预防气管切开患者经外周静脉置入中心静脉导管发生颈内静脉异位的新方法

New Method for Preventing Patients With Tracheotomy From Internal Jugular Vein Malposition of Peripherally Inserted Central Catheter

目的研究预防气管切开患者经外周静脉置入中心静脉导管(PICC)置管过程中发生颈内静脉异位的新方法。方法选择2009年2月—2014年11月在广州军区广州总医院采用超声引导行PICC置管的气管切开患者86例,采用随机数字表法将患者分为对照组和观察组,各43例。在PICC置管过程中,对照组采用指压法,观察组采用B超探头压迫法。观察两组PICC置管过程中导管异位入颈内静脉的发生率、置管时间、并发症发生情况;置管后X线检查PICC尖端位置正确率。结果置管过程中,观察组PICC异位入颈内静脉发生率为4.7%(2/43),低于对照组的34.9%(15/43)(χ2=12.904,P=0.005)。观察组置管时间为(14.7±3.1)s,短于对照组的(22.4±14.0)s(t=-3.512,P=0.001)。观察组并发症发生率(0)低于对照组的9.3%(4/43)(χ2=4.195,P=0.041)。置管后两组X线检查PICC尖端位置正确率均为100%。结论 B超探头压迫法较指压法能降低气管切开患者PICC导管异位入颈内静脉发生率,且具有置管时间短、安全的优点。

Objective To evaluate new method for preventing patients with tracheotomy from internal jugular vein malposition of peripherally inserted central catheter（ PICC）. Methods From February 2009 to November 2014,86 patients who underwent PICC placement guided with B-ultrasound were randomly divided into control group （ n=43 ） and observation group（n=43）with a random number table. B -ultrasound probe compression on the internal jugular vein was used in the observation group,while finger compression was used in the control group. Comparison was made in the incidence of internal jugular vein malposition,length of time of catheter placement,incidence of complications;after the catheter placement,the correct rate of PICC tip placement was examined by X-ray. Results Incidence of PICC malposition was significantly lower in the observation group than the control group〔4. 7%（2/43） vs. 34. 9%（15/43）,χ2 =12. 904,P=0. 005〕. The length of time of catheter was significantly shorter in the observation group than the control group〔（14. 7 ± 3. 1） s vs. （22. 4 ± 14. 0） s, t= -3. 512,P=0. 001〕. No complication was observed in the observation group,while the rate of complication in the control group was 9. 3%（4/43）,with a statistically significant difference（χ2 =4. 195,P=0. 041）. After the catheter placement, the correct rate of PICC tip placement in both groups was 100%. Conclusion The B-ultrasound probe compression method can significantly lower the incidence of internal jugular vein malposition of PICC in patients with tracheotomy. The length of time of catheter is shorter under this method and this method is safer.