微导丝辅助送管困难性PICC导管置入的观察
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摘要
目的:观察微导丝辅助送管困难性PICC导管置入的成功率。方法:将63例患者随机分为观察组31例,对照组32例。2组患者均采用改良Seldinger法联合超声引导穿刺,观察组在DSA监视下使用微导丝辅助送管,对照组在DSA监视下直接送管。比较2组PICC置管的到位率以及平均累积X线照射时间。结果:送管成功率观察组为96.8%,对照组为46.9%,2组比较差异有统计学意义(P<0.05)。观察组平均X线累积照射时间9.6分钟,对照组15例导管到位患者平均累积X线照射时间18.6分钟,17例患者在20分钟内未送管成功,改为微导丝辅助后,在平均X线累积照射时间10.5分钟内全部送管到位。结论:微导丝引导显著提高了送管困难性PICC导管置入的成功率,同时减少了患者和操作者X线照射时间。
Objective: To observe the success rate of micro-wire interoducing the insertion of difficult feeding type peripherally inserted central catheter(PICC). Methods: All 63 patients were randomized into 31 cases of the observation group and 32 cases of the control group. Both groups accepted modified Seldinger method combined with ultrasound guided puncture, the patients in the observation group received micro-wire assisting the insertion of the catheter on the foundation of DSA, and the patients in the control group were inserted directly under the observation of DSA. Average cumulative X-ray irradiation time and PICC success rate of both groups were compared. Results: Feeding success rate of the observation group was 96.8%, higher than 46.9% of the control group, and the difference had statistical meaning(P <0.05). Average cumulative X-ray irradiation time of the observation group was 9.6 minutes, while the time for 15 patients with successfully insertion in the control group was18.6 minutes, 17 patients failed in 20 minutes, and changed into micro-wire assisting; the time was 10.5 minutes and succeeded completely. Conclusion: Interoducied by micro-wire could significantly raise the success rate of difficult feeding type PICC, at the same time, and reduce X-ray irradiation time of the patients and the operators.
Objective: To observe the success rate of micro-wire interoducing the insertion of difficult feeding type peripherally inserted central catheter(PICC). Methods: All 63 patients were randomized into 31 cases of the observation group and 32 cases of the control group. Both groups accepted modified Seldinger method combined with ultrasound guided puncture, the patients in the observation group received micro-wire assisting the insertion of the catheter on the foundation of DSA, and the patients in the control group were inserted directly under the observation of DSA. Average cumulative X-ray irradiation time and PICC success rate of both groups were compared. Results: Feeding success rate of the observation group was 96.8%, higher than 46.9% of the control group, and the difference had statistical meaning(P <0.05). Average cumulative X-ray irradiation time of the observation group was 9.6 minutes, while the time for 15 patients with successfully insertion in the control group was18.6 minutes, 17 patients failed in 20 minutes, and changed into micro-wire assisting; the time was 10.5 minutes and succeeded completely. Conclusion: Interoducied by micro-wire could significantly raise the success rate of difficult feeding type PICC, at the same time, and reduce X-ray irradiation time of the patients and the operators.
引文
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[13]叶沙,邓君玲,倪虹,等.不同尖端定位技术对PICC置管术后并发症的影响[J].中南医学科学杂志,2015,43(2):230-233.
[14]徐海英,谷小燕,王兰.超声引导下改良塞丁格PICC送管时导丝替换的效果观察[J].护理学报,2015,22(8):56-58.
[15]Sharpe EL,Roig JC.A novel technique for difficult removalofa neonatal peripherally inserted central catheter(PICC)[J].J Perinatol,2012,32(1):70-71.
[16]Ohki Y,Yoshizawa Y,Watanabe M,et al.Complications of percutaneously inserted central venous catheters in Japanese neonates[J].Pediatr Int,2008,50(5):636-639.
[17]侯海霞,鞠进.PICC置管中延迟撤除支撑导丝对颈内静脉导管异位复位成功率的影响[J].现代医药卫生,2014,30(21):3220-3222.
[18]宋来昌,党磊,王文辉,等.DSA监视下PICC导管置入的技术与技巧[J].卫生职业教育,2012,30(22):129-130.
