大隐静脉PICC置管在上腔静脉压迫征患者中的应用
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摘要
目的探讨大隐静脉PICC置管在上腔静脉压迫征患者中的应用效果,为临床对上腔静脉压迫征患者合理的静脉通路选择提供依据。方法对2015年1月—2016年8月入住浙江省中医院的12例因有上腔静脉压迫征无法将PICC管置入上腔静脉的预行中心静脉置管化疗的肿瘤患者给予正确、全面评估,并与医生讨论后制定开通静脉通路的方案,向患者及家属详细说明目的与方法,征得患者及家属的同意,按医院PICC置管操作规范流程,对双下肢大隐静脉进行全面细致的评估,在大腿中上段确定穿刺点并做好标记,测量从预穿刺点至剑突的距离为置管长度,以穿刺点为中心用75%酒精和2%的葡萄糖酸氯己定顺时针、逆时针各3遍严格消毒皮肤,直径≥20 cm,依次铺大单洞巾、套探头套,做好最大的无菌屏障后行大隐静脉置入PICC导管,置管成功后予IV3000敷贴妥善固定,并对所有患者临床资料进行总结分析。结果 12例患者均一次置管成功,导管头端定位于下腔静脉内,置管成功率100%;12例患者中11例在完成所有化疗疗程后拔管,1例因无法忍受化疗副作用主动放弃化疗而拔管;所有患者在导管留置期间内无并发症发生。结论因有上腔静脉压迫征无法将PICC导管置入上腔静脉的肿瘤患者经大隐静脉PICC置管是开通静脉通路安全而有效的方法,该方法解决了上腔静脉压迫综合征不能在上肢输液的问题,具有一定的临床优势,值得临床推广应用。
Objective To investigate the efficacy of PICC placement via the greater saphenous vein and explore best approach for clinical catheterization in patients with superior vena cava syndrome( SVCS). Methods A total of 12 tumor patients with SVCS who were unable to place PICC into the superior vena cava for chemotherapy via central venous catheter( CVC) in our hospital between January,2015 and August,2016 were enrolled into this study. On the basis of evolution and consultation with patients,family members and doctors,PICC placement via the greater saphenous vein was performed according to PICC catheterization standard operation procedure( including marker,measurement,disinfect,puncture,catheter placement and fixation with IV3000). The clinical data of all patients were summarized and analyzed. Results The catheterization via saphenous vein was performed in all 12 patients with an success rate of 100%. The extubation was carried out in 11 cases when all courses of chemotherapy were completed,and 1 case gave up chemotherapy due to intolerable side effects of chemotherapy. There was no complication in all patients during the catheter indwelling period. Conclusion PICC placement via the greater saphenous vein is a safe and effective method for patients with SVCS who were unable to place PICC into the superior vena cava for chemotherapy. With certain clinical advantages,it solves the problems in intravenous infusions in the upper extremities and is worthy of clinical application.
Objective To investigate the efficacy of PICC placement via the greater saphenous vein and explore best approach for clinical catheterization in patients with superior vena cava syndrome( SVCS). Methods A total of 12 tumor patients with SVCS who were unable to place PICC into the superior vena cava for chemotherapy via central venous catheter( CVC) in our hospital between January,2015 and August,2016 were enrolled into this study. On the basis of evolution and consultation with patients,family members and doctors,PICC placement via the greater saphenous vein was performed according to PICC catheterization standard operation procedure( including marker,measurement,disinfect,puncture,catheter placement and fixation with IV3000). The clinical data of all patients were summarized and analyzed. Results The catheterization via saphenous vein was performed in all 12 patients with an success rate of 100%. The extubation was carried out in 11 cases when all courses of chemotherapy were completed,and 1 case gave up chemotherapy due to intolerable side effects of chemotherapy. There was no complication in all patients during the catheter indwelling period. Conclusion PICC placement via the greater saphenous vein is a safe and effective method for patients with SVCS who were unable to place PICC into the superior vena cava for chemotherapy. With certain clinical advantages,it solves the problems in intravenous infusions in the upper extremities and is worthy of clinical application.
引文
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[11]华芳,黄国金.PICC在中晚期恶性肿瘤静脉输液化疗中的临床应用[J].中国误诊学杂志,2012,12(15):3843-3844.
