导管漂移技术在预防PICC置管中颈内静脉异位的应用与研究

The application and research of catheter drift technique in preventing ectopic jugular vein in PICC catheterization

目的:探讨导管漂移技术在预防PICC置管过程中颈内静脉异位的临床实践价值。方法:将拟行PICC置管的100例患者随机分为对照组49例和实验组51例,对照组予以常规置管,即送管过程中适时的指导患者转头压肩,特殊患者请助手按压颈部以阻断颈部静脉后继续将导管送至测量长度;实验组采用导管漂移技术置管,即当导管送至锁骨中点前开始撤退约4cm导丝后继续将导管送至测量长度,置管过程无需转头压肩或压迫颈部以阻断颈部静脉;观察比较两组患者PICC置管过程中导管颈内静脉异位情况及置管过程舒适度。结果:对照组发生导管异位7例,均为颈内静脉异位,实验组发生导管异位,差异有统计学意义(P<0.05),两组患者置管舒适度比较结果显示“护士置管时,我需要保持下颌紧贴锁骨的动作很长,觉得不舒服”这个条目实验组优于对照组差异有统计学意义(P<0.01)。结论:PICC置管过程中采取导管漂移技术能安全、有效地预防导管异位且置管过程患者舒适度高,具有较大的临床推广价值。

Objective:To explore the clinical value of catheter drift technique in preventing ectopic internal jugular vein during PICC catheterization.Methods:100 patients who planned to have PICC catheterization were randomly divided into the control group(49 cases)and the experimental group(51 cases).The control group was given routine catheterization,that is,in the process of catheterization,timely guiding the patients to turn their head and press their shoulders.In the experimental group,catheter drift technique was used for catheterization,that is,when the catheter was sent to the midpoint of the clavicle,the catheter was withdrawn about 4cm before the catheter was sent to the midpoint of the clavicle,and then the catheter was sent to the measured length.In the process of catheterization,there was no need to turn the head to press the shoulder or press the neck to block the neck vein.The ectopic status of internal jugular vein catheter and the comfort level of catheterization during PICC catheterization between the two groups were observed and compared.Results:7 cases of catheter heterotopia occurred in the control group,with ectopic internal jugular vein,while there was no catheter heterotopia in the experimental group,the difference statistically significant(P<0.05).In the two groups,catheter comfort comparison results show that"when the nurse?put the catheter in,I need to keep my lower jaw against the collarbone for a long time,so I don't feel well"for this item the experimental group was better than that of the control group,and the difference was statistically significant(P<0.01).Conclusion:catheter drift technique during PICC catheterization can safely and effectively prevent ectopic catheterization to the internal jugular vein,and the comfort level of patients during catheterization is high,which is worthy of clinical promotion and application.