超音波透過性のよいカテーテル固定用ドレッシングフィルムを,産学連携(看護理工学会員と賛助会員の企業との連携)により製作し,一般医療機器として上市にいたった.入院患者に対し新ドレッシングフィルムを使用し,視診できない血管をエコーで画像描出できたことでカテーテル留置が成功し実用化できたことより,開発が完了したことを報告する.今後はさらに使用実績を積み,ユーザビリティーや医療従事者,患者双方の満足感,費用対効果の検証もしながら,さらなる現場のニーズを開発者にフィードバックしていく必要がある.(著者抄録)

目的 骨盤臓器脱(POP)を含む骨盤底障害のリスクファクターとして最も多いのは妊娠・出産である。しかし,POPの原因は胎児による産道への負荷だけでなく,腹腔内圧の上昇による骨盤内臓器の下降がある。POPは多彩な自覚症状を示すため,問診による診断が困難である。POPの特異的症状の有病率と腹腔内圧を上昇させる習慣などの危険因子との関係がわかれば,産後の女性のPOP発症を予防できる可能性がある。本研究の目的は,産後5年間の骨盤臓器脱の自覚症状の有病率を産褥期ごとに明らかにすることである。さらに,これらの自覚症状の危険因子を明らかにすることである。方法 本調査は,東京大学医学部附属病院で経腟分娩を行った人を対象とした横断的研究であった。質問票は,Prolapse Distress Inventory(POPDI-6)を含むPelvic Floor Distress Inventory-short form 20 日本語版を使用した。産後半年ごとにPOPの症状経験率を算出した。またライフスタイルや出産記録など参加者の特徴を質問票やカルテから把握した。参加者を症状のあり,なしの2群に分け,2群間で有意差のある変数を用いてロジスティック回帰分析を行った。結果 合計3776名に質問票を配布し,1056名(28.0%)から回答を得た。有効回答数は681名であり,産後5年間にPOPの自覚症状があった女性は36%,産後半年以内にあった女性は43%であった。産後の各期間において,POP症状を持つ割合に有意な差はなかった。POP症状を有する女性は,そうでない女性に比べて,失禁,硬便,妊娠前の排便時に力む習慣,産後の硬便を経験する割合が有意に高かった。結論 妊娠前の生活習慣と産後の排泄状態が産後のPOP症状に関係していたため,POP症状の悪化,発症を予防するためには,産後早期の症状の有無のモニタリングや排泄ケア,骨盤底に負担をかけない日常生活行動へのアドバイスなどのケアの必要性が示唆された。(著者抄録)

Intravenous infusion using a peripheral intravenous catheter (PIVC) is often complicated by catheter failure (CF). We hypothesized that catheterization of an upper arm vein instead of a forearm vein may help prevent CF. This study was designed to compare the incidence of CF in patients receiving hyper-stimulant drugs when catheters are placed in the forearm using short PIVCs (SPCs) with that when catheters are placed in the upper arm using the new long PIVCs. Patients admitted to a university hospital in Tokyo, Japan were enrolled in this study and were assigned to the SPC or the new long PIVC group. The primary outcome was the incidence of CF until 7 days. The secondary outcomes were the number of CFs per 1,000 days, the duration of the indwelling catheter, and the presence of thrombi and subcutaneous edema. Forty-seven patients were analyzed (median age, 67.0 years). The incidence of CF was 0% in the new long PIVCs and 32.0% (8 catheters) in the SPCs (p = 0.007), and the number of CF per 1,000 days was 0/1,000 and 81.7/1,000 days, respectively (p = 0.001). A significant difference in the duration of the indwelling catheter until CF occurrence was observed between the two groups (p = 0.004). Thrombi and subcutaneous edema were observed more frequently in the SPC group (p < 0.001). Catheterization of an upper arm vein using the new long PIVC to administer a hyper-stimulant drug might reduce CF compared with catheterization of a forearm vein using SPC.

Background: Ultrasound guidance increases the success rate of peripheral intravenous catheter placement. However, the longer time required to obtain ultrasound-guided access poses difficulties for ultrasound beginners. Notably, interpretation of ultrasonographic images is considered as one of the main reasons of difficulty in using ultrasound for catheter placement. Therefore, an automatic vessel detection system (AVDS) using artificial intelligence was developed. This study aimed to investigate the effectiveness of AVDS for ultrasound beginners in selecting puncture points and determine suitable users for this system. Methods: In this crossover experiment involving the use of ultrasound with and without AVDS, we enrolled 10 clinical nurses, including 5 with some experience in peripheral intravenous catheterization using ultrasound-aided methods (categorized as ultrasound beginners) and 5 with no experience in ultrasound and less experience in peripheral intravenous catheterization using conventional methods (categorized as inexperienced). These participants chose two puncture points (those with the largest and second largest diameter) as ideal in each forearm of a healthy volunteer. The results of this study were the time required for the selection of puncture points and the vein diameter of the selected points. Results: Among ultrasound beginners, the time required for puncture point selection in the right forearm second candidate vein with a small diameter (&lt;3 mm) was significantly shorter when using ultrasound with AVDS than when using it without AVDS (mean, 87 vs 247 s). Among inexperienced nurses, no significant difference in the time required for all puncture point selections was found between the use of ultrasound with and without AVDS. In the vein diameter, significant difference was shown only in the absolute difference at left second candidate among inexperienced participants. Conclusion: Ultrasonography beginners needed less time to select the puncture points in a small diameter vein using ultrasound with AVDS than without AVDS.

