经外周静脉穿刺中心静脉置管术带管患者导管折叠的相关因素分析

Factors related to the catheter folding in patients with PICC maintenance

目的分析经外周静脉穿刺中心静脉置管术(peripherally inserted central catheter,PICC)带管患者导管折叠的相关因素,为采取预防措施避免导管断裂提供科学依据。方法观察记录2013年11月至2014年5月在本院门诊常规维护的PICC带管患者的导管穿刺部位、与肘关节的距离和角度、导管的外露长度、再返院时PICC导管是否有折叠及折痕的位置。采用Logistic回归模型分析导管折叠的相关因素。结果本研究共纳入577例次PICC维护患者,其中再返院时有110(19.1%)例次导管出现折痕,其中95.5%的导管折叠痕迹为导管接口处。多因素分析结果表明导管的穿刺部位在肘关节(OR=3.275,95%CI:1.613~6.647)、导管外露长度长≤2cm(OR=0.314,95%CI:0.156~0.631)、导管与肘关节的距离≤3cm(OR=0.432,95%CI:0.234~0.796)及其相交角度>80°(OR=49.921,95%CI:23.125~107.349)与导管折叠有相关性。结论导管穿刺部位和摆放位置近肘关节者、导管外露长度越短且与肘关节横向线相交角度越接近90°者较易出现折叠。对外露短近肘关节的导管维护时宜使导管与关节横行线相交角度小于80°。

Objective To explore factors related to the catheter folding in patients with Peripherally Inserted Central Catheter（PICC） maintenance in order to provide the basis for preventing the catheter breakage and fracture.Method We prospectively analyzed the related data from outpatients with PICC maintenance from November 2013 to May 2014.These data include the puncture point of the PICC catheter,the distance and the angle between catheter and elbow joint,the exposed length of catheter,the PICC catheter is folded or not,and the folded position of the catheter with the Logistic regression model.Result Among all 577 cases with PICC maintenance,110 cases had catheter folding（the incidence was 19.1%）,in which 105 cases（95.5%） were folded at the catheter interface.The factors related to the catheter folding were catheter puncture site at the elbow（OR=3.275,95% CI：1.613~6.647）,long catheter exposed length≤2cm（OR= 0.314,95% CI：0.156~0.631）,distance between tube and elbow ≤3cm（OR=0.432,95% CI：0.234~0.796） and intersection angle 〉80 degrees（OR=49.921,95% CI：23.125~107.349）.Conclusion We must pay more attention to keep the intersection angle of the catheter and the elbow joint below 80 degree.