针尖微调提高首优静脉穿刺成功率在手臂输液港植入术中应用

Needle tip fine-tuning to improve the success rate of the first superior venipuncture in the operation of arm port planting

目的手臂输液港作为一种新型静脉通道工具已逐渐用于患者化疗,静脉穿刺是其植入过程中的重要环节。本研究探讨手臂输液港植入术中针尖微调提高首优静脉穿刺成功率应用效果。方法选取2017-01-01-2018-04-30南京医科大学第一附属医院乳腺病科收治的245例放置手臂输液港的乳腺癌化疗患者作为研究对象。2017-01-01-2017-11-31收治的129例患者作为对照组,首优静脉穿刺后导丝无法按要求长度送入血管时拔针选择次优静脉穿刺;2017-12-01-2018-04-30收治的116例患者作为观察组,首优静脉穿刺后导丝无法按要求长度送入血管时不拔针在B超引导下微调针尖,观察针尖与血管横轴面关系,若针尖靠近管壁上方则针尖下移,反之上移,尽量保证针尖在血管正中间,针芯重新置入导丝。比较两组手臂输液港放置成功率、首优静脉穿刺成功率、穿刺时疼痛评分、导管放置成功耗时和手臂输液港相关并发症等指标。结果两组手臂输液港放置成功率均为100%;观察组首优静脉置管成功率为93.10%,高于对照组(82.17%),差异有统计学意义,χ2=6.606,P=0.012;观察组患者疼痛评分为(1.21±0.06)分,低于对照组(1.39±0.06)分,差异有统计学意义,t=2.065,P=0.020;观察组导管放置成功耗时为(23.94±0.27)min,低于对照组(24.67±0.20)min,差异有统计学意义,t=2.174,P=0.015;两组并发症比较差异无统计学意义,t=3.357,P=0.124。结论针尖微调可有效提高首优静脉穿刺成功率,减轻患者疼痛,缩短穿刺时间,值得在手臂输液港植入术中推广应用。

OBJECTIVE As a new type of venous channel tool,arm port has been gradually used in patients with chemotherapy.Venipuncture is a very important step in the process of arm port implantation.This report is to study the effect of needle tip fine-tuning on the success rate of the first superior venipuncture in the implantation of an arm port.METHODS From January 1,2017 to April 30,2018,245 cases of breast cancer patients with arm port were selected as research subjects who were admitted in Department of Breast Disease,the First Affiliated Hospital of Nanjing Medical University.From January 1,2017 to November 31st,129 patients were assigned to a control group.After the first superior venipuncture,the guide wire was sent to the vessel without the required length to select the inferior venipuncture.From January 12,2017 to January 20,2013,116 patients were treated as observation group.After the first venous puncture?the guide wire could not be delivered to the blood vessel according to the required length.The needle tip was finely adjusted under the guidance of B-ultrasound,and the needle tip and blood vessel were observed.In the horizontal axis relationship,if the needle tip was close to the tube wall,the needle tip moved downward.If the needle tip was near the tube wall,the needle tip moved up.Try to ensure that the needle tip was in the middle of the blood vessel and the needle core was reinserted into the guide wire.The success rate of the arm port placement and first superior venipuncture,the score of pain during the puncture,the time of successful catheter placement,and arm port related complications were compared.RESULTS The success rate of the two groups of arm infusion port was 100%;the success rate of the first-inferior venous catheter was 93.10%in the observation group,which was higher than that of the control group(82.17%).The difference was statistically significant,χ^2=6.606,P=0.012;in observation group the patient's pain score[(1.21±0.06)points]was lower than that of the control group[(1.39±0.06)points],the difference was statistically significant,t=2.065,P=0.020;in the observation group catheter was placed into power consumption[(23.94±0.27)min]and which was lower than that of the control group[(24.67±0.20)min],the difference was statistically significant,t=2.174,P=0.015;there was no significant difference in complications between the two groups,t=3.357,P=0.124.CONCLUSIONS The micro adjustment of needle tip can improve the success rate of venipuncture,reduce the pain of the patients,and shorten the time of puncture.It is worth popularizing in the implantation of the arm port.