Nursing Assistance During Whole-Process Ultrasound-Guided Percutaneous Portal Vein Puncture for Islet Transplantation

Nursing Assistance During Whole-Process Ultrasound-Guided Percutaneous Portal Vein Puncture for Islet Transplantation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nursing Assistance During Whole-Process Ultrasound-Guided Percutaneous Portal Vein Puncture for Islet Transplantation Yangyang Lei, Shan Guo, Mianni Chen, Huijuan Zhao, Huixia Lan, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6245373/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aims to develop nursing guidelines for diabetic patients undergoing ultrasound-guided islet transplantation via percutaneous portal vein puncture and catheterization, providing valuable insights for perioperative care. Methods From December 2017 to September 2023, 27 patients underwent 44 ultrasound-guided islet transplantations at our hospital. Comprehensive nursing support was provided preoperatively, intraoperatively, and postoperatively. Results All 44 procedures were successful. Intraoperative complications included upper abdominal pain/nausea/vomiting in 3 cases (6.8%), transient portal vein pressure increase in 8 cases (18.2%), and active bleeding post-catheter removal in 6 cases (13.6%). No delayed portal vein bleeding or thrombosis occurred. Conclusions Nursing interventions are critical for the success of ultrasound-guided islet transplantation. Key measures include preoperative assessment and patient education, intraoperative monitoring of vital signs and portal vein pressure, and postoperative prevention of bleeding complications. Islet Transplantation Portal Vein Catheterization Ultrasound Guidance Nursing Introduction At present, the treatment of diabetes is mainly based on pharmacological interventions. The vast majority of patients with Type I diabetes require multiple daily injections of insulin or insulin pump therapy, while those with Type II diabetes predominantly utilize medications under the guidance of endocrinologists [ 1 ]. In recent years, with the further development of medical technology, islet transplantation has gradually become a research hotspot. It involves establishing a transplantation channel through percutaneous portal vein puncture and catheterization, transplanting isolated and purified islets into the portal vein sinus, enabling the recipient to secrete insulin normally, thereby controlling blood sugar levels [ 2 ]. Currently, islet transplantation has high safety and proven efficacy, with the proportion of patients who have discontinued insulin use five years after islet transplantation reaching 50% [ 3 ]. Both domestically and internationally, ultrasound combined with X-ray-guided techniques has become the standard surgical approach for islet transplantation. which uses X-ray fluoroscopy or ultrasound scanning for portal vein puncture, followed by radiological interventional angiography to monitor the catheter placement within the portal vein during islet transplantation [ 4 ]. However, X-rays and contrast procedures are complex, radioactive, and the contrast agents have nephrotoxicity and other drawbacks [ 5 ]. The whole-process ultrasound-guided percutaneous portal vein puncture technique for islet transplantation represents an innovative surgical advancement characterized by its radiation-free nature, precise puncture capabilities, and the ability to safely perform portal vein catheterization while allowing real-time dynamic observation of the islet transplantation process into the portal vein [ 3 ]. Since December 2017, our hospital has been using whole-process ultrasound-guided technique for percutaneous portal vein puncture and catheterization to complete islet transplantation [ 6 – 7 ]. However, the portal vein system is different from the arterial system, as it has slower blood flow and is pressure-sensitive. How to combine the characteristics of portal vein blood flow to perform key nursing techniques during ultrasound-guided percutaneous portal vein puncture transplantation surgery to reduce the occurrence of upper abdominal and liver area pain, nausea, vomiting, and bleeding in patients during surgery poses a challenge to clinical nursing and requires further in-depth research and summary. From December 2017 to September 2023, our hospital performed ultrasound-guided percutaneous portal vein puncture islet transplantation surgery on 27 cases (44 procedures), and the nursing situation is reported as follows. Data and Methods 1.1 General Data Our hospital treated patients in need of ultrasound-guided percutaneous portal vein puncture islet transplantation from December 2017 to September 2023. 1.2 Inclusion and Exclusion Criteria Inclusion Criteria: ①Patients diagnosed with diabetes who exhibit uncontrolled blood glucose levels despite receiving pharmacological treatment; this includes individuals experiencing significant hypoglycemia, hyperglycemia fluctuations, diabetes-related complications, etc., who need daily insulin injections but still cannot control blood sugar well; ②There must be one donor providing islets, with the donor age between 18 and 50 years old, and the donor and recipient (patient) blood types must match; ③Patients with no history of malignant tumors, active infections, severe heart disease, liver dysfunction, pulmonary dysfunction, and other diseases. Exclusion Criteria: ①Patients with untreated or uncontrolled mental disorders, drug addiction, etc.; ②Patients with severe cardiovascular diseases, liver diseases, etc., who cannot tolerate surgery; ③Patients diagnosed with infectious diseases, malignant tumors, or any other significant medical conditions. 1.3 Preoperative Medication Antibiotic treatment: 2 hours before surgery, ceftriaxone sodium and sulbactam sodium (Shupushen) 3.0g was administered intravenously; Immunosuppressive treatment: Before transplantation, and on the 1st, 2nd, and 3rd days after transplantation, rabbit anti-human thymocyte immunoglobulin (ATG) (total dose of 6 mg/kg) was administered intravenously; Before transplantation and on the 4th day after transplantation, basiliximab (Shulai) 20mg was administered intravenously; Maintenance treatment: Treated with tacrolimus (blood concentration 4 ~ 6ng/mL) combined with sirolimus (blood concentration 8 ~ 12ng/mL) or mycophenolate mofetil (750mg) orally, twice daily. 