静脉内心电图引导PICC尖端定位的临床研究

Clinical research of intravenous electrocardiogram guided PICC tip position

目的探讨静脉内心电图(ECG)引导PICC尖端定位的可靠性和安全性。方法 将2010年7～12月行PICC置管的肿瘤患者60例,根据置管方式的不同分为外周静脉组和颈外静脉组,每组各30例。导管尖端位置和方向的确定依据ECGⅡ导联P波的变化,记录置管到位率及长度。导管固定后行X线检查(胸部正位片)确定导管尖端位置。结果ECG引导的两组PICC置管到位率均较高,差异无统计学意义(P>0.05);不同时段的置入长度相比较,差异有统计学意义(P<0.05)。结论通过ECGⅡ导联P波的变化可以引导PICC尖端位置的定位,指导术中置管方向,提高置管成功率和安全性,且外周静脉血管条件差时,可首选颈外静脉置管。

Objective To explore the reliability and security of PICC tip position under the guidance of intravenous electrocardiogram（ECG）.Methods Sixty cancer patients with PICC insertion from July to December 2010 were divided into peripheral vein group（30 cases） and external jugular vein group（30 cases）.The tip position and direction of catheter were determined by the change of P waves at Ⅱ lead in ECG.The arrival rate of cannulation and insertion length was recorded.X-ray examination for anteroposterior chest was conducted to determine the tip position after the catheter was fixed in the vein.Results Both the arrival rates of PICC cannulation in the two groups were high and no significant difference was found between the two groups（P〉0.05）.There was signifcant difference in the insertion length in different periods（P〈0.05）.Conclusion The positioning and the direction of PICC tip position can be guided by the changes of P waves at Ⅱ lead in ECG,which can improve the reliability and security of PICC cannulation.Moreover,external jugular vein may be preferred in case of poor conditions in the peripheral vein.