Despite the widespread use of peripheral intravenous catheters, unscheduled catheter failure before completion of treatment occurs frequently. If a large vein is selected, catheter failures may be prevented despite administering a highly irritant drug. In this study, we attempted to use a catheter that can be placed in a large upper arm vein. The new catheter was 88 mm long but had no guidewire to reduce contamination risk. This study aimed to evaluate the safety of the first-in-human trial for the new catheter with the administration of highly irritant drugs. This study was conducted at a university hospital in Tokyo, Japan. Eight Japanese adults were hospitalized adults with planned administration of non-cancer drugs with high irritant potential using a peripheral catheter. A trained nurse catheterized with the new catheter in the upper arm using ultrasonography. The catheterization site was monitored by staff and a research nurse once every 24 hours for up to 7 days. No adverse events or catheter failure occurred and the catheter placement success rate was 100%. In two patients, a temporary occlusion alarm of the infusion pump occurred, possibly due to the flexion of the catheter base. The new peripheral intravenous catheter did not interrupt medical treatments as is common after placement, but safety administered the irritant drugs. However, because this catheter may be easily affected by the contraction of the muscle at the fixation position, the position and method of catheter fixation in the upper arm need to be carefully considered.

Background: Peripheral intravenous catheter (PIVC) insertion often fails on the first attempt. Risk factors include small vein size and dehydration, causing vein deformation and displacement due to puncture resistance of the vessel. The authors developed a short, thin-tipped bevel needle and compared its puncture performance with needles of four available PIVCs using an ex vivo model. Methods: The PIVC with the thin-tipped short bevel needle was compared to four available PIVCs using an ex vivo model which simulated the cephalic vein of the human forearm. The ex vivo model consisted of a porcine shoulder and porcine internal jugular vein, and was used for evaluation of the rate of vein deformation and vessel displacement during needle insertion. Results: An ex vivo model was created with a vessel diameter of 2.7–3.7 mm and a depth of 2–5 mm. The thin-tipped short bevel PIVC needle was associated with a significantly lower compressive deformation rate and venous displacement compared to the needles of the other four PIVCs. Conclusion: The thin-tipped short bevel needle induced lower compressive deformation and displacement of the vein than the conventional needles. This needle has the potential to improve the first-attempt success rate of peripheral intravenous catheterization in patients with difficult venous access.

OBJECTIVES: Complications due to peripheral intravenous catheters (PIVC) can be assessed using ultrasound imaging; however, it is not routinely conducted due to the need for training in image reading techniques. This study aimed to develop and validate a system that automatically measures blood vessel diameters on ultrasound images using artificial intelligence (AI) and provide recommendations for selecting an implantation site. DESIGN: Pilot study. SETTING: The University of Tokyo Hospital, Japan. PRIMARY AND SECONDARY OUTCOME MEASURES: First, based on previous studies, the vessel diameter was calculated as the mean value of the maximum long diameter plus the maximum short diameter orthogonal to it. Second, the size of the PIVC to be recommended was evaluated based on previous studies. For the development and validation of an automatic detection tool, we used a fully convoluted network for automatic estimation of vein location and diameter. The agreement between manually generated correct data and automatically estimated data was assessed using Pearson's product correlation coefficient, systematic error was identified using the Bland-Altman plot, and agreement between catheter sizes recommended by the research nurse and those recommended by the system was evaluated. RESULTS: Through supervised machine learning, automated determination was performed using 998 ultrasound images, of which 739 and 259 were used as the training and test data set, respectively. There were 24 false-negatives indicating no arteries detected and 178 true-positives indicating correct detection. Correlation of the results between the system and the nurse was calculated from the 178 images detected (r=0.843); no systematic error was identified. The agreement between the sizes of the PIVC recommended by the research nurse and the system was 70.2%; 7% were underestimated and 21.9% were overestimated. CONCLUSIONS: Our automated AI-based image processing system may aid nurses in assessing peripheral veins using ultrasound images for catheterisation; however, further studies are still warranted.t.