1.4 Surgical Method The patient was placed under local anesthesia and intravenous analgesia with the head turned to the left side. The right arm was elevated above the head, the right shoulder abducted at 90°, and the right forearm flexed at 100°. A soft pillow was placed beneath the right arm. The right arm peripheral venous access was chosen first. Before transplantation, the conical flask containing islet cells was left to stand for 10 minutes to allow the islet cells to settle, subsequently, the supernatant liquid was removed. Fresh islet cell culture medium was injected, and heparin solution was added for mixing purposes to assist in connecting the portal vein infusion pipeline (preparation included a 50 mL syringe, a 16G puncture needle, etc., as well as an islet infusion device). Under ultrasound guidance, percutaneous portal vein puncture and catheterization were performed to establish a transplantation channel. Sixty-nine mg of Sonovue + 0.9% saline 5mL was mixed by shaking up and down vigorously for 20 seconds, then 0.05mL of Sonovue contrast agent + saline 10mL was shaken vigorously and mixed well. The resulting mixed solution was then slowly injected into the catheter by an assisting surgeon in order to perform catheter angiography. When both the left and right branches of the portal vein were visualized, it was confirmed that the catheter was in the main trunk of the portal vein. The isolated and purified islet cells were infused into the portal vein sinus. Prior to the procedure, a solution consisting of 100 mL of saline combined with 12,500 U of heparin sodium was prepared, calculated at a dosage of 70 U/kg to determine the total amount required. This solution was thoroughly mixed with the islet cell suspension and continuously infused into the patient's body. During the operation, continuous ECG monitoring was performed, and vital signs, blood sugar levels, and portal vein pressure changes were monitored in real-time, with low-flow oxygen administered via nasal cannula. The infusion of islet cells took about 20 to 30 minutes. After the infusion was completed, the catheter was removed, and the catheter was slowly retracted while slowly injecting the Human Fibrin Sealant until the catheter was completely removed from the body. After the operation, the patient was instructed to rest in a supine position with the head turned to one side, the right arm was withdrawn to the right side of the body, and an abdominal ultrasound was rechecked after 30 minutes. If there was no abdominal bleeding, the operation was concluded. Results All 27 patients (44 cases) successfully completed the operation, with the operation time ranging from 50 to 168 minutes, and the median operation time was 105 minutes. Among them, 3 cases (6.8%) experienced upper abdominal and liver area pain, nausea, and vomiting during the operation; 8 cases (18.2%) had a transient increase in portal vein pressure (exceeding 20mmHg) during the operation; 6 cases (13.6%) had active bleeding during the operation, all of which were relieved after symptomatic treatment and nursing care. All patients had no delayed bleeding or complications such as portal vein thrombosis after the operation during the follow-up visit one week later. Discussion Islet transplantation is a surgical method for the treatment of diabetes, which is a β-cell replacement therapy and one of the most effective means of treating diabetes currently. After islet transplantation, patients no longer need insulin injections or insulin pumps, nor do they need to strictly implement dietary control and exercise plans; it can also reduce or avoid complications such as diabetic nephropathy and microvascular lesions in patients. Studies have shown that islet transplantation can extend the patient's life. For example, GRUESSNER and others found that the 5-year survival rate of patients after islet transplantation is over 85%. At present, ultrasound + X-ray guided islet transplantation is the mainstream surgical method at home and abroad. The whole-process ultrasound-guided percutaneous portal vein puncture islet transplantation proposed by our hospital for the first time has achieved good results. However, complications such as upper abdominal and liver area discomfort, transient increase in portal vein pressure, intraoperative active bleeding, or postoperative portal vein thrombosis may occur during the operation process. Therefore, meticulous preoperative, intraoperative, and postoperative nursing care must be ensured throughout the process. 3.1 Preoperative Nursing 3.1.1 Blood Sugar Management The success of islet transplantation is closely related to postoperative islet function and preoperative blood sugar levels, making preoperative blood sugar control an indispensable and important part of the preparation for islet transplantation [ 9 ]. On the one hand, hyperglycemia before surgery can lead to impaired islet function after surgery; on the other hand, hyperglycemia can cause excessive insulin secretion, thereby damaging the pancreatic islet β-cells, and also increase the risk of surgery. Therefore, it is essential to control the blood sugar of patients before surgery [ 10 ]. In this group of patients, a Digital glucose sensor was installed on the back side of the right upper arm to monitor blood sugar fluctuations in real-time, and after medication control, the blood sugar levels of the patients before surgery fluctuated between 4.1 to 17.7 mmol/L. 3.1.2 Use of Antibiotics and Immunosuppressive Drugs The use of antibiotics is necessary to prevent infection risks associated with ultrasound-guided percutaneous portal vein puncture islet transplantation. Additionally, patients receive immunosuppressive therapy before and after the procedure, thus requiring antibiotic prophylaxis. The application of antibiotics before surgery can also reduce postoperative inflammatory reactions and tissue damage. All 27 patients in this group (44 procedures) were routinely administered antibiotics 2 hours before surgery, and none exhibited surgery-related infection symptoms postoperatively. Immunosuppressive drugs can effectively reduce the incidence of immune rejection reactions after transplantation and improve the success rate of the transplant. However, these drugs can have certain impacts on the patient's immune system and liver and kidney functions. It is necessary to assess the patient's liver and kidney functions before surgery to ensure the safe use of the medication. The patients in this group were administered immunosuppressive drugs such as Simulect and Atgam, with no adverse reactions observed. 