不同中心静脉置管方式致导管末端异位的比较及分析

Comparison and analysis of tip malposition after different central venous catheterizations

目的比较肿瘤患者外周静脉置入中心静脉导管(PICC)与传统中心静脉导管(CVC)2种置管导管末端异位情况。方法选择1656名共1799例次PICC/CVC置管后的肿瘤患者,常规胸部正位X线检查确认置管走向及导管末端位置,计算导管末端异位发生率,对导管末端异位者进行调整并观察转归。结果 PICC置管失败率2.68%,CVC置管失败率0.34%,2组比较差异显著(P<0.01)。胸部X线检查导管末端异位发生率4.84%,其中PICC末端异位发生率6.42%,显著高于CVC末端异位发生率4.01%(P<0.01)。PICC末端异位调整成功率为71.1%,CVC末端异位调整成功率为26.7%,2组比较差异显著(P<0.01)。结论与CVC置管相比,肿瘤患者PICC置管导管末端异位发生率较高,但较容易调整。PICC/CVC置管后应常规胸部正位X线片确认导管走向和导管末端位置。

Objective To compare and analyze tip malposition of 2 central venous catheteri-zations in cancer patients.Methods Totally 1656 cancer patients received 1799 cases of peripheral-ly inserted central catheter（PICC）/conventional central venous catheter（CVC）were consecutively assessed by means of routine post-catheterization chest X-ray.The catheter with its tip strike and terminal position were confirmed individually.All tip malpositions were calculated.And the catheters with tip malpositions were readjusted and reevaluated.Results The failure rate in PICC group （2.68%）was significantly higher than that in CVC group（0.34%,P 〈0.01）.Eighty three catheters（4.84%）were found tip malpositioned,in which 38 catheters（6.42%）were from PICC group and 45 ones（4.01%）from CVC group （P 〈0.01）.The achievement ratio of readjustment for tip malposition in PICC group （71.1%）was much higher than that in CVC group （26.7%,P〈0.01）.Conclusion Compared with CVCs in cancer patients,the prevalence of tip malposition from PICCs was higher although the tip malpositions in PICCs were more likely to be corrected with readjustment.These findings suggest that tip position of PICC /CVC should be confirmed post-catheterization with chest x-ray.