[19]Sharp R,Grech C,Fielder A,et al.The patient exper ience of a peripherally inserted central catheter(PICC):A qualitative descriptive study[J].Contemp Nurse,2014,48(1):26-35
[20]商锋华,李红娟,祁红霞,等.巧用导引导丝在DSA引导下调整难调性PICC置管后异位[J].齐齐哈尔医学院学报,2013,34(14):2178-2179.
[21]Carpeggiani C,Picano E.Management of medical radiation:perspectives from cardiology[J].Current Radiology Reports,2015,3(1):79-81.
[2]Walker G,Todd A.Nurse-led PICC insertion:is it cost effective[J].Br J Nurs,2013,22(19):9-15.
[3]Burns T,Lamberth B.Facility wide benefits of radiology vascular access teams[J].Radiol Manage,2010:32(1):28-32.
[4]杨英珍,杜华,李峰.超声引导下PICC置管困难的原因分析及处理方法[J].临床护理杂志,2014,13(3):30-32.
[5]乔爱珍,苏讯,陈玉静,等.塞丁格技术在血管超声引导下PICC置管的临床实践[J].护士进修杂志,2009,24(21):2013-2014.
[6]Li J,Fan YY,Xin MZ,et al.A randomised controlled trial comparing the long-term effects of peripherally inserted central catheter placement in chemothe rapy patients using B-mode ultrasound with modified seldinger technique versus blind puncture[J].Eur J Oncol Nurs,2014,18(1):94-103.
[7]赵建新,朱晓黎,孙鸽.介入法在难置型外周中心静脉置管中的应用分析[J].临床放射学杂志,2011,30(9):1373-1377.
[8]Oliver G,Jones M.ECG or X-ray as the‘gold modified′for establishing PICC-tip location[J].Br J Nurs.201419(8):S10-16.
[9]Smith B,Neuharth RM,Hendrix MA,el al.Intravenous electrocardiographic guidance for placement of peri pherally inserted central catheters[J].J Electrocardiol,2010,43(3):274-278.
[10]金静芬,陈春芳,赵锐祎,等.经外周穿刺置入中心静脉导管异位处理方法的研究进展[J].中华护理杂志,2013,48(2):184-187.
[11]Cotogni P,Pittiruti M Focus on peripherally inserted central catheters in critically ill patients[J].World J Crit Care Med,2014,3(4):80-94.
[12]陆美艳,沈晓莉.32例PICC置管失败患者经颈外静脉置管成功的体会[J].当代护士(中旬刊),2015,13(5):134-135.
[13]叶沙,邓君玲,倪虹,等.不同尖端定位技术对PICC置管术后并发症的影响[J].中南医学科学杂志,2015,43(2):230-233.
[14]徐海英,谷小燕,王兰.超声引导下改良塞丁格PICC送管时导丝替换的效果观察[J].护理学报,2015,22(8):56-58.
[15]Sharpe EL,Roig JC.A novel technique for difficult removalofa neonatal peripherally inserted central catheter(PICC)[J].J Perinatol,2012,32(1):70-71.
[16]Ohki Y,Yoshizawa Y,Watanabe M,et al.Complications of percutaneously inserted central venous catheters in Japanese neonates[J].Pediatr Int,2008,50(5):636-639.
[17]侯海霞,鞠进.PICC置管中延迟撤除支撑导丝对颈内静脉导管异位复位成功率的影响[J].现代医药卫生,2014,30(21):3220-3222.
[18]宋来昌,党磊,王文辉,等.DSA监视下PICC导管置入的技术与技巧[J].卫生职业教育,2012,30(22):129-130.
[19]Sharp R,Grech C,Fielder A,et al.The patient exper ience of a peripherally inserted central catheter(PICC):A qualitative descriptive study[J].Contemp Nurse,2014,48(1):26-35
[20]商锋华,李红娟,祁红霞,等.巧用导引导丝在DSA引导下调整难调性PICC置管后异位[J].齐齐哈尔医学院学报,2013,34(14):2178-2179.
[21]Carpeggiani C,Picano E.Management of medical radiation:perspectives from cardiology[J].Current Radiology Reports,2015,3(1):79-81.