耐高压注射型PICC导管异位的原因分析及处理对策

Cause analysis of misplacement of high pressure resistant injectable PICC and related countermeasures

目的探讨耐高压注射型经外周静脉穿刺中心静脉置管(PICC)导管异位的原因及处理对策。方法收集452例耐高压注射型PICC导管发生异位的病例,从置管途径、异位发生部位、处理方法及结果进行分析。结果 452例导管异位发生部位:右颈内静脉237例,左颈内静脉145例,对侧锁骨下静脉14例,奇静脉17例,反折锁骨静脉腋静脉29例,导管过深(进入心房心室)10例。头静脉置管异位率(36.84%)高于贵要静脉(13.10%)和肱静脉(15.15%),左侧静脉置管异位率明显高于右侧静脉。双腔导管的异位率(27.50%)明显高于单腔导管的异位率(11.68%)。经调整处理后451例导管调至正确位置,1例调管失败在数字血管造影(DSA)下协助拔管。结论护士在耐高压注射型PICC置管前应全面评估患者病情及血管条件、置管过程中适当调整患者体位、掌握熟练的穿刺技术有助于降低导管异位的发生,多数异位可以通过各种方法纠正。

Objective To analyze potential causes of misplacement of high pressure resistant injectable peripherally inserted central catheter（ PICC）,and to provide related countermeasures.Methods To retrospectively collect the clinical data of 452 cases with misplacement during catheterization of high pressure resistant injectable PICC,and to analyze the outcome from perspectives of catheter access,the location and the treatment methods of misplacement. Results In terms of location,237 cases with the catheter tip in right internal jugular vein,145 cases in left internal jugular vein,14 cases in contralateral subclavian vein,17 cases in azygos vein,29 cases in infraclavicular axillary vein,and 10 cases in atrium or ventricle. The misplacement rate by cephalic vein access（ 36. 84%） was higher than that by basilic vein（ 13. 10%） and brachial vein（15. 15%）. The misplacement rate by left-sided veins access was higher than that by right-sided veins. The misplacement rate by using double-lumen catheters（27. 50%） was higher than that by using single-lumen catheters（11. 68%）. All misplacement of catheter tips were adjusted to the right place,except for 1 case of catheter withdrawing under the digital subtraction angiography（DSA）. Conclusion Nurses should carry out the comprehensive assessment of patients before placing the high pressure resistant injectable PICC. It is also helpful to reduce the occurrence of catheter misplacement by adjusting patients＇ position and enhancing the puncture skills of nurses.