Nursing care of a patient with severe skin rash,heart failure,catheterrelated bloodstream infection and thrombosis after immunotherapy
DONG Shan1 LI Shanping1▲ YUAN Ling2 YUAN Wanyan
1.Comprehensive Cancer Center,Drum Tower Hospital Affiliated to Nanjing University School of Medicine,Jiangsu Province,Nanjing 210008,China;
2.Department of Nursing,Drum Tower Hospital Affiliated to Nanjing University School of Medicine,Jiangsu Province,Nanjing 210008,China
摘要总结1 例免疫检查点抑制剂治疗后并发重度皮疹、心力衰竭等免疫相关不良事件，伴输液港导管相关性血流感染与血栓形成的肺癌患者的护理体会。患者入院后立即通过多学科团队合作快速明确感染源、控制全身及局部感染，关注皮疹变化并加强皮肤护理，由静脉治疗专科护士负责植入式静脉输液港的维护与移除，同时严格控制出入量，持续体液负平衡，维持有效循环血容量。经多学科团队合作治疗21 d 后，患者移除植入式静脉输液港，全身及局部感染控制，生命体征平稳，皮疹消退，出院后随访30 d，均无异常。通过多学科团队快速明确病因、控制感染，并维持体液负平衡、加强皮肤护理是治疗与护理此类多发性免疫相关不良反应伴导管相关性血流感染与血栓形成的有效措施。
Abstract：To summarize the nursing experience of a lung cancer patient with severe rash,heart failure and other immune-related adverse events after treatment with immune checkpoint inhibitors,as well as port catheter-related bloodstream infection and thrombosis.Immediately after the patient is admitted to the hospital,the multidisciplinary team cooperates to quickly identify the source of infection,control systemic and local infection,pay attention to rash changes and strengthen skin care,and the specialist nurse in intravenous therapy is responsible for the maintenance and removal of the implanted venous infusion port,while strictly controlling access volume,maintain negative fluid balance,and maintain effective circulating blood volume.After 21 days of multidisciplinary team treatment,the implanted venous infusion port was removed,the systemic and local infection was controlled,the vital signs were stable,the rash subsided,and there was no abnormality in the follow-up for 30 days after discharge.Rapid identification of the cause,control of infection,maintenance of negative fluid balance,and enhanced skin care through a multidisciplinary team are effective measures to treat and care for such multiple immune-related adverse reactions with catheter-related bloodstream infection and thrombosis.
董珊；李善萍； 袁玲； 袁万燕. 多发免疫相关不良反应伴导管相关性血流感染与血栓形成1例患者的护理体会[J]. 中国当代医药, 2022, 29(28): 167-170.
DONG Shan1 LI Shanping1▲ YUAN Ling2 YUAN Wanyan. Nursing care of a patient with severe skin rash,heart failure,catheterrelated bloodstream infection and thrombosis after immunotherapy. 中国当代医药, 2022, 29(28): 167-170.
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