门诊PICC导管回血53例的处理体会

Experience on treating back blood during PICC catheter maintenance:a report of 53 cases

目的探讨适合门诊PICC导管回血的处理方法与效果。方法对2017年1—7月在我专科门诊PICC导管维护的578例患者,其中导管回血53例,回血率10.9%,先使用抽有2 ml肝素盐水(浓度100 u/ml)的20 ml注射器负压抽吸、快速放松,并配合指腹揉搓,三个操作步骤反复进行数次,耗时5次30 min再通33例,剩余20例无效者,在此基础上增加尿激酶溶栓再通。结果 PICC导管回血53例,再通率100%,使用肝素溶栓再通占62.26%,使用尿激酶溶栓再通占37.74%,观察尿激酶溶栓患者24 h,均未发生牙龈及皮肤黏膜出血及肺栓塞等并发症。结论应加强PICC门诊患者及家属自我护理知识及技能培训,尽早发现回血,尽早回医院处理,否则导管内血液由微血栓形成血凝块,最后发展成坚硬的血栓,处理耗时长甚至溶栓失败需拔出导管。早期微血栓血凝块期:导管回血的颜色较新鲜,触摸较软能揉碎,注射器回抽有移动,仅使用肝素溶栓即可且耗时短;晚期坚硬的血栓形成期:导管回血的颜色深为深褐色,触摸坚硬不能揉碎,注射器回抽没有移动,需增加尿激酶溶栓耗时长。配合使用注射器负压抽吸、快速放松,指腹揉搓三步法,借助负压使药液吸入导管内,指腹揉搓导管外露部分,使药物与血液充分接触并将血栓揉碎脱落易于抽出,综合应用以上措施溶栓耗时较短,效果满意,适合在门诊推广使用。

Objective To investigate the method suitable for treating PICC catheter return blood in outpatient treatment and its effect. Methods A total of 578 cases of outpatient patients received PICC maintenance in our hospital during January 2017 and July 2017 were enrolled in this study. Among the 578 patients,back blood occurred in 53 cases,account for 10. 9%. When the symptom occurred,we firstly operate syringe vacuum suction by using an injector（ the injector was previously filled with 2 ml heparin saline at the concentration of 100 u/ml）,rapid relaxation secondly,and combined with the finger-belly rubbing. Three steps are repeated for a few times. Finally,30 min later 33 cases achieved repatency. The other 20 cases achieved repatency after the application of taken urokinase. Results The recanalization rate of the 53 cases was 100%,heparin thrombolysis accounted for 62. 26%,and Urokinase thrombolysis account for 37. 74%. 24 h after theapplication of urokinase for thrombolysis, we found no complications（ gingival bleeding, Skin mucosal hemorrhage,pulmonary embolism） occur.Conclusions We should strengthen the self-care knowledge and skills training of PICC for outpatient patients and their families,find the return blood early and return to the hospital as soon as possible. Otherwise,the blood in the catheter will form clot from micro-thrombus,which eventually develops into a hard thrombus,and takes a long time to process and even fails to dissolve the latch. Early stage of micro-thrombus blood coagulation stage： catheter rush color is fresher,soft touch can crush it,the blood could move when syringe pumping,the use of heparin thrombolysis can deal with it in a short time. Late-stage hard thrombus formation： the color of catheter rush is dark brown,touch hard and can＇t been crushed,it doesn＇t move when use syringe pumping,urokinase thrombolysis is need to increase and cost a long time. In conjunction with the use of syringe negative pressure suction,rapid relaxation,finger-belly rubbing three-step,with the help of negative pressure in the catheter the drug can input the catheter,rub the exposed part of the catheter with the finger,so that the drug and blood fully contact fully and the broken clot is easy to draw out. The application of the above measures,the thrombolysis time will relatively short and achieve satisfactory results,suitable for use in outpatient clinics.