AIM: We aimed to reveal detailed descriptive data on peripheral intravenous catheter (PIVC) failure related to insertion timing during the treatment cycle, in patients with lymphoma, leukemia, and myeloma. METHODS: We conducted a prospective descriptive study to investigate the incidence of PIVC failure, defined as PIVC removal prior to completing infusion therapy. This was judged by ward nurses for adult patients requiring PIVC insertion for chemotherapy. A research nurse confirmed the timing and determined the causes of PIVC failure using ultrasonographic imaging. Descriptive data were collected in the hematology and oncology ward of a tertiary hospital in Japan. RESULTS: We recruited 85 patients (with 303 PIVCs), and analyzed 67 patients (with 280 PIVCs). Of these, 118 PIVCs (42%) were inserted during the chemotherapeutic dosing period of the treatment cycle, and 106 (38%), during the rest period. The incidence of cumulative PIVC failure was 43.2% of all analyzed PIVCs (89.97 per 1,000 PIVC days). Of the PIVCs in patients with lymphoma, those inserted during the dosing period were less likely to show PIVC failure (32% vs. 57%, p < .001). Conversely, those inserted after the treatment cycle were more likely to show PIVC failure (22% vs. 7%, p = .002). CONCLUSION: This study demonstrated that the incidence of PIVC failure in patients with hematological malignancies was unacceptably high. Conceivably, the incidence of PIVC failure varies by the onset time of side effects in the treatment cycle. This should be considered when using PIVCs and selecting optimal vascular access devices for patients with hematological malignancies.

Previous studies have proposed that pelvic misalignment may be associated with stress urinary incontinence through a decrease in the contractile function of the pelvic floor muscles; however, this relationship remains unclear. This study aimed to clarify the relationship between low back pain, an indication of pelvic misalignment, and stress urinary incontinence at 3 months postpartum. We conducted a cross-sectional study of women who gave birth to full-term babies between July 2008 and July 2009. Stress urinary incontinence was defined as urinary leakage when coughing, sneezing, or exercising. Low back pain was defined as pain between the ribs and gluteal sulcus in the preceding 2 months. Of the 228 subjects included in the study, the prevalence of stress urinary incontinence was 22.8% (n = 52). The prevalence of low back pain in the stress urinary incontinence group was significantly higher than that in the non-stress urinary incontinence group (78.8% [n = 41] vs. 57.4% [n = 101]; p = 0.005). Stress urinary incontinence was associated with older age, primiparity, vaginal delivery, and low back pain at 3 months. In conclusion, low back pain was associated with stress urinary incontinence after adjusting for pregnancy and delivery factors, suggesting pelvic misalignment contributes to the development of stress urinary incontinence. We propose that including care for pelvic misalignment in pelvic floor muscle training, the treatment of choice for stress urinary incontinence, could be beneficial.

背景:末梢静脈点滴の合併症は、時には潰瘍化にいたる重要な問題である。血流の多い血管を使用することにより、合併症予防の可能性が示されてきたが、末梢静脈の血流測定方法は確立されていない。そこで本研究では健常者における超音波検査装置による上肢静脈血流量測定の信頼性妥当性検証を行い、血流量測定を行うこととした。方法:対象は健常成人8人、上肢12本とした。上肢主要静脈である上腕尺側静脈、前腕橈側皮静脈、前腕尺側皮静脈、前腕正中皮静脈を測定部位とし、訓練を受けた看護師が測定を行った。並存妥当性の検証を行うため、従来手技である手動による測定とAuto Volume Flow(AVF)機能を用いて測定を行い、ピアソンの相関係数を計算した。評価者内信頼性検証として級内相関係数(ICC)を、既知集団妥当性として豊富な血流量が予測される上腕尺側静脈と前腕に位置する静脈を比較した。結果:測定者内信頼性について、従来手技では、すべての測定の平均は25.5ml/minで、ICC(1,1)(1,3)はそれぞれ0.91(p<0.01)、0.97(p<0.01)であった。並存妥当性については、従来手技、AVFによる測定との相関はr=0.96(p<0.01)であった。既知集団妥当性として、前腕の主要静脈の血流量はいずれも上腕尺側静脈と有意な差を示した(p<0.01)。結論:上肢末梢静脈の超音波検査装置による血流測定の信頼性および妥当性が示された。(著者抄録)

