两种不同钝性分离法在超声引导下经外周静脉穿刺中心静脉导管置管的效果评价

Two Different Blunt Separation Methods for the Ultrasound-guided PICC Placement

目的探讨两种不同钝性分离法在超声引导下结合改良塞丁格技术经外周静脉穿刺中心静脉导管(peripherally inserted central catheters,PICC)置管的效果。方法 2018年1-2月,便利抽样法选取在浙江省人民医院专科门诊行PICC置管的140例患者为研究对象,根据随机数字表法将其分为观察组(70例)和对照组(70例)。观察组采用盲穿刺针外鞘与扩张器组装钝性分离,对照组采用可撕裂外鞘与扩张器组装钝性分离。比较两组一次送鞘成功率,置管后48h出血量及置管后7d内维护次数。结果观察组一次性送鞘成功率较对照组高(95.71%vs 84.29%),差异有统计学意义(P<0.05);观察组置管后48h穿刺点渗血纱布层数及置管后7d内换药次数均较对照组少(均P<0.001)。结论在超声引导下结合改良塞丁格PICC置管中,采用盲穿刺针外鞘与扩张器组装行钝性分离,可减少患者穿刺点渗血量及导管维护次数。

Objective To explore the effect of two different blunt separation methods on bleeding at puncture point for the ultrasound-guided peripherally inserted central catheters(PICC)placement.Methods From January to February 2018,140 cases of PICC patients were selected and divided by random number table into observation group and control group,with 70 cases in each group.The control group used the traditional puncture needle sheath and dilator to assemble blunt separation,while the observation group used the tearable sheath and dilator to assemble blunt separation.The one-time successful rate,the volume of bleeding within 48 hours and the times of maintenance within 7 days after insertion were compared between two groups.Results The one-time successful rate of insertion in the observation group was 95.71%,which was higher than that in the control group of 84.29%,the difference was statistically significant(P<0.05).The number of layers of bleeding gauze at puncture point within 48 hours and the number of maintenance times within 7 days after catheterization were observed,which were less in the observation group than those in the control group(P<0.001).Conclusions Traditional insertion needle sheath and expander in blunt separation is a safe way of protecting blood vessel in PICC catheterization and reduce the risk of bleeding and the times of catheter maintenance.