防止恶病质患者PICC导管置入过程中移位的方法

Prevention Measures of PICC Catheter Displacement for Cachexia Patients

目的探讨减少消化系统疾病所致恶病质患者置入三向瓣膜式PICC导管移位至颈内静脉的方法。方法便利选取2010年1月至2012年7月在长海医院消化科行PICC置管的恶病质患者188例,均为消化系统疾病所致,BMI<18.5。将188例患者随机分为对照组90例和观察组98例:对照组采取PICC常规置管法,即当导管头端到达肩部后协助患者将下颌靠近穿刺侧肩部,防止导管进入颈内静脉;观察组当导管到达锁骨下静脉中段时,助手在同侧锁骨上窝靠近胸锁关节处以四指并拢向内下方用力按压颈内静脉,防止导管进入颈内静脉。结果对照组与观察组的置管成功率分别为91.1%(81/90)及97.9%(95/98),差异有统计学意义(χ2=5.395,P<0.05)。结论恶病质患者置入PICC过程中,通过指压法可以有效减少PICC置管移位的发生,提高置管的成功率和工作效率。

Objective To study the prevention measures of three-way valve-type PICC catheter displace- ment to jugular vein for cachexia patients caused by digestive system cancers. Methods From January 2010 to July 2012,188 cachexia patients with digestive system cancers（BMI〈 18. 5） were randomly divided into control group（n=90） and experimental group（n=98）. Patients in the control group were assisted to make the submaxillary close to the shoulder on the operation side when the tip of catheter was inserted to this area to prevent the catheter into the internal jugular vein. In the experimental group, the jugular veins of the patients were pressed inward and downward forcefully by the assistant with four fingers putting together at the supraclavicular fossae close to sternoclavicular joint, when the catheter was inserted to prevent the catheter into the internal jugular vein. Results The success rates of PICC catheter in the control group and in the experimental group were 91. 1% （81/90）and 97. 9% （95/98）respectively, and the difference was statistically significant（X^2 = 5. 395,P%0.05）. Conclusion The finger-press method can effectively prevent the PICC catheter displacement and improve the success rate of catheter and efficiency for cachexia patients.