腔内心电图引导新生儿PICC尖端定位的研究进展
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摘要
腔内心电图PICC尖端定位法是指在PICC置管过程中,通过导丝或者盐水柱作为腔内电极代替体表心电图的右锁骨下方电极进入上腔静脉获取心房P波,根据P波形态的变化探测PICC尖端的位置。该方法具有定位成功率高、安全性高、节约时间、节省费用等优点,近年来在新生儿中的应用也日益广泛。本文就腔内心电图PICC尖端定位法在新生儿中应用的依据、导联及引导方式的选择、优势和局限等方面进行综述,以期为临床提供参考,使该方法更好地在临床推广应用。
Intracavitary electrocardiogram means that in the process of PICC catheterization, the guide wire or saline column is used as the intracavity electrode instead of right shoulder electrode of the standard surface electrocardiogram to enter the superior vena cava and obtain the atrial P wave to know the position of PICC tip. Intracavitary electrocardiogram has been increasing applied in newborns because of the advantages on localization accuracy, safety, time and cost saving.This article reviews the basis of intracavitary electrocardiography in the positioning of neonatal PICC, the choice of lead and guidance, the advantages and limitations, to provide references for clinical application.
Intracavitary electrocardiogram means that in the process of PICC catheterization, the guide wire or saline column is used as the intracavity electrode instead of right shoulder electrode of the standard surface electrocardiogram to enter the superior vena cava and obtain the atrial P wave to know the position of PICC tip. Intracavitary electrocardiogram has been increasing applied in newborns because of the advantages on localization accuracy, safety, time and cost saving.This article reviews the basis of intracavitary electrocardiography in the positioning of neonatal PICC, the choice of lead and guidance, the advantages and limitations, to provide references for clinical application.
引文
[1]吴文理,陈佩仪,宋燕伶,等.腔内心电图技术用于新生儿PICC置管头端定位的效果观察.实用医学杂志,2016,32(20):3443-3445.Wu WL,Chen PY,Song YL,et al.Effectiveness of intracavitary electrocardiogram for positioning the tip of peripherally inserted central catheter in neonates.The Journal of Practical Medicine,2016,32(20):3443-3445.
[2]Infusion Nurses Society.Infusion therapy standards of practice.J Infus Nurs,2016,39(1s):S38-S39.
[3]孙红,王蕾,聂圣肖.心电图引导PICC尖端定位的多中心研究.中华护理杂志,2017,52(8):916-920.Sun H,Wang L,Nie SX.The ECG method for positioning the tip of peripherally inserted central catheter:results of a multicenterstudy.Chinese Journal of Nursing,2017,52(8):916-920.
[4]Pittiruti M,Scoppettuolo G,Greca AL,et al.The EKG method for positioning the tip of piccs:results from two preliminary studies.JAVA,2008,13(4):112-119.
[5]冯毕龙,姚述远,周素军,等.PICC置管过程中腔内心电图的变化及其对置管操作的指导作用.中华护理杂志,2010,45(1):26-28.Feng BL,Yao SY,Zhou SJ,et al.The changes and role of intracavitary electrocardiogram in the placement of peripherally inserted central venous catheters.Chinese Journal of Nursing,2010,45(1):26-28.
[6]赵林芳,曹秀珠,陈春华,等.心内心电图特异性P波形态变化在瓣膜式PICC头端定位中的应用研究.中华护理杂志,2015,50(11):1374-1378.Zhao LF,Cao XZ,Chen CH,et al.The specific P-waveform of intracavitary ECG method for positioning the tip of valved peripherally inserted central catheters.Chinese Journal of Nursing,2015,50(11):1374-1378.
[7]Smith B,Neuharth RM,Hendrix MA,et al.Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters.J Electrocardiol,2010,43(3):274-278.
[8]Zhou L,Xu H,Liang J,et al.Effectiveness of Intracavitary Electrocardiogram Guidance in peripherally inserted central catheter tip placement in neonates.J Perinat Neonatal Nurs,2017,31(4):326-331.