3.1.3 Preoperative Visit and Psychological Nursing Before surgery, the surgical nurse assists the physician in visiting the patient, reviews the medical records to understand the patient's medical history and various test results, and assesses the patient's attitude towards surgery and psychological endurance. On one hand, due to the patient's history of diseases such as diabetes, nephropathy, hypertension, or a history of surgeries like renal transplantation or pancreas-kidney transplantation, long-term illness can lead to adverse psychological effects. On the other hand, there are concerns about complications during the surgery and doubts about the effectiveness of the surgery. Therefore, it is essential to communicate and provide psychological guidance to the patient before surgery, patiently answer questions raised by the patient and their family, introduce the purpose, method, advantages, surgical process, the surgeon's experience and technical level, successful cases, the composition and cooperation of the medical team, and the hospital's equipment conditions to build confidence in treatment; inform the patient about the precautions during the perioperative period to ensure the patient accepts the surgery with a good mental state. In this group, the preoperative anxiety of the patients was relieved, and they were able to cooperate with the surgical treatment. 3.2 Intraoperative Nursing 3.2.1 Position Management The patients in this group were placed in a supine position with the head turned to the left side to prevent aspiration due to patient vomiting. The right arm was raised above the head, the right shoulder abducted 90°, the right forearm flexed 100°, and a soft pillow was placed under the right arm to prevent brachial plexus nerve overstretching and injury caused by the surgical position. The patients were asked about their comfort during the surgery, and minor adjustments were made as necessary to improve patient comfort. Since all patients in this group had a history of diabetes, skin observation and management were conducted before surgery. For example, cotton pads were wrapped around areas of skin damage, prominent bones, and pressure areas to prevent pressure injuries during surgery. 3.2.2 Prevention of Portal Vein Thrombosis The diameter of a single islet cell is approximately 50–300µm, and when islet cells form clusters, the diameter is larger, which can easily trigger thrombi that block small vessels. To prevent the formation of islet cell clusters, it is necessary to master the injection technique of islet cells. During the injection process, the islet cell heparin suspension must be continuously and vigorously agitated to prevent blockages. Nurses closely observed the patient's vital signs, facial expressions, and bodily reactions, and promptly reported to the surgeon to prevent the formation of portal vein thrombosis. None of the patients in this group experienced blockages during the islet cell injection process. 3.2.3 Monitoring Blood Glucose To observe changes in blood glucose levels during surgery, a Digital glucose sensor was installed on the posterior side of the right upper arm before surgery to dynamically monitor blood glucose fluctuations. Blood glucose was recorded every 10 minutes during surgery and reported to the surgeon. When blood glucose was higher than 11mmol/L, Gansulin R injection solution 10U + physiological saline 50mL was administered at a rate of 10mL/h; when blood glucose was ≤ 3.9mmol/L, 10% glucose 500mL was administered intravenously or 50% glucose was taken orally. The blood glucose levels of the patients in this group (44 procedures) were stable during the islet transplantation process, fluctuating between 3.8 and 16.4mmol/L. 3.2.4 Monitoring Portal Vein Pressure After the infusion of islet cells in the portal vein sinus, the pressure in the portal vein may increase temporarily. When the portal vein pressure rises above 20mmHg, it will increase the risk of portal vein thrombosis. All patients in this group were monitored for portal vein pressure, with physiological saline 500mL covered with a pressure bag, connected to a pressure monitoring device, and the pressure bag was pressurized to 300mmHg. The transducer was vented and connected to the equipment according to the invasive central venous pressure operation procedure for measurement; measurements were taken every 10 minutes and promptly fed back to the surgeon. In this group, 8 cases had a transient increase in portal vein pressure during the transplantation procedure, and the infusion was paused until it returned to normal levels before resuming. 3.2.5 Complication Nursing 3.2.5.1 Pain Nursing Pain is a common issue during islet transplantation surgery. Ultrasound-guided portal vein puncture and increased portal vein pressure may cause pain and restlessness during surgery. Three cases in this group had upper abdominal and liver area pain and other symptoms during surgery, which were considered to be caused by transient portal vein pressure elevation. Symptomatic management was administered, enabling the patients to successfully complete the surgical procedure following verbal reassurance and relaxation therapy provided by nursing staff. 3.2.5.2 Nausea and Vomiting Nursing Nausea and vomiting are common complications during ultrasound-guided percutaneous portal vein puncture and catheterization islet transplantation surgery and are related to the increase in portal vein pressure caused by islet infusion. Three cases in this group experienced nausea and vomiting, and the infusion was immediately stopped to prevent bleeding caused by vomiting and restlessness. The patients were instructed to turn their heads to the left to prevent aspiration, and metoclopramide hydrochloride (Maxolon) was administered intravenously or promethazine hydrochloride (Phenergan) was administered intramuscularly. The patients were comforted and the surgery was continued after the symptoms were relieved. 3.2.5.3 Active Bleeding Nursing The infusion of islet cells requires percutaneous puncture of the portal vein, and poor closure of the puncture needle tract after surgery can lead to portal vein bleeding and active abdominal bleeding. In addition, heparin anticoagulation is routinely used during and after surgery to prevent portal vein thrombosis, thus the risk of bleeding is relatively high. Patients in this group were educated on the key points that needed to be cooperated with during the surgery; during the puncture of the portal vein and the infusion of islet cells, nurses closely monitored the patient's facial expressions and bodily reactions, asked about the patient's feelings in a timely manner, and closely observed changes in the patient's vital signs. After surgery, a sandbag was used to compress the puncture site, and a belly bandage was used for pressure dressing for 30 minutes to prevent portal vein bleeding caused by poor closure of the needle tract. Six cases in this group had active bleeding during surgery, and ultrasound-guided ablation hemostasis was performed, with no postoperative bleeding occurring. 