纤维蛋白鞘形成导致患儿外周静脉置入中心静脉导管拔管困难的临床分析

Analysis of reasons for the difficulty in extubation caused by the formation of PICC fibrin sheath in children

目的探讨患儿外周静脉置入中心静脉导管(PICC)拔管困难的原因及应对办法。方法回顾性分析2015年3月至2016年3月在本中心进行的237例患者PICC置入的临床资料。按PICC留置时间共分为4组,统计PICC纤维蛋白鞘发生率,拔管困难发生率,以及D-二聚体水平差异。结果237例的PICC纤维蛋白鞘发生率100%;PICC置入拔管困难发生率3.38%,均发生于PICC留置的200天后,4组不同时间段拔管困难情况差异有统计学意义(P=0.035);4个PICC留置时间组间D-二聚体水平差异无统计学意义(P=0.077)。结论 PICC拔管困难可能与置管时间有关,随着时间的推移PICC形成黏附更坚固的纤维蛋白鞘,拔管困难与PICC相关血栓形成无明显相关性。目前应对PICC拔管困难的手段较多,但较被动,缺乏主动预防措施。

Objective To investigate and explore the cause and coping strategies of difficulty in decannulation of PICC in children. Methods The clinical data of 237 cases of PICC placement performed at our center from March 2015 to March 2016 were retrospectively analyzed. Patients were divided into four groups according to their PICC indwelling time. The incidence of PICC fibrin sheath formation, the incidence of difficulty in decannulation and the level of D-dimer were statistically analyzed. Results The incidence of PICC fibrin sheath formation in 237 cases was 100%, and there was no statistically significant difference among 4 groups. The incidence of difficulty in decannulation was 3.38%, which occurred no longer than200 days after PICC placement. The difference was statistically significant. No significant difference of the level of D-dimer was found in each group. Conclusions Catheterization time might be responsible for PICC difficulty in decannulation. PICC formed a more robust fibrinogen sheaths that adhere to vein in the process of time. There is no correlation between PICC-related thrombosis and PICC difficulty in decannulation. At present there have been many ways to deal with PICC difficulty in decannulation, but most of them are passive instead of proactive and preventative.