棉布条颈部按压法预防PICC导管异位入颈内静脉的效果观察

Effects of improved intubation in preventing accidental PICC intubation into internal jugular vein

目的探讨改良按压法预防经外周静脉置入中心静脉导管(peripherally inserted central venous catheter,PICC)导管异位入颈内静脉的效果。方法采用随机数字表法将2014年8月-2016年5月在本科室会诊行PICC置管患者180例分为对照组和观察组,每组各90例。对照组采用按传统的偏头法,观察组根据患者的颈部与肩部空隙的大小情况制作合适的按压布条,当导管头端送至15cm时将布条放置在颈内静脉的位置,助手将制作的布条在颈内静脉的位置向内、向下按压至最底部,嘱患者偏头并同时用下巴压紧布条。比较两组患者导管异位入颈内静脉的发生率。结果观察组导管异位入颈内静脉的发生率明显低于对照组,两组比较,差异有统计学意义(11.11%vs 3.33%,P<0.05)。结论 PICC置管时使用布条按压颈内静脉的方法能降低导管异位入颈内静脉的发生率,值得临床推广应用。

Objective To explore the effects of improved intubation in preventing accidental PICC intubation into internal jugular vein.Methods 180 patients with PICC were randomly divided into two groups:control and trial group.In the control group,the routine intubation with head sided was performed,and in the trial group,the intubation was done with gauze of different size according to the space between the neck and shoulder pressed downward and inward at the spot of internal jugular vein to the bottom and meanwhile having the patient turn the head aside and press the gauze with their draw when the tube head was inserted 15 cm deep.The two groups were compared in terms of the rate of PICC intubation into internal jugular vein.Result The incidence of catheterization by accident into the internal jugular veinin the trial group was significantly lower than that of the control group(P<0.05).Conclusion The intubation with gauze pressed at the internal jugular vein can obviously reduce the incidence of catheterization by accident into the internal jugular vein.This method is worthy of clinical popularization and application.