3.3 Postoperative Nursing After the completion of the islet cell suspension infusion, ECG monitoring continued for 30 minutes to observe changes in the patient's heart rate, blood pressure, blood oxygen, and other indicators. It is important to observe for symptoms such as pale complexion, cold and clammy skin, changes in consciousness, and to ask about any discomfort. After 30 minutes, an abdominal ultrasound was rechecked to determine if there was active bleeding from the portal vein or other complications. If the ultrasound confirmed active bleeding, the nursing staff quickly cooperated with the surgeon to perform ultrasound-guided radiofrequency ablation hemostasis, referring to the nursing cooperation for ultrasound-guided liver tumor radiofrequency ablation surgery; if the patient had no bleeding and no physical discomfort, the patient was transported back to the ward and a handover was conducted with the ward nurse. Conclusion This group summarized the nursing experience of 27 cases (44 procedures) of ultrasound-guided islet transplantation surgery. They emphasize the importance of several key factors in ensuring successful outcomes: 1. Preoperative visits to assess the patient's condition, along with providing psychological support and patient education regarding relevant disease knowledge. 2. Close monitoring of vital signs, portal vein pressure, and blood glucose levels during surgery to prevent complications. 3. Postoperative measures aimed at preventing active bleeding from the portal vein. These elements are deemed crucial for the successful completion of ultrasound-guided percutaneous portal vein puncture islet transplantation surgery. Abbreviations ECG: Electrocardiogram Declarations Fund Project: This project is a major research plan project of the National Natural Science Foundation, project number 92059201. Ethics approval and consent to participate This study was conducted in accordance with the principles of the Declaration of Helsinki (2013 revision) and was approved by the the IEC for Clinical Research and Animal Trials of the First Affiliated Hospital of Sun Yat-sen University (Approval No. [2022]557, Ethical Review). All tissues were procured from Organ Procurement Organizations of the First Affiliated Hospital of Sun Yat-sen University, confirming compliance with ethical procurement standards and verifying that no materials were obtained from prisoners. Informed consent was obtained from all study participants. For vulnerable individuals, consent for participation was provided by their legally authorized representatives or appropriate proxies. Clinical trial number: not applicable. Consent for publication ： not applicable. Availability of data and materials ： not applicable. Competing Interests ： The authors declare no competing interests. Author Contributions Statement ： Yangyang Lei and Shan Guo wrote the main manuscript text. Mianni Chen, Huijuan Zhao, Huixia Lan, Zhenli Huang, Jialin Wang, Bei Huang collected clinical data. Bowen Zhuang analysed clinical data. Xiaoyan Xie and Xun Zeng supervised the manuscript. All authors reviewed the manuscript. Acknowledgements ： The authors thank Nan Zhang for technical support. References KLEINBERGER J W，POLLIN T I. Personalized medicine in diabetes mellitus：current opportunities and future prospects［J］. Ann N Y Acad Sci，2015，1346（1）：45-56. HERING B J，BALLOU C M，BELLIN M D，et al. Factors associated with favourable 5 year outcomes in islet transplant alone recipients with type 1 diabetes complicated by severe hypoglycaemia in the Collaborative Islet transplant registry［J］. Diabetologia，2023，66（1）：163-173. YANG D，ZHUANG B，DUAN J，et al. Ultrasound-guided human islet transplantation：safety，feasibility，and efficacy analysis［J］. Academic radiology，2023，30（Suppl 1）：s268-s277. OWEN R J，RYAN E A，O’KELLY K，et al. Percutaneous transhepatic pancreatic islet cell transplantation in type 1 diabetes mellitus：radiologic aspects［J］. Radiology，2003，229（1）：165-170. Malone CD, Fetzer DT, Monsky WL, Itani M, Mellnick VM, Velez PA, Middleton WD, Averkiou MA, Ramaswamy RS. Contrast-enhanced US for the Interventional Radiologist: Current and Emerging Applications. Radiographics. 2020 Mar-Apr;40(2):562-588. doi: 10.1148/rg.2020190183. PMID: 32125955. Jinliang Duan, Fang Bai, Daopeng Yang. 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pharmacological interventions. The vast majority of patients with Type I diabetes require multiple daily injections of insulin or insulin pump therapy, while those with Type II diabetes predominantly utilize medications under the guidance of endocrinologists [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In recent years, with the further development of medical technology, islet transplantation has gradually become a research hotspot. It involves establishing a transplantation channel through percutaneous portal vein puncture and catheterization, transplanting isolated and purified islets into the portal vein sinus, enabling the recipient to secrete insulin normally, thereby controlling blood sugar levels [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Currently, islet transplantation has high safety and proven efficacy, with the proportion of patients who have discontinued insulin use five years after islet transplantation reaching 50% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Both domestically and internationally, ultrasound combined with X-ray-guided techniques has become the standard surgical approach for islet transplantation. which uses X-ray fluoroscopy or ultrasound scanning for portal vein puncture, followed by radiological interventional angiography to monitor the catheter placement within the portal vein during islet transplantation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, X-rays and contrast procedures are complex, radioactive, and the contrast agents have nephrotoxicity and other drawbacks [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The whole-process ultrasound-guided percutaneous portal vein puncture technique for islet transplantation represents an innovative surgical advancement characterized by its radiation-free nature, precise puncture capabilities, and the ability to safely perform portal vein catheterization while allowing real-time dynamic observation of the islet transplantation process into the portal vein [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Since December 2017, our hospital has been using whole-process ultrasound-guided technique for percutaneous portal vein puncture and catheterization to complete islet transplantation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, the portal vein system is different from the arterial system, as it has slower blood flow and is pressure-sensitive. How to combine the characteristics of portal vein blood flow to perform key nursing techniques during ultrasound-guided percutaneous portal vein puncture transplantation surgery to reduce the occurrence of upper abdominal and liver area pain, nausea, vomiting, and bleeding in patients during surgery poses a challenge to clinical nursing and requires further in-depth research and summary. From December 2017 to September 2023, our hospital performed ultrasound-guided percutaneous portal vein puncture islet transplantation surgery on 27 cases (44 procedures), and the nursing situation is reported as follows.