PURPOSE: Chemotherapy administration can affect subcutaneous tissue at the catheterization site with no macroscopic signs or subjective symptoms. Yet clinical studies about the impact of chemotherapy on tissue at the catheterization site, except for apparent extravasation cases, are limited. This study aimed to investigate subcutaneous tissue changes in nonmacroscopically damaged catheterization sites after chemotherapy administration. METHODS: Participants were people with cancer receiving outpatient chemotherapy. Ultrasonographic images were used to assess the condition of subcutaneous tissues, including the vein, at the catheterization site before catheterization, immediately after chemotherapy, and on the next scheduled treatment day. Data on macroscopic inspection, palpation, and subjective symptoms were also collected and analyzed. RESULTS: Data from 41 participants were analyzed. All had normal subcutaneous tissues before catheterization. After treatment, 16 (39.0%) manifested abnormalities such as subcutaneous edema, vessel wall thickening, and/or thrombosis; there was no extravasation immediately after treatment. On the next treatment day, 15 (36.6.%) showed persistent or new onset of abnormalities, including subcutaneous edema. Eight of the 15 did not exhibit any subjective symptoms or macroscopic or palpation findings. CONCLUSION: After chemotherapy administration via peripheral intravenous catheters, it was found that this damage, which was difficult to detect by the conventional assessment method, persisted. Ultrasonography can provide useful information to avoid reusing damaged sites for chemotherapy administration.

BACKGROUND: The increase in the success rate of peripheral intravenous catheterization against a difficult intravenous access (DIVA) using ultrasonography is reported; however, reports related to the effectiveness of using ultrasonography in increasing the success rate for visible and palpable veins is limited. Furthermore, according to a previous study, first attempt success in catheterization contributes to low catheter failure incidence. Thus, we developed a catheterization method using ultrasonography for peripheral veins including visible and palpable veins. This study investigates the effectiveness of ultrasonography use in improving the success rate of catheterization and preventing the catheter failure for peripheral veins including visible and palpable veins. METHODS: Adult inpatients were recruited. Trained nurses inserted intravenous catheters using ultrasonography. Ultrasonography was used for all vein assessment, target vein selection, and puncturing (i.e. target point selection and/or needle guidance), regardless of the target vein's visibility or palpability. Catheters with over a 24-h dwelling time were followed for catheter failure incidence. RESULTS: Thirty-one patients were recruited, and they required 34 catheterizations. Total number of catheterization attempts were 39. Of the peripheral veins, 51.3% (20/39) were visible and palpable, 48.7% (19/39) were DIVA. The rate of successful intravenous cannulation was 29 of 34 (85.3%) after one attempt and 4 of 34 (total 97.0%) after two attempts. The catheterization failure incidence was 3.2% (1/31) in the catheter that had an over 24-h dwelling time. CONCLUSIONS: Using ultrasonography to all target veins might have contributed to higher success rates of catheterization and extremely low incidence of catheter failure based on objective findings. Selecting the vein with larger diameters and healthy tissue as puncture point and showing center of vessel lumen clearly using ultrasonography might have been contributed the results.

はじめに:高齢の糖尿病患者数の増加に伴い,高齢者に適した血糖自己測定(SMBG)の教育やデバイスのニーズは高い.そこで,高齢者がSMBGの手技獲得時の困難さに影響する要因と看護の実態を検討した.方法:SMBGの教育を行う看護師にフォーカス・グループ・インタビューを行い,質的帰納的に分析した.結果・考察:高齢者のSMBG手技獲得時の困難さに影響する要因は<身体の機能低下や反応>,<新しい技術習得時の適応力の低下>,<教育環境の不備>,<デバイスとのミスマッチング>,であることが明らかとなった.看護師は[手技獲得時の困難さに影響する要因への看護],[手技獲得時の困難さへの看護],[手技獲得時の困難さにより生じるものへの看護]をしていた.困難を繰り返し経験すると,苛立ちや悲嘆,手技獲得の意欲低下など<負の感情>が生じる可能性があり,学習目標の設定,評価に患者の参加を促すことや,自己効力感を高める看護の必要性が示唆された.(著者抄録)

末梢静脈カテーテル留置中は,患者の睡眠を含むさまざまな日常生活が妨げられる.本研究は末梢静脈にカテーテルが留置されることによる,睡眠への影響を明らかにすることを目的とした.大学病院の眼科病棟に入院し,翌日に手術予定で就床前に末梢静脈カテーテルが留置された患者を「留置群」(53人)とし,「非留置群」(55人)とともに,睡眠状態を観察した.睡眠パラメータの測定にはシート型体振動計,主観的睡眠感の調査には質問票を使用した.留置群,非留置群の間で,睡眠の質に違いは認められなかった.留置群の36.5%はカテーテルが気になり中途覚醒し,覚醒の理由で最も多かったのは「動きに伴う痛み」(63.2%)であった.留置群のサブグループ解析をしたところ,動きに伴う痛みを感じていた者は,感じていなかった者よりも,睡眠の断片化指標が有意に高く(p=0.004),主観的睡眠感が悪くなっていた.カテーテル留置群と,非留置群とを比較した場合,睡眠の質に違いは認められなかったが,カテーテルによって体動に伴う痛みを感じていた患者の睡眠の質には影響していた.(著者抄録)

