DSA引导在儿科PICC困难置管中的应用体会

Application of DSA guidance in pediatric patients with difficult PICC catheterization

目的总结6例PICC置管困难患儿数字减影血管造影机(DSA)引导下介入置管的应用体会经验。方法回顾性分析自2017年11月至2019年11月我院小儿外科PICC置管过程中出现导管推送困难的病例。结果本组6例置管困难患儿,其中5例在DSA引导下置管成功,1例经静脉造影明确导管推送困难原因为头臂静脉闭塞,更换为下肢大隐静脉穿刺后置管成功。术后随访7 d,6例患儿均无术中并发症及中期并发症。结论对于儿童PICC置管过程中推送导管困难的情况,选择DSA设备引导下送管或实施静脉造影,能正确调整儿童PICC头端异位或明确原因,可解决不同原因引起的送管困难。

Objective To summarize the experience of 6 pediatric patients with PICC catheterization difficulties under DSA guidance.Methods The data of 6 pediatric patients with catheterization difficulties during the insertion of PICC in our hospital from November 2017 to November 2019 were retrospectively analyzed,and the application methods of DSA devices in the pediatric PICC catheterization difficulties were summarized.Results Among the 6 cases of pediatric patients with PICC catheterization difficulties,5 of which were successfully catheterized under DSA guidance.and 1 case had difficulty in catheter pushing due to brachiocephalic vein cava occlusion by venography,which was replaced by lower extremity great saphenous vein puncture.There were no intraoperative complications or intermediate complications in 6 cases after 7 days follow-up.Conclusions For children with difficulties in PICC catheterization,choosing DSA devices to guide catheterization or performing venous angiography can correctly adjust the ectopic location of the PICC tip or clarify the causes,and solve the catheterization difficulties caused by different reasons.