\u003c/p\u003e"},{"header":"Data and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 General Data\u003c/h2\u003e \u003cp\u003e Our hospital treated patients in need of ultrasound-guided percutaneous portal vein puncture islet transplantation from December 2017 to September 2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1.2 Inclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eInclusion Criteria: ①Patients diagnosed with diabetes who exhibit uncontrolled blood glucose levels despite receiving pharmacological treatment; this includes individuals experiencing significant hypoglycemia, hyperglycemia fluctuations, diabetes-related complications, etc., who need daily insulin injections but still cannot control blood sugar well; ②There must be one donor providing islets, with the donor age between 18 and 50 years old, and the donor and recipient (patient) blood types must match; ③Patients with no history of malignant tumors, active infections, severe heart disease, liver dysfunction, pulmonary dysfunction, and other diseases. Exclusion Criteria: ①Patients with untreated or uncontrolled mental disorders, drug addiction, etc.; ②Patients with severe cardiovascular diseases, liver diseases, etc., who cannot tolerate surgery; ③Patients diagnosed with infectious diseases, malignant tumors, or any other significant medical conditions.\u003c/p\u003e\n\u003ch3\u003e1.3 Preoperative Medication\u003c/h3\u003e\n\u003cp\u003eAntibiotic treatment: 2 hours before surgery, ceftriaxone sodium and sulbactam sodium (Shupushen) 3.0g was administered intravenously; Immunosuppressive treatment: Before transplantation, and on the 1st, 2nd, and 3rd days after transplantation, rabbit anti-human thymocyte immunoglobulin (ATG) (total dose of 6 mg/kg) was administered intravenously; Before transplantation and on the 4th day after transplantation, basiliximab (Shulai) 20mg was administered intravenously; Maintenance treatment: Treated with tacrolimus (blood concentration 4\u0026thinsp;~\u0026thinsp;6ng/mL) combined with sirolimus (blood concentration 8\u0026thinsp;~\u0026thinsp;12ng/mL) or mycophenolate mofetil (750mg) orally, twice daily.\u003c/p\u003e\n\u003ch3\u003e1.4 Surgical Method\u003c/h3\u003e\n\u003cp\u003eThe patient was placed under local anesthesia and intravenous analgesia with the head turned to the left side. The right arm was elevated above the head, the right shoulder abducted at 90\u0026deg;, and the right forearm flexed at 100\u0026deg;. A soft pillow was placed beneath the right arm. The right arm peripheral venous access was chosen first. Before transplantation, the conical flask containing islet cells was left to stand for 10 minutes to allow the islet cells to settle, subsequently, the supernatant liquid was removed. Fresh islet cell culture medium was injected, and heparin solution was added for mixing purposes to assist in connecting the portal vein infusion pipeline (preparation included a 50 mL syringe, a 16G puncture needle, etc., as well as an islet infusion device). Under ultrasound guidance, percutaneous portal vein puncture and catheterization were performed to establish a transplantation channel. Sixty-nine mg of Sonovue\u0026thinsp;+\u0026thinsp;0.9% saline 5mL was mixed by shaking up and down vigorously for 20 seconds, then 0.05mL of Sonovue contrast agent\u0026thinsp;+\u0026thinsp;saline 10mL was shaken vigorously and mixed well. The resulting mixed solution was then slowly injected into the catheter by an assisting surgeon in order to perform catheter angiography. When both the left and right branches of the portal vein were visualized, it was confirmed that the catheter was in the main trunk of the portal vein. The isolated and purified islet cells were infused into the portal vein sinus. Prior to the procedure, a solution consisting of 100 mL of saline combined with 12,500 U of heparin sodium was prepared, calculated at a dosage of 70 U/kg to determine the total amount required. This solution was thoroughly mixed with the islet cell suspension and continuously infused into the patient's body. During the operation, continuous ECG monitoring was performed, and vital signs, blood sugar levels, and portal vein pressure changes were monitored in real-time, with low-flow oxygen administered via nasal cannula. The infusion of islet cells took about 20 to 30 minutes. After the infusion was completed, the catheter was removed, and the catheter was slowly retracted while slowly injecting the Human Fibrin Sealant until the catheter was completely removed from the body. After the operation, the patient was instructed to rest in a supine position with the head turned to one side, the right arm was withdrawn to the right side of the body, and an abdominal ultrasound was rechecked after 30 minutes. If there was no abdominal bleeding, the operation was concluded.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll 27 patients (44 cases) successfully completed the operation, with the operation time ranging from 50 to 168 minutes, and the median operation time was 105 minutes. Among them, 3 cases (6.8%) experienced upper abdominal and liver area pain, nausea, and vomiting during the operation; 8 cases (18.2%) had a transient increase in portal vein pressure (exceeding 20mmHg) during the operation; 6 cases (13.6%) had active bleeding during the operation, all of which were relieved after symptomatic treatment and nursing care. All patients had no delayed bleeding or complications such as portal vein thrombosis after the operation during the follow-up visit one week later.