逆流防止弁付き末梢静脈留置針の使用により、血液への恐れや留置の困難感が軽減するか、穿刺・留置の成功につながっているかを明らかにすることを目的とした。都内大学病院4部署を2群に分け、介入前後を比較した。穿刺時の主観的な経験、STAI(State-Trait Anxiety Inventory)、留置成功までの穿刺回数、静脈留置針の操作性などを質問紙にて調査した。対照群26名(307件)、介入群25名(292件)が分析対象となった。血液への恐れや焦りは導入前後で軽減したが、STAIの状態不安は導入前後ともに、群間に差はなく、穿刺回数の減少も差は認められなかった。カテーテルの操作性は、介入群で有意に評価が悪い項目があった。しかし血液曝露への恐れ、チューブ接続時の汚染への恐れは軽減していた。カテーテルの操作性の改善は求められたが、逆流防止弁付きカテーテルによって血液への恐れや焦りは軽減しており、感染防止の観点から、穿刺時の血液曝露の予防、接続する際の感染予防に効果がある可能性が示唆された。(著者抄録)

はじめに:高齢の糖尿病患者数の増加に伴い,高齢者に適した血糖自己測定(SMBG)の教育やデバイスのニーズは高い.そこで,高齢者がSMBGの手技獲得時の困難さに影響する要因と看護の実態を検討した.方法:SMBGの教育を行う看護師にフォーカス・グループ・インタビューを行い,質的帰納的に分析した.結果・考察:高齢者のSMBG手技獲得時の困難さに影響する要因は<身体の機能低下や反応>,<新しい技術習得時の適応力の低下>,<教育環境の不備>,<デバイスとのミスマッチング>,であることが明らかとなった.看護師は[手技獲得時の困難さに影響する要因への看護],[手技獲得時の困難さへの看護],[手技獲得時の困難さにより生じるものへの看護]をしていた.困難を繰り返し経験すると,苛立ちや悲嘆,手技獲得の意欲低下など<負の感情>が生じる可能性があり,学習目標の設定,評価に患者の参加を促すことや,自己効力感を高める看護の必要性が示唆された.(著者抄録)

末梢静脈カテーテル留置中は,患者の睡眠を含むさまざまな日常生活が妨げられる.本研究は末梢静脈にカテーテルが留置されることによる,睡眠への影響を明らかにすることを目的とした.大学病院の眼科病棟に入院し,翌日に手術予定で就床前に末梢静脈カテーテルが留置された患者を「留置群」(53人)とし,「非留置群」(55人)とともに,睡眠状態を観察した.睡眠パラメータの測定にはシート型体振動計,主観的睡眠感の調査には質問票を使用した.留置群,非留置群の間で,睡眠の質に違いは認められなかった.留置群の36.5%はカテーテルが気になり中途覚醒し,覚醒の理由で最も多かったのは「動きに伴う痛み」(63.2%)であった.留置群のサブグループ解析をしたところ,動きに伴う痛みを感じていた者は,感じていなかった者よりも,睡眠の断片化指標が有意に高く(p=0.004),主観的睡眠感が悪くなっていた.カテーテル留置群と,非留置群とを比較した場合,睡眠の質に違いは認められなかったが,カテーテルによって体動に伴う痛みを感じていた患者の睡眠の質には影響していた.(著者抄録)

This case showed that anticancer drug administration induces unhealthy subcutaneous tissue (thrombus or edema) without subjective symptoms, abnormal sign by palpation, or inspection, which have an extravasation risk.

BACKGROUND: Peripheral intravenous catheter placement is frequently unsuccessful at the first attempt. One suggested risk factor is a small vein size, because of the consequences of mechanical forces generated by the needle tip. We developed short bevel needles with a very thin tip and evaluated their puncture performance in two in vitro models. METHODS: Peripheral intravenous catheters with a new needle ground using the lancet method (experimental catheter (L)) or backcut method (experimental catheter (B)) were compared with a conventional peripheral intravenous catheter (Surshield Surflo®) in a penetration force test and a tube puncture test. Penetration forces were measured when peripheral intravenous catheters penetrated a polyethylene sheet. The tube puncture test was used to evaluate whether the peripheral intravenous catheters could puncture a polyvinyl chloride tube at two positions, at the center and at 0.5 mm from the center of the tube. RESULTS: Mean penetration forces at the needle tip produced by experimental catheters (L) (0.05 N) and (B) (0.04 N) were significantly lower than those produced by the conventional catheter (0.09 N) (p < 0.01). At the catheter tip, mean forces produced by experimental catheter (B) and the conventional catheter were 0.16 N and 0.26 N, respectively (p < 0.05). In the tube puncture test, the frequency at which the conventional catheter punctured the center-shifted site on the tube at an angle of 20° and speed of 50 mm/min was low (40%). In contrast, experimental catheters (L) and (B) were 100% successful at puncturing both the center and center-shifted sites at 20°. CONCLUSION: Puncture performance was comparable between the lancet-ground and backcut-ground needles except for penetration forces at the catheter tip. The experimental catheters produced lower penetration forces and induced puncture without target displacement at smaller angles compared with the conventional catheter. Therefore, optimization of the needle can prevent vein deformation and movement, which may increase the first-attempt success rate.

