两种穿刺方法在超声导管头端定位下行儿童PICC置管中的应用

Access of peripherally inserted central catheter to children under ultrasonic tip positioning by different puncture techniques

目的:比较两种外周静脉穿刺方法在儿童经外周静脉置入中心静脉导管(PICC)中的效果及探讨在超声心动图辅助导管头端定位下行儿童PICC置管术的临床价值。方法:选择60例行PICC置管术患儿,随机分为观察组与对照组,每组各30例。观察组(男18例,女12例)经外周静脉(贵要静脉、肘正中静脉、头静脉)穿刺采用超声血管定位下血管穿刺方法,对照组(男16例,女14例)外周静脉穿刺采用盲穿方法。比较两组患儿外周静脉一次穿刺成功率、贵要静脉选择率、外周静脉穿刺时间、置管时间、置管中、后相关并发症发生率。结果:和对照组相比,观察组外周静脉一次穿刺成功率高(93.3%),贵要静脉穿刺选择率高(90.0%),外周静脉穿刺时间及总的PICC置管时间短,穿刺点渗血及静脉炎的发生率低(P<0.05)。结论:超声血管定位联合超声心动图辅助导管头端定位行儿童PICC置管术操作方便,能够提高一次穿刺、置管成功率,缩短操作时间,减少并发症,值得在临床推广。

Objective: To compare the efficacies two different puncture techniques for access of peripherally inserted central catheter(PICC) to children under the echocardiography monitoring. Methods :Sixty children undergoing PICC catheterization were equally randomized into observational group(18 boys and 12 girls) and control group(16 boys and 14 girls).Children in the observational group received PICC (basilic vein,median elbow vein,cephalic vein) under the echocardiography monitoring,and those in the control group were managed with blind puncturing via peripheral veins.Then the two groups were compared regarding the success rate of primary puncture of peripheral vein,selection rate of basilic vein,puncture time,and incidence of complications during and after catheterization. Results :The observational group had higher successful puncturing rate(93.3%) and more involvement of basilica vein (90.0%),yet reduced puncturing time and total PICC positioning and lower incidences of bleeding at the puncturing site and phlebitis as compared with the control group P< 0.05). Conclusion :PICC access in children under the echocardiography monitoring may be widely recommended in clinic for the easy performance,higher successful rate of primary puncture of the peripheral vein,reduced operative time and complications.