\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eIslet transplantation is a surgical method for the treatment of diabetes, which is a β-cell replacement therapy and one of the most effective means of treating diabetes currently. After islet transplantation, patients no longer need insulin injections or insulin pumps, nor do they need to strictly implement dietary control and exercise plans; it can also reduce or avoid complications such as diabetic nephropathy and microvascular lesions in patients. Studies have shown that islet transplantation can extend the patient's life. For example, GRUESSNER and others found that the 5-year survival rate of patients after islet transplantation is over 85%. At present, ultrasound + X-ray guided islet transplantation is the mainstream surgical method at home and abroad. The whole-process ultrasound-guided percutaneous portal vein puncture islet transplantation proposed by our hospital for the first time has achieved good results. However, complications such as upper abdominal and liver area discomfort, transient increase in portal vein pressure, intraoperative active bleeding, or postoperative portal vein thrombosis may occur during the operation process. Therefore, meticulous preoperative, intraoperative, and postoperative nursing care must be ensured throughout the process.\u003c/p\u003e\u003ch3\u003e3.1 Preoperative Nursing\u003c/h3\u003e\u003ch2\u003e3.1.1 Blood Sugar Management\u003c/h2\u003e\u003cp\u003eThe success of islet transplantation is closely related to postoperative islet function and preoperative blood sugar levels, making preoperative blood sugar control an indispensable and important part of the preparation for islet transplantation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. On the one hand, hyperglycemia before surgery can lead to impaired islet function after surgery; on the other hand, hyperglycemia can cause excessive insulin secretion, thereby damaging the pancreatic islet β-cells, and also increase the risk of surgery. Therefore, it is essential to control the blood sugar of patients before surgery [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In this group of patients, a Digital glucose sensor was installed on the back side of the right upper arm to monitor blood sugar fluctuations in real-time, and after medication control, the blood sugar levels of the patients before surgery fluctuated between 4.1 to 17.7 mmol/L.\u003c/p\u003e\u003ch2\u003e3.1.2 Use of Antibiotics and Immunosuppressive Drugs\u003c/h2\u003e\u003cp\u003eThe use of antibiotics is necessary to prevent infection risks associated with ultrasound-guided percutaneous portal vein puncture islet transplantation. Additionally, patients receive immunosuppressive therapy before and after the procedure, thus requiring antibiotic prophylaxis. The application of antibiotics before surgery can also reduce postoperative inflammatory reactions and tissue damage. All 27 patients in this group (44 procedures) were routinely administered antibiotics 2 hours before surgery, and none exhibited surgery-related infection symptoms postoperatively. Immunosuppressive drugs can effectively reduce the incidence of immune rejection reactions after transplantation and improve the success rate of the transplant. However, these drugs can have certain impacts on the patient's immune system and liver and kidney functions. It is necessary to assess the patient's liver and kidney functions before surgery to ensure the safe use of the medication. The patients in this group were administered immunosuppressive drugs such as Simulect and Atgam, with no adverse reactions observed.\u003c/p\u003e\u003ch2\u003e3.1.3 Preoperative Visit and Psychological Nursing\u003c/h2\u003e\u003cp\u003eBefore surgery, the surgical nurse assists the physician in visiting the patient, reviews the medical records to understand the patient's medical history and various test results, and assesses the patient's attitude towards surgery and psychological endurance. On one hand, due to the patient's history of diseases such as diabetes, nephropathy, hypertension, or a history of surgeries like renal transplantation or pancreas-kidney transplantation, long-term illness can lead to adverse psychological effects. On the other hand, there are concerns about complications during the surgery and doubts about the effectiveness of the surgery. Therefore, it is essential to communicate and provide psychological guidance to the patient before surgery, patiently answer questions raised by the patient and their family, introduce the purpose, method, advantages, surgical process, the surgeon's experience and technical level, successful cases, the composition and cooperation of the medical team, and the hospital's equipment conditions to build confidence in treatment; inform the patient about the precautions during the perioperative period to ensure the patient accepts the surgery with a good mental state. In this group, the preoperative anxiety of the patients was relieved, and they were able to cooperate with the surgical treatment.\u003c/p\u003e\u003ch2\u003e3.2 Intraoperative Nursing\u003c/h2\u003e\u003ch2\u003e3.2.1 Position Management\u003c/h2\u003e\u003cp\u003eThe patients in this group were placed in a supine position with the head turned to the left side to prevent aspiration due to patient vomiting. The right arm was raised above the head, the right shoulder abducted 90°, the right forearm flexed 100°, and a soft pillow was placed under the right arm to prevent brachial plexus nerve overstretching and injury caused by the surgical position. The patients were asked about their comfort during the surgery, and minor adjustments were made as necessary to improve patient comfort. Since all patients in this group had a history of diabetes, skin observation and management were conducted before surgery. For example, cotton pads were wrapped around areas of skin damage, prominent bones, and pressure areas to prevent pressure injuries during surgery.\u003c/p\u003e\u003ch2\u003e3.2.2 Prevention of Portal Vein Thrombosis\u003c/h2\u003e\u003cp\u003eThe diameter of a single islet cell is approximately 50–300µm, and when islet cells form clusters, the diameter is larger, which can easily trigger thrombi that block small vessels. To prevent the formation of islet cell clusters, it is necessary to master the injection technique of islet cells. During the injection process, the islet cell heparin suspension must be continuously and vigorously agitated to prevent blockages. Nurses closely observed the patient's vital signs, facial expressions, and bodily reactions, and promptly reported to the surgeon to prevent the formation of portal vein thrombosis. None of the patients in this group experienced blockages during the islet cell injection process.