PURPOSE: Extravasation incidence is exceptionally low; however, ulceration or necrosis occurs in severe cases, possibly requiring surgical treatment. Early extravasation signs and symptoms are not always evident on treatment day, and inflammation, which leads to ulceration or necrosis, may appear several days later. Therefore, to minimize damage, identification of high-risk groups is required. This study aims to investigate the relationship between subcutaneous edema which is an early extravasation sign, and skin surface temperature using a thermosensitive liquid crystal film. METHODS: Patients receiving chemotherapy through a peripheral intravenous catheter were recruited. Subcutaneous tissue around the catheterization site was observed for the presence of subcutaneous edema by ultrasonography. During chemotherapy initiation, a thermosensitive liquid crystal film was placed on the catheterization site. Color changes of the film were observed, and each case was classified according to low-temperature distribution patterns. To investigate the factors associated with temperature distribution pattern, logistic regression analysis was performed using clinically selected independent variables. RESULTS: Data from 63 patients were analyzed. No obvious extravasation was observed. Film analysis revealed 34 cases of broadening low-temperature area from the vein and 23 cases of non-broadening low-temperature area from the vein. Subcutaneous edema was observed in 18 patients: 17 with broadening low-temperature area from the vein and 1 with non-broadening low-temperature area from the vein. Subcutaneous edema was positively correlated with broadening low-temperature area from the vein. CONCLUSION: Catheter site skin temperature distribution pattern during chemotherapy was associated with subcutaneous edema which is the early extravasation sign immediately after chemotherapy.

抗がん剤の血管外漏出の早期発見は重要であるが,そのアセスメントはむずかしく,客観的手法が求められている.そこで液体貯留が皮膚表面温度の低下をもたらすことから,非侵襲的かつ持続使用可能で安全な血管外漏出アセスメントツールとして,液晶感温フィルムを開発した.研究目的は,開発したフィルムの使用感,安全性,皮膚表面温度の可視化における実現可能性を確認することである.患者40名と看護師8名を対象とした.明らかな血管外漏出はなかった.使用後の調査において,患者は全員がフィルムを使用してもよいと答え,かゆみなどの不快感があったものはいなかった.看護師は,感温フィルムをカテーテル固定用フィルムの上に貼付し,通常通り薬剤投与を行い,使用感を感温フィルム1枚ごとに評価した.看護師の回答の80%において観察の頻度は変わらなかったことから,業務負担への影響は少ないと考えられた.カメラで記録された温度分布は6つのパターンに分類された.以上より,血管外漏出アセスメントツールとしての実現可能性が示唆された.(著者抄録)

超高齢社会のなかで,血糖自己測定(SMBG)を実施する高齢者のためのデバイスや教育方法の開発に対するニーズは高い.本研究の目的はSMBG手技の観察により高齢糖尿病患者のSMBG実施の困難を明らかにすることである.SMBGの手技を録画し,手技を言語化して,生じている困難を帰納的に抽出する質的研究を行った.参加者は65歳以上の高齢糖尿病者29名であった.高齢者には「準備」「電極の挿入」「針の取りはずし」「穿刺」に関連した困難があり,「採血量が不足している」や「針が出てこない」などの失敗を経験していた.SMBG手技を習得したあとでも,高齢者はSMBGの実施に困難を抱えていた.ボタンやレバーを間違ったり,技術が不十分であっても彼らはさまざまな工夫をしながらSMBGを継続していた.定期的な手技の確認とフィードバックが高齢者には必要かもしれない.これらの知見は高齢者に使用しやすいSMBGデバイスを開発する必要性を示している.(著者抄録)