[9]何广荣,李洪伟.心房内心电图定位技术在新生儿超声引导下颈内静脉置入中心静脉导管2例.介入放射学杂志,2016,25(5):461-462.He GR,Li HW.Ultrasound-guided implantation of PICC via internal jugular vein in neonates by using intra-atrialECG positioning technique:report of two cases.Journal of Interventional Radiology,2016,25(5):461-462.
[10]李黎,陈月香,李向君,等.PICC置管中腔内心电图P波形态改变及临床意义的研究.护士进修杂志,2017,32(6):557-558.Li L,Chen YX,Li XJ,et al.Study on the morphological changes and clinical significance of P wave in inserting PICC.Journal of Nurses Training,2017,32(6):557-558.
[11]吴翔,韩钟霖,李荣梅,等.腔内心电图P波形态变化与三向瓣膜式中心静脉导管头端位置判断.中华心律失常学杂志,2017,21(5):392-396.Wu X,Han ZL,Li RM,et al.Relationships bet ween the changes of P-wave for m of intracavitary electrocardiogram and the tip position of valved peripherally inserted central catheter.Chinese Journal of Cardiac Arrhythmias,2017,21(5):392-396.
[12]陈旭素,黄毓婵.麻醉科护理基本知识与技术.北京:人民军医出版社,2015:111.Chen XS,Huang YC.Basic knowledge and technology of anesthesiology nursing.Beijing:People's Military Surgeon Publishing House,2015:111.
[13]姚辉,宋敏,刘玉莹.静脉内心电图引导PICC尖端定位的临床研究.中华护理杂志,2011,46(8):748-750.Yao H,Song M,Liu YY.Clinical research of intravenous electrocardiogram guided PICC tip position.Chinese Journal of Nursing,2011,46(8):748-750.
[14]黄道花,万红燕,高晓炎.B超引导下应用心电图定位PICC尖端位置的临床研究.东南大学学报(医学版),2017,36(1):107-109.Huang DH,Wan HY,Gao XY.Clinical study of applying ECG to locate the position of PICCtip under B-ultrasound guidance.Journal of Southeast University(Medical Science Edition),2017,36(1):107-109.
[15]Pittiruti M,La Greca A,Scoppettuolo G.The electrocardiographic method for positioning the tip of central venous catheters.J Vasc Access,2011,12(4):280-291.
[16]袁玲,李蓉梅,李善萍,等.两种方法经三向瓣膜式PICC引导腔内心电图的效果比较.中华护理杂志,2015,50(9):1055-1059.Yuan L,Li RM,Li SP,et al.Comparison of two methods for guiding intracavitary electrocardiogram via Groshong peripherally inserted central catheters.Chinese Journal of Nursing,2015,50(9):1055-1059.
[17]谭莲,甘秀妮.两种方式经瓣膜式PICC引导腔内心电图稳定性与准确性的对照研究.第三军医大学学报,2017,39(5):466-471.Tan L,Gan X N.Stabilit y and accu racy of 2 met hod s for g uid i ng i nt racav it a r y electrocardiography via Groshong peripherally inserted central catheter:a comparison based on 180 cases.Journal of Third Military Medical University,2017,39(5):466-471.
[18]任小萍,杨金丽,周洪昌,等.泵注法在腔内心电图定位瓣膜式PICC中的应用.护理实践与研究,2017,14(24):140-142.Ren XP,Yang JL,Zhou HC,et al.Application of pump injection method in the localization of valve type PICC by intracavitary electrocardiogram.Nursing Practice and Research,2017,14(24):140-142.
[19]凌其英,陈虹,唐敏,等.心电监护仪在新生儿PICC置管中的定位效果.中国当代儿科杂志,2018,20(5):363-367.Ling QY,Chen H,Tang M,et al.Efficiency of electrocardiogram monitor for positioning the catheter tip inperipherally inserted central catheter placement in neonates.Chinese Journal of Contemporary Pediatris,2018,20(5):363-367.
[20]Yuan L,Li R,Meng A,et al.Superior success rate of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement in patients with cancer:a randomized open-label controlled multicenter study.PLoSOne,2017,12(3):e0171630.