\u003c/p\u003e\u003ch2\u003e3.2.3 Monitoring Blood Glucose\u003c/h2\u003e\u003cp\u003eTo observe changes in blood glucose levels during surgery, a Digital glucose sensor was installed on the posterior side of the right upper arm before surgery to dynamically monitor blood glucose fluctuations. Blood glucose was recorded every 10 minutes during surgery and reported to the surgeon. When blood glucose was higher than 11mmol/L, Gansulin R injection solution 10U + physiological saline 50mL was administered at a rate of 10mL/h; when blood glucose was ≤ 3.9mmol/L, 10% glucose 500mL was administered intravenously or 50% glucose was taken orally. The blood glucose levels of the patients in this group (44 procedures) were stable during the islet transplantation process, fluctuating between 3.8 and 16.4mmol/L.\u003c/p\u003e\u003ch2\u003e3.2.4 Monitoring Portal Vein Pressure\u003c/h2\u003e\u003cp\u003eAfter the infusion of islet cells in the portal vein sinus, the pressure in the portal vein may increase temporarily. When the portal vein pressure rises above 20mmHg, it will increase the risk of portal vein thrombosis. All patients in this group were monitored for portal vein pressure, with physiological saline 500mL covered with a pressure bag, connected to a pressure monitoring device, and the pressure bag was pressurized to 300mmHg. The transducer was vented and connected to the equipment according to the invasive central venous pressure operation procedure for measurement; measurements were taken every 10 minutes and promptly fed back to the surgeon. In this group, 8 cases had a transient increase in portal vein pressure during the transplantation procedure, and the infusion was paused until it returned to normal levels before resuming.\u003c/p\u003e\u003ch2\u003e3.2.5 Complication Nursing\u003c/h2\u003e\u003ch2\u003e3.2.5.1 Pain Nursing\u003c/h2\u003e\u003cp\u003ePain is a common issue during islet transplantation surgery. Ultrasound-guided portal vein puncture and increased portal vein pressure may cause pain and restlessness during surgery. Three cases in this group had upper abdominal and liver area pain and other symptoms during surgery, which were considered to be caused by transient portal vein pressure elevation. Symptomatic management was administered, enabling the patients to successfully complete the surgical procedure following verbal reassurance and relaxation therapy provided by nursing staff.\u003c/p\u003e\u003ch2\u003e3.2.5.2 Nausea and Vomiting Nursing\u003c/h2\u003e\u003cp\u003eNausea and vomiting are common complications during ultrasound-guided percutaneous portal vein puncture and catheterization islet transplantation surgery and are related to the increase in portal vein pressure caused by islet infusion. Three cases in this group experienced nausea and vomiting, and the infusion was immediately stopped to prevent bleeding caused by vomiting and restlessness. The patients were instructed to turn their heads to the left to prevent aspiration, and metoclopramide hydrochloride (Maxolon) was administered intravenously or promethazine hydrochloride (Phenergan) was administered intramuscularly. The patients were comforted and the surgery was continued after the symptoms were relieved.\u003c/p\u003e\u003ch2\u003e3.2.5.3 Active Bleeding Nursing\u003c/h2\u003e\u003cp\u003eThe infusion of islet cells requires percutaneous puncture of the portal vein, and poor closure of the puncture needle tract after surgery can lead to portal vein bleeding and active abdominal bleeding. In addition, heparin anticoagulation is routinely used during and after surgery to prevent portal vein thrombosis, thus the risk of bleeding is relatively high. Patients in this group were educated on the key points that needed to be cooperated with during the surgery; during the puncture of the portal vein and the infusion of islet cells, nurses closely monitored the patient's facial expressions and bodily reactions, asked about the patient's feelings in a timely manner, and closely observed changes in the patient's vital signs. After surgery, a sandbag was used to compress the puncture site, and a belly bandage was used for pressure dressing for 30 minutes to prevent portal vein bleeding caused by poor closure of the needle tract. Six cases in this group had active bleeding during surgery, and ultrasound-guided ablation hemostasis was performed, with no postoperative bleeding occurring.\u003c/p\u003e\u003ch2\u003e3.3 Postoperative Nursing\u003c/h2\u003e\u003cp\u003eAfter the completion of the islet cell suspension infusion, ECG monitoring continued for 30 minutes to observe changes in the patient's heart rate, blood pressure, blood oxygen, and other indicators. It is important to observe for symptoms such as pale complexion, cold and clammy skin, changes in consciousness, and to ask about any discomfort. After 30 minutes, an abdominal ultrasound was rechecked to determine if there was active bleeding from the portal vein or other complications. If the ultrasound confirmed active bleeding, the nursing staff quickly cooperated with the surgeon to perform ultrasound-guided radiofrequency ablation hemostasis, referring to the nursing cooperation for ultrasound-guided liver tumor radiofrequency ablation surgery; if the patient had no bleeding and no physical discomfort, the patient was transported back to the ward and a handover was conducted with the ward nurse.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis group summarized the nursing experience of 27 cases (44 procedures) of ultrasound-guided islet transplantation surgery. They emphasize the importance of several key factors in ensuring successful outcomes: 1. Preoperative visits to assess the patient's condition, along with providing psychological support and patient education regarding relevant disease knowledge. 2. Close monitoring of vital signs, portal vein pressure, and blood glucose levels during surgery to prevent complications. 3. Postoperative measures aimed at preventing active bleeding from the portal vein. These elements are deemed crucial for the successful completion of ultrasound-guided percutaneous portal vein puncture islet transplantation surgery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eECG: Electrocardiogram\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFund Project:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project is a major research plan project of the National Natural Science Foundation, project number 92059201.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles of the Declaration of Helsinki (2013 revision) and was approved by the the\u0026nbsp;IEC for Clinical Research and Animal Trials of the First Affiliated Hospital of Sun Yat-sen University (Approval No. [2022]557, Ethical Review). All tissues were procured from Organ Procurement Organizations of the First Affiliated Hospital of Sun Yat-sen University, confirming compliance with ethical procurement standards and verifying that no materials were obtained from prisoners.