超声与腔内心电图引导44例危重症患儿PICC尖端定位的护理

Nursing care of critically ill children with PICC tip positioning guided by ultrasound and intracardiac electrogram

总结44例采用超声与腔内心电图进行PICC尖端定位的危重症患儿的护理经验。护理要点包括:置管前分段测量并记录导管内置长度;及时获取腔内心电图,观察P波变化;当导管置入长度接近预测长度时,立即采用超声心脏探头于患儿剑突下获取四腔心切面,根据推注生理盐水产生的不同超声征象间接引导导管尖端位于最佳位置。置管后首次胸部X线摄影显示导管尖端在位40例,导管尖端过深4例。

To summarize the nursing experience of 44 critically ill children with PICC catheter tip localization guided by ultrasound and intracardiac electrogram.The key points of nursing care included:measured and recorded the length of the catheter in sections before the catheter insertion;obtained the intracardiac electrogram in time and observed the change of P wave;when the insertion length of catheter reached to the predicted length,the phased array probe was used to obtain the four-chamber heart section under xiphoid,and indirectly guided the catheter tip in the optimal position according to the different ultrasonic signs produced by normal saline injection.After catheterization the first chest X-ray showed that the catheter tip was in optimal positions in 40 cases and the catheter tip was too deep in 4 cases.