超声引导下改良塞丁格技术行经外周静脉置入中心静脉导管常见问题及对策

Common problems and countermeasure of ultrasound-guided modified Seldinger technique for peripherallyinserted central catheter placement

目的探讨超声引导下改良塞丁格技术行经外周静脉置人中心静脉导管（PICC）过程中遇到的常见问题及对策。方法对140例超声引导下改良塞丁格技术行PICC置管，分析置管过程中出现的常见问题并提出相应的对策。结果140例患者中置管成功率为98．6％，135例（96．4％）1次穿刺成功，5例（3．6％）2次穿刺成功。此外，10例（7．1％）送导丝不畅，5例（3．6％）PICC管送入不畅，3例（2．1％）在送管至同侧锁骨下静脉处受阻，3例（2．1％）PICC管异位至颈内静脉，2例（1．4％）PICC管分别在上腔静脉及腋静脉处折返，均经处理，置管成功。结论超声引导下改良塞丁格技术行PICC置管过程中常见的问题有穿刺失败、送导丝不畅或失败、送管不畅或失败，要善于总结经验教训，才能提高置管成功率。

Objective To investigate the common problems and countermeasure of using ultrasoundguided modified Seldinger technique in peripherally inserted central catheter （PICC） placement. Method The clinical data of 140 patients who underwent PICC placement using ultrasound-guided modified Seldinger technique were retrospectively analyzed. Results The success rate of catheterization was 98.6% among these 140 patients, with 135 （96.4%） succeeded after a single attempt and 5 （3.6%） after 2 attempts. Besides, 7.1% （ n = 10） had difficulty in inserting the guide wire, 3.6% （n =5） had difficult catheteration, 2. 1% （n =3） met resistance when inserting catheter into ipsilateral subclavian vein, 2. 1% （ n = 3 ） experienced dystopia of inserting catheter into internal jugulular vein, and 1.4% （n = 2） experienced the bending of PICC in the superior vena cava and axillary vein. All of these problems were handled successfully. Conclusions The common problems of PICC placement include puncture failure, difficulty in inserting guide wire, and difficult catheteration. A good knowledge of these problems will help increase the success rate.