超声探头颈内静脉阻断法减少PICC置管异位
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摘要
目的探讨减少PICC置管术中导管颈内静脉异位的有效方法。方法选择符合纳入标准需行PICC置管治疗的106例患者作为研究对象,按照随机数字表法分为对照组与观察组各53例。对照组给予常规的患者上肢外展与躯干呈90°体位,当导管头端到达肩部时采用偏头法阻断颈内静脉;观察组采用视锐Ⅴ超声探头压迫法阻断颈内静脉,比较两组异位发生率。结果观察组导管异位发生率3.77%,显著低于对照组的20.75%(P<0.01),两组胸廓内静脉异位、奇静脉异位、锁骨下静脉返折发生率比较,差异无统计学意义(均P>0.05)。结论 PICC置管操作中,采用视锐Ⅴ超声探头压迫法可显著提高导管一次到位率,降低术中导管颈内静脉异位发生率,减少置管过程中调管次数。
Objective To explore a method to reduce catheter tip malposition during PICC insertion.Methods Totally, 106 patients meeting the inclusion criteria and scheduled to receive PICC placement were evenly randomized into a control group and an intervention group according to the random number table.During PICC insertion, the patients were routinely asked to abduct the arm 90 degrees, and when the catheter tip reached the shoulder part, the control group were asked to turn the head to allow the nurse to advance the catheter, while the intervention group stayed put to allow the nurse to use the Site-Rite~? 5 ultrasonic probe to compress the internal jugular vein before the nurse advanced the catheter. The incidence rates of PICC malpositions were compared between the two groups.Results The total incidence rate of PICC malpositions in the intervention group was significantly lower than that of the control group(3.77% vs. 20.75%,P<0.01).However, no significant differences were found in the incidence rates of malposition in the internal thoracic vein, or the azygos vein, and in the rate of catheter tip folding back in the subclavian vein, between the two groups(P>0.05 for all).Conclusion During PICC insertion, the technique of using the Site-Rite~? 5 ultrasonic probe to compress the internal jugular vein before advancing the catheter could improve the rate of successful initial PICC tip placement,reduce PICC malposition into the internal jugular vein, as well as the frequency of catheter adjustment.
Objective To explore a method to reduce catheter tip malposition during PICC insertion.Methods Totally, 106 patients meeting the inclusion criteria and scheduled to receive PICC placement were evenly randomized into a control group and an intervention group according to the random number table.During PICC insertion, the patients were routinely asked to abduct the arm 90 degrees, and when the catheter tip reached the shoulder part, the control group were asked to turn the head to allow the nurse to advance the catheter, while the intervention group stayed put to allow the nurse to use the Site-Rite~? 5 ultrasonic probe to compress the internal jugular vein before the nurse advanced the catheter. The incidence rates of PICC malpositions were compared between the two groups.Results The total incidence rate of PICC malpositions in the intervention group was significantly lower than that of the control group(3.77% vs. 20.75%,P<0.01).However, no significant differences were found in the incidence rates of malposition in the internal thoracic vein, or the azygos vein, and in the rate of catheter tip folding back in the subclavian vein, between the two groups(P>0.05 for all).Conclusion During PICC insertion, the technique of using the Site-Rite~? 5 ultrasonic probe to compress the internal jugular vein before advancing the catheter could improve the rate of successful initial PICC tip placement,reduce PICC malposition into the internal jugular vein, as well as the frequency of catheter adjustment.
引文
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[8] 柳伊娜,张爱萍,陆佩文.改良体位在PICC置管术中的临床应用研究[J].实用临床医药杂志,2015,19(20):34-36.
[9] 宋敏,霍平,姚辉,等.指压法阻止PICC进入颈静脉[J].护理学杂志,2013,28(3):7-8.
[10] 胡倩,宋敏,李雪玉,等.3种颈部静脉阻断方法在预防PICC置管时导管异位效果比较[J].中华护理杂志,2013,48(2):160-162.
[2] 周英,吕学波,娄怡,等.改良PICC置管体位对减少导管异位的作用[J].护理学杂志,2015,30(21):42-44.
[3] 李佳,李雪玉,宋敏,等.PICC导管尖端异位于颈内静脉的预防与护理研究进展[J].上海护理,2018,18(2):57-59.
[4] 石英,李艳华,易建华.PICC导管异位的预防与正位处理研究进展[J].护理学报,2012,19(2):21-23.
[5] Wang D,Amesur N,Shuklal G,et al.Peripherally inserted central catheter placement with the sonic flashlight:initial clinical trial by nurses[J].J UItrasound Med,2009,28(5):651-656.
[6] Infusion Nurses Society.Infusion Therapy Standards of Practice[J].J Infus Nurs,2016,39(1 Suppl):1-169.
[7] 邵乐文,胡晓蓉,金爱云,等.113例肿瘤患者PICC置管过程中导管异位的识别与复位[J].中华护理杂志,2018,53(4):454-456.
[8] 柳伊娜,张爱萍,陆佩文.改良体位在PICC置管术中的临床应用研究[J].实用临床医药杂志,2015,19(20):34-36.
[9] 宋敏,霍平,姚辉,等.指压法阻止PICC进入颈静脉[J].护理学杂志,2013,28(3):7-8.
[10] 胡倩,宋敏,李雪玉,等.3种颈部静脉阻断方法在预防PICC置管时导管异位效果比较[J].中华护理杂志,2013,48(2):160-162.