\u0026nbsp;Informed consent was obtained from all study participants. For vulnerable individuals, consent for participation was provided by their legally authorized representatives or appropriate proxies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003enot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003enot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions Statement\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eYangyang Lei and Shan Guo wrote the main manuscript text. Mianni Chen, Huijuan Zhao, \u0026nbsp;Huixia Lan, \u0026nbsp;Zhenli Huang, Jialin Wang, Bei Huang collected clinical data. \u0026nbsp;Bowen Zhuang analysed clinical data. Xiaoyan Xie and Xun Zeng supervised the manuscript. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe authors thank Nan Zhang for technical support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKLEINBERGER J W，POLLIN T I. Personalized medicine in diabetes mellitus：current opportunities and future prospects［J］. Ann N Y Acad Sci，2015，1346（1）：45-56.\u003c/li\u003e\n\u003cli\u003eHERING B J，BALLOU C M，BELLIN M D，et al. Factors associated with favourable 5 year outcomes in islet transplant alone recipients with type 1 diabetes complicated by severe hypoglycaemia in the Collaborative Islet transplant registry［J］. Diabetologia，2023，66（1）：163-173.\u003c/li\u003e\n\u003cli\u003eYANG D，ZHUANG B，DUAN J，et al. Ultrasound-guided human islet transplantation：safety，feasibility，and efficacy analysis［J］. Academic radiology，2023，30（Suppl 1）：s268-s277.\u003c/li\u003e\n\u003cli\u003eOWEN R J，RYAN E A，O\u0026rsquo;KELLY K，et al. Percutaneous transhepatic pancreatic islet cell transplantation in type 1 diabetes mellitus：radiologic aspects［J］. Radiology，2003，229（1）：165-170.\u003c/li\u003e\n\u003cli\u003eMalone CD, Fetzer DT, Monsky WL, Itani M, Mellnick VM, Velez PA, Middleton WD, Averkiou MA, Ramaswamy RS. Contrast-enhanced US for the Interventional Radiologist: Current and Emerging Applications. Radiographics. 2020 Mar-Apr;40(2):562-588. doi: 10.1148/rg.2020190183. PMID: 32125955. \u003c/li\u003e\n\u003cli\u003eJinliang Duan, Fang Bai, Daopeng Yang. Pancreatic islet transplantation for 3 cases of graft failure after pancreatic transplantation［J］. Practical Journal of Organ Transplantaiton，2022，10（5）：392-394.\u003c/li\u003e\n\u003cli\u003eAnbin Hu, Xiangchao Ling, Jinliang Duan. Early efficacy of islet transplantation in the treatment of adult advanced diabetes［J］. National Medical Journal of China，2020，100（26）：2040-2043.\u003c/li\u003e\n\u003cli\u003eHao Hu, Jianping Li. Status and Progress of Islet Transplantation［J］. Chinese Journal of Modern Operative Surgery，2009，13（4）：313-317.\u003c/li\u003e\n\u003cli\u003eGRUESSNER A C，SUTHERLAND D E. Pancreas transplant outcomes for united states（US）cases as reported to the united network for organ sharing（UNOS）and the international pancreas transplant registry（IPTR）［J］. Clin Transpl，2008：45-56.\u003c/li\u003e\n\u003cli\u003eMATSUMOTO S，OKITSU T，IWANAGA Y，et al. Insulin independence after living-donor distal pancreatectomy and islet allotransplantation［J］. Lancet（London，England），2005，365（9471）：1642-1644.\u003c/li\u003e\n\u003cli\u003eSZEMPRUCH K R，BANERJEE O，MCCALL R C，et al. Use of anti-inflammatory agents in clinical islet cell transplants：a qualitative systematic analysis［J］. Islets，2019，11（3）：65-75.\u003c/li\u003e\n\u003cli\u003eDuan K, Liu J, Zhang J, Chu T, Liu H, Lou F, Liu Z, Gao B, Wei S, Wei F. Advancements in innate immune regulation strategies in islet transplantation. Front Immunol. 2024 Jan 15;14:1341314. doi: 10.3389/fimmu.2023.1341314. PMID: 38288129; PMCID: PMC10823010. \u003c/li\u003e\n\u003cli\u003eWARD C，ODORICO J S，RICKELS M R，et al. International survey of clinical monitoring practices in pancreas and islet transplantation［J］. Transplantation，2022，106（8）：1647- 1655.\u003c/li\u003e\n\u003cli\u003eKAWAHARA T，KIN T，KASHKOUSH S，et al. Portal vein thrombosis is a potentially preventable complication in clinical islet transplantation［J］. Am J Transplant，2011，11（12）：2700-2707.\u003c/li\u003e\n\u003cli\u003eKAWAHARA T，KIN T，SHAPIRO A M. A comparison of islet autotransplantation with allotransplantation and factors elevating acute portal pressure in clinical islet transplantation［J］. J Hepatobiliary Pancreat Sci，2012，19（3）：281-288.\u003c/li\u003e\n\u003c/ol\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Islet Transplantation, Portal Vein Catheterization, Ultrasound Guidance, Nursing","lastPublishedDoi":"10.21203/rs.3.rs-6245373/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6245373/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003e This study aims to develop nursing guidelines for diabetic patients undergoing ultrasound-guided islet transplantation via percutaneous portal vein puncture and catheterization, providing valuable insights for perioperative care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eFrom December 2017 to September 2023, 27 patients underwent 44 ultrasound-guided islet transplantations at our hospital. Comprehensive nursing support was provided preoperatively, intraoperatively, and postoperatively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAll 44 procedures were successful. Intraoperative complications included upper abdominal pain/nausea/vomiting in 3 cases (6.8%), transient portal vein pressure increase in 8 cases (18.2%), and active bleeding post-catheter removal in 6 cases (13.6%). No delayed portal vein bleeding or thrombosis occurred.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eNursing interventions are critical for the success of ultrasound-guided islet transplantation. Key measures include preoperative assessment and patient education, intraoperative monitoring of vital signs and portal vein pressure, and postoperative prevention of bleeding complications.\u003c/p\u003e","manuscriptTitle":"Nursing Assistance During Whole-Process Ultrasound-Guided Percutaneous Portal Vein Puncture for Islet Transplantation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-08 16:07:44","doi":"10.21203/rs.3.rs-6245373/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"48846263-27f2-47d3-a8ec-9ef000174c57","owner":[],"postedDate":"May 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-01T07:38:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-08 16:07:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6245373","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6245373","identity":"rs-6245373","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}