[21]宋健,汪春林,胡君娥.心房内心电图应用于PICC导管头端定位效果Meta分析.护理学报,2017,24(13):14-18.Song J,Wa ng CL,Hu J E.Ef fect of at r ial electrogram on PICC catheter tip location:a meta analysis.Journal of Nursing(China),2017,24(13):14-18.
[22]Oliver G,Jones M.Evaluation of an electrocardiograph-based PICC tip verification system.Br J Nurs,2013,22(14):S24-S28.
[23]Oliver G,Jones M.ECG-based PICC tip verification system:an evaluation 5 years on.Br JNurs,2016,25(19):S4-S10.
[24]Cales YK,Rheingans J,Steves J,et al.Electrocardiogram-guided peripherally inserted central catheter tip confirmation using a standard electrocardiogram machine and a wide-mouth electrocardiogram clip compared with traditional chest radiograph.JAVA,2016,21(1):44-54.
[25]潘龙芳,洪跃玲,唐丽,等.心电定位PICC穿刺技术的临床应用研究.重庆医科大学学报,2015,40(3):472-476.Pan LF,Hong YL,Tang L,et al.Application of electrocardiographic method for positioning the tiplocation of PICC.Journal of Chongqing Medical University,2015,40(3):472-476.
[26]Mundi MS,Edakkanambeth Varayil J,Mc Mahon MT,et al.Accuracy of intravenous electrocardiography confirmation of peripherally inserted central catheter for parenteral nutrition.Nutr Clin Pract,2016,31(2):207-210.
[27]郭玲,秦英,王国蓉,等.成人中心静脉置管腔内心电图稳定性及影响因素研究.中华护理杂志,2015,50(6):724-727.Guo L,Qin Y,Wang GR,et al.The influencing factors of intracavitary electrocardiogram stability during the catheterization of central venous.Chinese Journal of Nursing,2015,50(6):724-727.
[28]黄建业,丁如梅.心房内心电图引导定位技术置入PICC护理问题分析及对策.护理学杂志,2014,29(14):51-53.Huang JY,Ding RM.Nursing problems and countermeasures in atrial ECG guided PICC tip positioning.Journal of Nursing Science,2014,29(14):51-53.
[29]Nadroo AM,Glass RB,Lin J,et al.Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates.Pediatrics,2002,110(1):131-136.
[30]Connolly B,Amaral J,Walsh S,et al.Influence of arm movement on central tip location of peripherally inserted central catheters(PICCs).Pediatr Radiol,2006,36(8):845-850.
[31]Cho CH,Schlattmann P,Nagel S,et al.Cephalad dislocation of PICCs under different upper limb positions:influence of age,gender,BMI,number of lumens.J Vasc Access,2018,19(2):141-145.
[32]罗飞翔,陈朔晖,程晓英,等.极低出生体重儿PICC尖端位置与体重增长的相关性分析.中华护理杂志,2017,52(8):949-953.Luo FX,Chen SH,Cheng XY,et al.A correlation analysis of PICC tip position and weight gaining in very low birth weight infants.Chinese Journal of Nursing,2017,52(8):949-953.
[2]Infusion Nurses Society.Infusion therapy standards of practice.J Infus Nurs,2016,39(1s):S38-S39.
[3]孙红,王蕾,聂圣肖.心电图引导PICC尖端定位的多中心研究.中华护理杂志,2017,52(8):916-920.Sun H,Wang L,Nie SX.The ECG method for positioning the tip of peripherally inserted central catheter:results of a multicenterstudy.Chinese Journal of Nursing,2017,52(8):916-920.
[4]Pittiruti M,Scoppettuolo G,Greca AL,et al.The EKG method for positioning the tip of piccs:results from two preliminary studies.JAVA,2008,13(4):112-119.
[5]冯毕龙,姚述远,周素军,等.PICC置管过程中腔内心电图的变化及其对置管操作的指导作用.中华护理杂志,2010,45(1):26-28.Feng BL,Yao SY,Zhou SJ,et al.The changes and role of intracavitary electrocardiogram in the placement of peripherally inserted central venous catheters.Chinese Journal of Nursing,2010,45(1):26-28.
