高龄患者PICC并发静脉血栓的护理对策

Nursing strategy for elder patients with PICC complicated with venous thrombosis

目的探讨高龄患者经外周置人中心静脉导管（PICC）后并发静脉血栓的护理对策。方法总结31例PICC并发静脉血栓的治疗护理方法，包括肢体制动抬高，密切观察生命体征，遵医嘱皮下注射抗凝药物8～30d，抗凝期间严密观察有无出血、胸痛、呼吸困难、咳嗽、咯血等表现，配合局部物理治疗，治疗结束后分2或3次拔管。结果31例患者均顺利拔管，未发生断管、出血、血栓脱落。结论掌握拔管时机可有效防止断管、栓塞；老年、卧床、意识不清患者是预防和观察的重点人群；部分患者发生血栓后无症状，因此对高龄、置管时间长的患者有必要定期行超声检查，所有患者拔管前应行超声检查，确保安全拔管。

Objective To investigate nursing strategy for elder patients with PICC complicated with venous thrombosis. Methods Treating and nursing strategies for 31 eider patients with PICC complicated with venous thrombosis were evaluated, including braking limb elevation, observing vital signs. Subcutaneous injection of anticoagulant drugs were given for 8 to 30 days, and bleeding, chest pain, dyspnea, cough or hemoptysis were observed. Physical therapy were also applied and extubation were done in 2 to 3 times after treatment. Results All observed cases were extubated fluently without broken pipe, bleeding or shedding of thrombosis. Conclusions Timing of extubation is related with broken pipe and thrombosis. Unconscious elder patients who lie in bed need intimate observation. Some patients have no symptoms after thrombosis. Thus, carrying out ultrasonic examination periodically is helpful for elder patients with PICC for a long time. Furthermore, ultrasonic examination should be done before extubation to ensure safe extubation.