心脏移植术后患者PICC送管困难原因分析及对策

Analysis and countermeasures of difficulty in PICC delivery of patients after heart transplanta⁃tion

目的探讨心脏移植术后患者置入耐高压双腔的经外周穿刺中心静脉置管(PICC)出现送管困难的原因。方法回顾分析5例心脏移植术后置入耐高压双腔PICC时发生送管困难的原因及对策。结果23例心脏移植术后置管患者中出现送管困难5例。其中2例送管困难原因为静脉瘢痕致狭窄、畸形,1例为静脉解剖异常,移植术中曾做左头臂静脉离断;1例为体位因素、导管因素或血流动力学因素;1例未查找出具体原因。结论对于心脏移植术后患者置管出现送管困难,除考虑患者的静脉因素、体位摆放情况、导管本身材质情况外,不能忽视术后患者血流动力学的改变。为减少送管困难的发生,应充分做好置管前静脉的评估,排除畸形、狭窄。因此,了解患者的外伤史、手术史、术中情况,查阅既往CT结果尤为重要。

Objective To investigate the reasons for the difficulty in delivery of a high⁃pressure⁃resis⁃tant dual⁃chamber PICC in patients after heart transplantation,and to provide corresponding countermea⁃sures to improve the success rate of delivery.Methods A retrospective analysis of the causes and coun⁃termeasures of difficulty in delivery of a high⁃pressure PICC after heart transplantation.Results Five of 23 patients with catheterization after heart transplantation had difficulty in delivery.Among them,two cases of difficulty in delivery were caused by stenosis and malformation caused by venous scars,one case was abnormal vein anatomy,and left brachiocephalic vein was cut during transplantation;one case was due to positional factors or catheter factors or hemodynamic factors;one case was not found for specific reasons.Conclusion In the case of difficult tube delivery in post⁃transplant cardiac patients,in ad⁃dition to considering the patient′s venous condition,body position placement,and the material of the catheter itself,the hemodynamic changes in the postoperative patient should not be ignored.In order to reduce the occurrence of difficult tube delivery,pre⁃tubing venous assessment should be done adequately to exclude malformations and stenosis.Therefore,it is particularly important to know the patient′s trauma history,surgical history,intraoperative conditions,and to review previous CT findings.