[6]赵林芳,曹秀珠,陈春华,等.心内心电图特异性P波形态变化在瓣膜式PICC头端定位中的应用研究.中华护理杂志,2015,50(11):1374-1378.Zhao LF,Cao XZ,Chen CH,et al.The specific P-waveform of intracavitary ECG method for positioning the tip of valved peripherally inserted central catheters.Chinese Journal of Nursing,2015,50(11):1374-1378.
[7]Smith B,Neuharth RM,Hendrix MA,et al.Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters.J Electrocardiol,2010,43(3):274-278.
[8]Zhou L,Xu H,Liang J,et al.Effectiveness of Intracavitary Electrocardiogram Guidance in peripherally inserted central catheter tip placement in neonates.J Perinat Neonatal Nurs,2017,31(4):326-331.
[9]何广荣,李洪伟.心房内心电图定位技术在新生儿超声引导下颈内静脉置入中心静脉导管2例.介入放射学杂志,2016,25(5):461-462.He GR,Li HW.Ultrasound-guided implantation of PICC via internal jugular vein in neonates by using intra-atrialECG positioning technique:report of two cases.Journal of Interventional Radiology,2016,25(5):461-462.
[10]李黎,陈月香,李向君,等.PICC置管中腔内心电图P波形态改变及临床意义的研究.护士进修杂志,2017,32(6):557-558.Li L,Chen YX,Li XJ,et al.Study on the morphological changes and clinical significance of P wave in inserting PICC.Journal of Nurses Training,2017,32(6):557-558.
[11]吴翔,韩钟霖,李荣梅,等.腔内心电图P波形态变化与三向瓣膜式中心静脉导管头端位置判断.中华心律失常学杂志,2017,21(5):392-396.Wu X,Han ZL,Li RM,et al.Relationships bet ween the changes of P-wave for m of intracavitary electrocardiogram and the tip position of valved peripherally inserted central catheter.Chinese Journal of Cardiac Arrhythmias,2017,21(5):392-396.
[12]陈旭素,黄毓婵.麻醉科护理基本知识与技术.北京:人民军医出版社,2015:111.Chen XS,Huang YC.Basic knowledge and technology of anesthesiology nursing.Beijing:People's Military Surgeon Publishing House,2015:111.
[13]姚辉,宋敏,刘玉莹.静脉内心电图引导PICC尖端定位的临床研究.中华护理杂志,2011,46(8):748-750.Yao H,Song M,Liu YY.Clinical research of intravenous electrocardiogram guided PICC tip position.Chinese Journal of Nursing,2011,46(8):748-750.
[14]黄道花,万红燕,高晓炎.B超引导下应用心电图定位PICC尖端位置的临床研究.东南大学学报(医学版),2017,36(1):107-109.Huang DH,Wan HY,Gao XY.Clinical study of applying ECG to locate the position of PICCtip under B-ultrasound guidance.Journal of Southeast University(Medical Science Edition),2017,36(1):107-109.
[15]Pittiruti M,La Greca A,Scoppettuolo G.The electrocardiographic method for positioning the tip of central venous catheters.J Vasc Access,2011,12(4):280-291.
[16]袁玲,李蓉梅,李善萍,等.两种方法经三向瓣膜式PICC引导腔内心电图的效果比较.中华护理杂志,2015,50(9):1055-1059.Yuan L,Li RM,Li SP,et al.Comparison of two methods for guiding intracavitary electrocardiogram via Groshong peripherally inserted central catheters.Chinese Journal of Nursing,2015,50(9):1055-1059.
[17]谭莲,甘秀妮.两种方式经瓣膜式PICC引导腔内心电图稳定性与准确性的对照研究.第三军医大学学报,2017,39(5):466-471.Tan L,Gan X N.Stabilit y and accu racy of 2 met hod s for g uid i ng i nt racav it a r y electrocardiography via Groshong peripherally inserted central catheter:a comparison based on 180 cases.Journal of Third Military Medical University,2017,39(5):466-471.