BACKGROUND: Intravenous catheters are widely used but are often removed due to complications associated with catheter sleeve formation. A catheter sleeve can develop from a thrombus, and catheter-induced vascular endothelium damage may be a critical factor for thrombus formation. We investigated the effect of catheter-induced mechanical stimulation on venous endothelial cells and catheter sleeve formation and the efficacy of anti-thrombogenic technology for preventing catheter sleeve formation in vivo. METHODS: We surgically implanted poly(2-methoxyethyl acrylate)-coated and uncoated catheters with and without a stylet into the right external jugular vein of a rabbit model for 14 days. Catheter sleeve formation and the ratio of residual venous endothelial cells were compared using histological examination and immunostaining with an anti-CD31 antibody, respectively. RESULTS: Stiffening an uncoated catheter with a stylet induced catheter sleeve formation along more than two-thirds of the length of the catheter. The ratios of residual venous endothelial cells at the tip of uncoated catheters with and without a stylet were 3% and 36%, respectively. While poly(2-methoxyethyl acrylate) coating also reduced the ratio of venous endothelial cells at the tip of the stiffened catheter (12%), it prevented external thrombus and catheter sleeve formation. CONCLUSION: High levels of mechanical stimulation can affect catheter-related thrombosis and promote catheter sleeve formation, and anti-thrombogenic technology such as a poly(2-methoxyethyl acrylate) coating reduces thrombus formation and can prevent catheter sleeve formation on stiffened catheters. Further studies are required to determine the maximum degree of venous endothelial cell damage before catheter sleeve formation and to compare other anti-thrombogenic technologies with poly(2-methoxyethyl acrylate) for preventing catheter sleeve formation.

<p>Few studies have investigated the molecular mechanisms of catheter failure (CF). Herein, we performed histological and molecular biological analyses of the catheter tip to demonstrate its potential as a resource for biological investigation. Additionally, we searched for risk factors for the development of inflammation and coagulation, which are pathological conditions clarified by biological analysis. The CF group included 30 failed catheters involving thrombus and subcutaneous edema identified by ultrasonography. The No-CF group included 26 catheters with no complications. The removed catheter tips were fixed for hematoxylin-eosin (HE) staining with the application of a real-time reverse transcriptase polymerase chain reaction for eukaryotic 18S ribosomal RNA (rRNA), interleukin 1β, tumor necrosis factor α, tissue plasminogen activator, and plasminogen activator inhibitor 1 (SERPINE1). HE staining identified attached nuclear cells on the inner surfaces of both CF and No-CF catheters. The 18S rRNA was amplified in all samples. The expression level of SERPINE1 was significantly higher in the CF group than in the No-CF group (p = 0.01), whereas the expression levels of other genes did not differ between the groups. Symptoms of CF associated with the expression of SERPINE1 were analyzed. The catheter being in contact with blood vessels during placement was a suggested factor related to the high expression of SERPINE1 (p = 0.04). Catheter tips are a potential resource for biological investigation, and expression analysis of the attached cells can reflect the pathological condition of the catheterized tissue. Further studies using catheter tips are required to elucidate the molecular mechanisms of CF.</p>

Paclitaxel, a taxane, is frequently administered intravenously as an anticancer agent. When a peripheral intravenous catheter is used for paclitaxel infusion, clinical nurses often observe signs such as slight swelling at the catheter placement site, lack of blood return, and difficulty in continuing the infusion. However, the cause(s) of such phenomena at the puncture site has not yet been elucidated. The aim of this study was to obtain ultrasonography images of subcutaneous tissues and veins of patients undergoing paclitaxel and carboplatin chemotherapy and compare ultrasonography images taken immediately before catheter removal with those of patients receiving other types of taxanes. We studied 24 patients receiving chemotherapy, including seven receiving paclitaxel and carboplatin chemotherapy, through a peripheral intravenous catheter in a chemotherapy unit for outpatients of a university hospital in Japan. Ultrasonography images of venipuncture sites were obtained before catheter insertion and immediately before catheter removal. We observed subcutaneous edema in the absence of visible manifestations at the puncture sites of all patients undergoing paclitaxel and carboplatin chemotherapy, but not in any patients receiving other types of taxanes. When vesicant agents and vehicles have caused subclinical subcutaneous edema, clinical nurses may detect early slight extravasation by using ultrasonography.

Blood sampling for self-monitoring of blood glucose is difficult for the elderly with low dexterity. We developed and tested the utility of an automatic puncturing and sampling (APS) system as a part of an automatic SMBG device, but success rates of securing sufficient blood volume was low (61.9%). Thus, the squeezing condition was changed to increase its success rate. The aim of this study is to investigate the impact to the amount of bleeding by making changes to the squeezing condition. In our previous experiment, blood sampling was performed simultaneously with squeezing, whereas the present study tested blood sampling after squeezing. This method increased the success rate (75%) among eight subjects who had a low success rate (25%) in the previous experiment using the APS system.

