美国新生儿重症监护室中经外周中心静脉置管的临床应用

The practice of peripherally inserted central venous catheter in an American Neonatal Intensive Care Unit

目的评价美国NICU中PICC的使用率和并发症发生率,为其在国内NICU的推广应用提供借鉴。方法对2005年1月至2006年12月入住华盛顿大学医学院圣路易斯儿童医院NICU的所有接受PICC新生儿的临床资料进行回顾性分析。结果NICU中使用PICC的病人比例为51.15%,PICC使用率为28.14%,各种并发症的发生率分别为堵管6.04%(43例),脱管2.39%(17例),渗漏1.12%(8例),水肿1.26%(9例),静脉炎2.53%(18例),胸腔渗出0.28%(2例),每1000个导管日并发CRBSI为2.99,发生CRBSI的危险因素为胎龄、置管时间、机械通气时间。结论PICC在NICU中的使用是安全易行的。操作人员的专业培训有助于降低PICC相关并发症的发生率。

Objective ： To determine the utilization ratio, complications and outcomes of PICC in a level Ⅲ NICU. Methods ： Data were collected retrospectively among neonates who accepted PICC in their stay of NICU in St. Louis Children＇s Hospital in Washington University school of medicine between January 1, 2005 and December 31, 2006. Results： A total of 712 patients （51.15%） were placed on PICC. The PICC utilization ratio was 28.14% （ number of PICC line - days/number of patient - days）. Complications included line occlusion （ 43/712 lines ）, catheter slipped out （ 17/712 lines ）, infiltration （ 8/712 lines ）, acute edema （ 9/712 lines）, phlebitis （18/712 lines）, pleural effusion （2/712 lines）, and CRBSI （35/712）. The incidence of CRBSI was 2. 99 per 1000 PICC linedays. By multivariate logistic regression analysis, smaller gestational age , length of catheter and duration of mechanical ventilation were found to be predictive of CRBSI development. Conclusions ： The practice of placing of PICC in NICU is safe and feasible with minor complications. It is suggested that training of NICU bedside nurses to place PICCs will decrease complications and improve patient outcomes.