[18]任小萍,杨金丽,周洪昌,等.泵注法在腔内心电图定位瓣膜式PICC中的应用.护理实践与研究,2017,14(24):140-142.Ren XP,Yang JL,Zhou HC,et al.Application of pump injection method in the localization of valve type PICC by intracavitary electrocardiogram.Nursing Practice and Research,2017,14(24):140-142.
[19]凌其英,陈虹,唐敏,等.心电监护仪在新生儿PICC置管中的定位效果.中国当代儿科杂志,2018,20(5):363-367.Ling QY,Chen H,Tang M,et al.Efficiency of electrocardiogram monitor for positioning the catheter tip inperipherally inserted central catheter placement in neonates.Chinese Journal of Contemporary Pediatris,2018,20(5):363-367.
[20]Yuan L,Li R,Meng A,et al.Superior success rate of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement in patients with cancer:a randomized open-label controlled multicenter study.PLoSOne,2017,12(3):e0171630.
[21]宋健,汪春林,胡君娥.心房内心电图应用于PICC导管头端定位效果Meta分析.护理学报,2017,24(13):14-18.Song J,Wa ng CL,Hu J E.Ef fect of at r ial electrogram on PICC catheter tip location:a meta analysis.Journal of Nursing(China),2017,24(13):14-18.
[22]Oliver G,Jones M.Evaluation of an electrocardiograph-based PICC tip verification system.Br J Nurs,2013,22(14):S24-S28.
[23]Oliver G,Jones M.ECG-based PICC tip verification system:an evaluation 5 years on.Br JNurs,2016,25(19):S4-S10.
[24]Cales YK,Rheingans J,Steves J,et al.Electrocardiogram-guided peripherally inserted central catheter tip confirmation using a standard electrocardiogram machine and a wide-mouth electrocardiogram clip compared with traditional chest radiograph.JAVA,2016,21(1):44-54.
[25]潘龙芳,洪跃玲,唐丽,等.心电定位PICC穿刺技术的临床应用研究.重庆医科大学学报,2015,40(3):472-476.Pan LF,Hong YL,Tang L,et al.Application of electrocardiographic method for positioning the tiplocation of PICC.Journal of Chongqing Medical University,2015,40(3):472-476.
[26]Mundi MS,Edakkanambeth Varayil J,Mc Mahon MT,et al.Accuracy of intravenous electrocardiography confirmation of peripherally inserted central catheter for parenteral nutrition.Nutr Clin Pract,2016,31(2):207-210.
[27]郭玲,秦英,王国蓉,等.成人中心静脉置管腔内心电图稳定性及影响因素研究.中华护理杂志,2015,50(6):724-727.Guo L,Qin Y,Wang GR,et al.The influencing factors of intracavitary electrocardiogram stability during the catheterization of central venous.Chinese Journal of Nursing,2015,50(6):724-727.
[28]黄建业,丁如梅.心房内心电图引导定位技术置入PICC护理问题分析及对策.护理学杂志,2014,29(14):51-53.Huang JY,Ding RM.Nursing problems and countermeasures in atrial ECG guided PICC tip positioning.Journal of Nursing Science,2014,29(14):51-53.
[29]Nadroo AM,Glass RB,Lin J,et al.Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates.Pediatrics,2002,110(1):131-136.
[30]Connolly B,Amaral J,Walsh S,et al.Influence of arm movement on central tip location of peripherally inserted central catheters(PICCs).Pediatr Radiol,2006,36(8):845-850.
[31]Cho CH,Schlattmann P,Nagel S,et al.Cephalad dislocation of PICCs under different upper limb positions:influence of age,gender,BMI,number of lumens.J Vasc Access,2018,19(2):141-145.
[32]罗飞翔,陈朔晖,程晓英,等.极低出生体重儿PICC尖端位置与体重增长的相关性分析.中华护理杂志,2017,52(8):949-953.Luo FX,Chen SH,Cheng XY,et al.A correlation analysis of PICC tip position and weight gaining in very low birth weight infants.Chinese Journal of Nursing,2017,52(8):949-953.