Dietary under-reporting is a common problem when using self-reported dietary assessment tools. However, there are few studies regarding under-reporting during pregnancy. This study aimed to explore the demographic and psychosocial characteristics related to dietary under-reporting in pregnant Japanese women. A cross-sectional study was conducted between 2010 and 2011 at a university hospital in Tokyo, Japan. Nutrient intake was assessed using a self-administered Diet History Questionnaire (DHQ), which had questions about the consumption frequency and portion size of selected food items. The 24-h urinary excretion levels of urea N and K were used as the dietary protein and K intake reference values, respectively. Under-reporting of protein and K was defined as the bottom 25 % of the reporting accuracy (the ratio of reported intake on the DHQ to the estimated intake based on urinary excretion). Under-reporters were defined as participants who under-reported both protein and K intake. Multiple logistic regression analysis was performed to examine the factors associated with under-reporters. Of 271 healthy women at 19-23 weeks of gestation, thirty-five participants (12·9 %) were identified as under-reporters. Under-reporters had a lower pre-pregnancy BMI (adjusted OR (AOR) = 0·81) and lower gestational weight gain (AOR = 0·82); they also reported managing their gestational weight gain with the aim to return to their pre-pregnancy weight soon after childbirth (AOR = 2·99). Healthcare professionals should consider the potential for dietary under-reporting and the possible related factors when assessing the dietary intakes of pregnant Japanese women using self-administered questionnaires.

抗がん剤の血管外漏出後の重症皮膚障害の発生要因の抽出を目的とした。2014年4〜9月に抗がん剤の点滴静脈内注射を受けた256件のうち漏出した25名を対象とした。滴下中にサーモグラフィーによる皮膚温度の測定と肉眼的観察を行った。重症群を再来時に硬結もしくは水疱があると定義し、重症群(12件)と軽症群(13名)に分け両群の要因を比較した。金沢医科大学倫理委員会の承認を得た。重症皮膚障害が発生した対象の特徴は、サーモグラフィーで血管外漏出を示唆する低温領域出現後の壊死性薬剤もしくは炎症性薬剤の投与時間が長い(重症群28分、軽症群6分、P=0.017)、投与時の腫脹なし(重症群92%、軽症群46%、P=0.03)、年齢が低い(重症群59.4歳、軽症群71.2歳、P=0.037)、であった。抗がん剤の血管外漏出後の重症皮膚障害の発生要因として、肉眼で腫脹が認識されないことによる長時間の漏出が示唆された。(著者抄録)

The risk of peripheral intravenous catheter failure varies according to the insertion site. This study examined catheter shape just after removal to evaluate the causes of catheter failure according to site. This study was a secondary analysis of previous study data. Our observational study was conducted during a 6-month period at The University of Tokyo Hospital. Participants were hospitalized adults who received infusion therapy via a short peripheral catheter. We acquired ultrasound images of blood vessels and surrounding tissues at the catheter insertion site before catheter removal and clinical images of the removed catheters. We analyzed 184 catheters from 142 participants. There were no significant differences in the catheter failure rate (29.9%) among insertion sites. Curvature in the middle of the catheter was present in 9.2% of cases; the median bend angle at the catheter base was 9.1° (range: 0.0°-68.3°). The bend angle of catheters inserted in the upper arm was significantly greater than of catheters in the forearm (p = 0.013). Catheter curvature was related to catheter failure (14.8% of failed catheters had curvature; p = 0.035) and occlusion (35.3% of occluded catheters had curvature; p = 0.008) in upper arm and forearm placements. The median distance from the elbow to the insertion site was shorter for failed catheters than for surviving catheters. To prevent catheter failure, especially occlusion resulting from catheter curvature, a catheter should be inserted at an appropriate insertion site far from the antecubital fossa.

Background: Performing self-monitoring of blood glucose (SMBG) is a clinical challenge for elderly people with low dexterity. An all-in-one-type SMBG device that can simply and easily puncture and monitor would be useful for them. We developed an automatic skin-puncturing and blood-sampling (APS) system for introducing of an all-in-one-type SMBG device. The aims of this study were to determine if the developed APS system, which has automatic puncturing, squeezing, and application functions, could provide sufficient blood sample volumes for SMBG and to determine the factors associated with failure in the use of the system by adult volunteers. Methods: We investigated the success rate of obtaining a 0.8-μL sample volume using the APS system and determined the factors associated with failure in 140 adult volunteers. The participant characteristics, induration of puncturing sites, and states of finger grip conditions were evaluated as factors of a puncturing failure. The participant characteristics, skin hydration, states of finger grip, skin elasticity of the finger pad, and blood flow were evaluated as factors of a squeezing failure. Results: The success rate was 61.9%. Puncturing failure was 21.6%, and squeezing failure was 16.5%. Automatic puncturing factors associated with failure were male sex, larger finger diameter, and thicker finger pad. The only squeezing failure factor was lower peripheral skin temperature. Conclusions: Improvement of the finger station groove shape to prevent ischemia and the squeezing angle would be useful developments of the all-in-one-type SMBG device for elderly people with decreased dexterity.