[12]李娥.乳腺癌化疗56例PICC的应用及护理[J].中国误诊学杂志,2012,12(13):3351.
[13]邢玉梅.经外周穿刺中心静脉置管术在肿瘤科护理工作中的应用[J].中国基层医药,2012,19(17):2703-2704.
[14]李玲敏,杨玉杰,闫冬,等.肿瘤化疗患者PICC置管的并发症原因分析及护理对策[J].基层医学论坛,2016,20(22):3127-3128.
[15]熊小云,陈丽莲,袁瑞琴,等.152例新生儿经大隐静脉穿刺置入PICC的效果观察[J].护理实践与研究,2013,10(10):116-117.
[16]李力,曾从容,杨春雪,等.新生儿下肢静脉PICC可行性研究[J].中国实用护理杂志,2014,30(7):51-52.
[17]刘秀红,薛波,杨志英,等.新生儿下肢经外周静脉穿刺置入中心静脉导管置管方法及长度的探讨[J].中国实用护理杂志,2015,31(29):2219-2220.
[18]Aria DJ,Vatsky S,Kaye R,et al.Greater saphenous venousaccess as an alternative in children[J].Pediatr Radiol,2014,44(2):187-192.
[2]莫美珍,文楚玲,钟华英,等.PICC与传统股静脉穿刺置管在结直肠癌患者持续静脉化疗中的应用比较[J].中国当代医药,2013,20(23):66-67.
[3]郭舒文,谢丽琴,许丽萍,等.早产儿经右下肢静脉留置PICC导管的可行性[J].中华护理杂志,2012,47(2):153-156.
[4]袁瑞琴,熊小云,陈丽莲,等.220例经大隐静脉置入PICC导管术在新生儿监护病房中的应用[J].全科护理,2013,11(2):106-108.
[5]连莲淑,陈雯雯,郑淑敏,等.早产儿经贵要静脉和大隐静脉留置PICC导管的效果分析[J].护士进修杂志,2014,29(16):1512-1514.
[6]汪昌玉,谢桂月.新生儿经大隐与肘部静脉留置PICC导管的效果比较[J].当代护士:学术版(中旬刊),2016(3):106-107.
[7]朱君丽.经大隐静脉PICC置管在新生儿中的应用[J].河北医药,2015,37(17):2688-2690.
[8]陈佳权,崔玉梅.68例上腔静脉压迫综合征放化疗疗效分析[J].现代肿瘤医学,2016,24(3):463-465.
[9]赵芳.PICC置管在乳腺癌化疗中的临床应用[J].河南外科学杂志,2013,19(1):140-141.
[10]贺秋玲.消化系统恶性肿瘤化疗应用PICC的观察与护理[J].中国医药指南,2012,10(17):54-56.
[11]华芳,黄国金.PICC在中晚期恶性肿瘤静脉输液化疗中的临床应用[J].中国误诊学杂志,2012,12(15):3843-3844.
[12]李娥.乳腺癌化疗56例PICC的应用及护理[J].中国误诊学杂志,2012,12(13):3351.
[13]邢玉梅.经外周穿刺中心静脉置管术在肿瘤科护理工作中的应用[J].中国基层医药,2012,19(17):2703-2704.
[14]李玲敏,杨玉杰,闫冬,等.肿瘤化疗患者PICC置管的并发症原因分析及护理对策[J].基层医学论坛,2016,20(22):3127-3128.
[15]熊小云,陈丽莲,袁瑞琴,等.152例新生儿经大隐静脉穿刺置入PICC的效果观察[J].护理实践与研究,2013,10(10):116-117.
[16]李力,曾从容,杨春雪,等.新生儿下肢静脉PICC可行性研究[J].中国实用护理杂志,2014,30(7):51-52.
[17]刘秀红,薛波,杨志英,等.新生儿下肢经外周静脉穿刺置入中心静脉导管置管方法及长度的探讨[J].中国实用护理杂志,2015,31(29):2219-2220.
[18]Aria DJ,Vatsky S,Kaye R,et al.Greater saphenous venousaccess as an alternative in children[J].Pediatr Radiol,2014,44(2):187-192.