体位辅助器的设计及在新生儿PICC尖端定位中的应用

Application of positioning aids in positioning the tip of PICC in neonates

目的评价自行设计的体位辅助器在新生儿PICC尖端定位中的应用效果。方法将浙江省某三级甲等医院新生儿科2018年1月—2020年12月PICC置管的247例新生儿作为试验组,2016年1月—2017年12月PICC置管的180例新生儿为对照组。两组在PICC穿刺时采用静脉内心电图引导尖端定位,成功固定后X线验证尖端位置,定位时试验组均采用体位辅助器固定体位,对照组采用新生儿标准姿势。比较两组置管穿刺中首次尖端定位成功率、置管定位时间、X线定位异位发生率。结果试验组置管穿刺中首次尖端定位成功232例(93.9%),高于对照组144例(80.0%);试验组置管穿刺中定位所需时间为(3.06±0.31)min,低于对照组(5.33±1.23)min,差异具有统计学意义(P<0.05);试验组置管X线定位异位发生率(5.67%)低于对照组(13.89%)。结论采用体位辅助器有助于提高新生儿静脉内心电图与X线定位结果的准确性,提高护士的工作效率,减少新生儿PICC异位及X线暴露。

Objective To evaluate the application effect of self-designed positioning aids in neonatal PICC tip localization.Methods 247 neonates with PICC catheterize from January 2018 to December 2020 in the neonatal department of a tertiary hospital in Zhejiang Province were selected as the experimental group,and 180 neonates with PICC catheterize from January 2016 to December 2017 were selected as the control group.During PICC puncture,intravenous electrocardiogram was used to guide tip positioning in both groups,and the position of the tip was verified by X-ray after successful fixation.During positioning,positioning aids were used in the experimental group to fix the position,and the standard neonatal position was used in the control group.The success rate of the first tip localization,the time of catheterization localization and the incidence of ectopic in X-ray verification were com pared between the two groups.Results In the experimental group,232 cases(93.9%)were successfully located for the first time,which was significantly higher than 144 cases(80.0%)in the control group.The positioning time of the expe-rimental group was(3.06±0.31)min,which was lower than that of the control group(5.33±1.23)min,and the difference was statistically significant(P<0.05).The incidence of ectopic location in experimental group(5.67%)was significantly lower than that in control group(13.89%).Conclusion The use of positioning aids can improve the accuracy of ECG positioning and X-ray positioning results,improve the work efficiency of nurses,and reduce PICC ectopic and X-ray exposure in children.