上腔静脉中心静脉导管置管最佳位置的体外测量方法研究

Optimal method to measure length of peripherally inserted central catheter through body surface

目的分析比较两种经外周留置中心静脉导管(PICC)前端位于上腔静脉最佳位置的体外测量方法,以减少血栓、感染及相关并发症的发生。方法选取2012年7-12月肿瘤患者390例成功行PICC置管的患者,根据体外测量方法不同分为两组,A组150例、B组240例,A组从穿刺点到右胸锁关节内侧再向下反折至胸柄联合处;B组从穿刺点到右胸锁关节内侧再向下反折至胸柄联合处下缘和第三肋之间,分析两组患者的X线定位结果。结果 A组150例患者中PICC导管前端位于上腔静脉最佳位置的有123例,占82.0%,B组240例患者有139例,占57.9%,A组明显高于B组,差异有统计学意义;A组患者发生并发症4例,发生率2.7%,其中感染1例,发生率0.7%,B组患者发生并发症7例,发生率2.9%,其中感染2例,发生率0.8%。结论从穿刺点到右胸锁关节内侧再向下反折至胸柄联合处为目前最佳置管长度的体外测量方法,解剖位置明确、测量较准确、易为临床掌握。

OBJECTIVE To compare the two methods to measure the lengths of two peripherally inserted central catheter （PICC） through body surface inserted in superior vena cava so as to find out the optimal method and reduce the incidence of thrombosis ,infections ,or related complications .METHODS A total of 390 tumor patients who successfully underwent the PICC from Jul 2012 to Dec 2012 were enrolled in the study and divided into the group A with 150 cases and the group B with 240 cases according to the body surface measurement methods .The lengths of catheters in the group A were measured from puncture site to the inside of right sternoclavicular joint to manubriosternal joint ;the lengths of catheters in the group B were measured from puncture site to the inside of right sternoclavicular joint to the position between manubriosternal joint and third rib .The chest radiography of the two groups of patients was analyzed .RESULTS Among the 150 patients in the group A ,there were 123 pa-tients with the tips of PICC located in the optimal position of superior vena cava ,the distribution rate was 82 .0% ;among the 240 patients in the group B ,there were 139 patients with the tips of PICC located in the optimal posi-tion of superior vena cava ,the distribution rate was 57 .9% ;the distribution rate of the group A was significantly higher than that of the group B .The complications occurred in 4 of 150 patients in the group A with the incidence of 2 .7% ,including 1 （0 .7% ） case of infection .The complications occurred in 7 cases in the group B with the in-cidence of 2 .9% ,among whom 2 cases were infected ,with the incidence of 0 .8% .CONCLUSION At present ,the optimal method to measure the length of PICC through body surface is from the puncture site to the inside of right sternoclavicular joint to manubriosternal joint ,with anatomical location clear ,measurement accurate ,and it is eas-y to master .