新生儿经外周置入中心静脉导管尖端位置超声定位技术的改进

Improvement of ultrasound positioning technique for peripherally inserted central catheter tip position in neonates

目的探讨并提供新生儿经外周置入中心静脉导管(PICC)导管尖端位置超声定位技术的新方法。方法对2019年1月至2021年4月北京市朝阳区妇幼保健院新生儿重症监护病房(NICU)住院、接受PICC置管并采用改进超声技术进行PICC尖端位置定位的174例患儿的相关资料进行回顾性分析,探讨改进定位技术的准确性、可靠性及时效性。其中经下肢置管时,在置管前先使用超声监测血管走形以选择最适宜置管的血管,然后进行置管。结果1.在174例采用新方法定位的PICC置管患儿中,一次插管准确达理想位置者172例,即一次成功率为98.9%。2例(1.1%)虽未达到理想位置,但在超声引导下得以矫正后达到理想位置。2.下肢静脉置管,在经超声引导确定血管后,一次成功率100.0%;置管耗时(31.50±2.58)min,较技术改进前置管耗时[(56.10±5.30)min]显著缩短(t=46.84,P<0.001),采用超声引导后一次置管总成功率提高7.0%,下肢静脉一次性置管成功率提高17.5%。3.发生并发症(导管尖端血栓形成)1例,发生率为0.57%;较技术改进前(2.70%,2/112例)下降了79.00%。结论采用改进的超声定位技术,使操作更加便捷、简单、快速、准确,一次性操作成功率更高,置管时间显著缩短,值得在临床应用。

Objective To explore a new method of ultrasound-guided positioning of the tip of neonatal peri-pherally inserted central catheter(PICC).Methods Clinical data of 174 newborn infants hospitalized in the Neonatal Intensive Care Unit(NICU)of Beijing Chaoyang District Maternal and Child Healthcare Hospital from January 2019 to April 2021 receiving PICC catheter intubated under the guidance of ultrasound for positioning the tip were retrospectively analyzed to explore the accuracy,reliability and feasibility of the improved ultrasound-guided positioning technique.Before lower extremity catheterization,ultrasound was performed to monitor the vascular pattern and catheterization of PICC was conducted under the guidance of ultrasound.Results (1)Among 174 infants intubated with ultrasound-guided positioning of the PICC tip,172(98.9%)of them had the ideal position,and 2(1.1%)did not achieve the ideal position,but achieved the ideal position after ultrasound-guided correction.(2)Lower extremity venous catheterization was successfully performed at 100.0%after ultrasound-guided monitoring of blood vessels.The time-consuming of lower extremity venous catheterization was significantly shorter than that of the previous method[(31.50±2.58)min vs.(56.10±5.30 min)](t=46.84,P<0.001).The total success rate of catheterization and catheterization of lower limb vein increased by 7.0%and 17.5%,respectively.(3)Only 1(0.57%)case reported the complication of catheter tip thrombosis,the complication rate of which decreased from the previous 79.00%to 2.70%(2/112 cases).Conclusions The improved ultrasound-guided positioning of the PICC tip is convenient,simple,faster and accurate,which enhances the success rate and is worthy to be applied in clinical practice.