PICC隧道针及皮下隧道建立方法的改良及应用

Improvement and application of PICC subcutaneous tunnel needle

目的改良PICC隧道针及皮下隧道建立方法,并探讨其应用效果。方法改良后的隧道针包含针柄、针芯和针头3个部分,针头呈圆弧倒角结构,可稳定连接导管。采用便利抽样法,选取2019年11月—2021年1月广东省某三级甲等医院收治的97例肿瘤患者作为试验组,采用改良后的隧道针,建立与穿刺静脉呈30°~45°的皮下隧道,在超声引导下置入PICC。选取2018年8月—2019年10月收治的115例肿瘤患者作为对照组,直接在超声引导下置入PICC。比较两组置管术中出血量和疼痛评分,置管后24 h穿刺点渗血渗液发生率,置管后1个月内导管脱出率、过敏性皮炎发生率、静脉炎发生率,置管后1个月时手臂舒适度。结果试验组置管术中出血量及疼痛评分高于对照组,差异具有统计学意义(P<0.001);试验组置管后24 h内穿刺点渗血渗液发生率、置管后1个月内导管脱出率及过敏性皮炎发生率低于对照组,差异具有统计学意义(P<0.05);两组置管后1个月内静脉炎发生率比较,差异无统计学意义(P=0.484);试验组置管后1个月时手臂舒适度高于对照组,差异具有统计学意义(P<0.001)。结论使用改良后的PICC隧道针及皮下隧道建立方法有助于降低患者穿刺点渗血渗液、导管脱出、过敏性皮炎的发生率,提高其手臂舒适度,且不增加静脉炎的发生率。

Objective To improve the subcutaneous tunnel needle and the method of establishing subcutaneous tunnel for PICC,and to explore its application effect.Methods The improved subcutaneous tunnel needle consists of 3 parts,including needle handle,solid needle core and needle head.The needle head has an arc chamfering structure,which can realize the stable connection between the catheter and the needle head.Patrticipants from a tertiary hospital in Guangdong Province were selected by convenience sampling.97 tumor patients from November 2019 to January 2021 were allocated into an experimental group,while 115 tumor patients from August 2018 to October 2019 were in the control group.The experimental group received the improved subcutaneous tunnel needle via a 30°~45°degree with venipuncture for PICC catheterization under B-ultrasound,while the control group was treated with Seldinger technique for PICC catheterization under B-ultrasound.The amount of bleeding and the highest pain score,the incidence of bleeding and exudation at the puncture point 24 hours after the operation,the incidence of catheter prolapse within a month after the operation,the incidence of allergic dermatitis,the incidence of mechanical phlebitis,and the comfort of the patients’arms at a month after the operation were compared between the 2 groups.Results The amount of bleeding and the highest pain score in the experimental group were higher than those in the control group,and the difference was statistically significant(P<0.001).The incidence of bleeding and exudation at the puncture point 24 hours after the operation,the incidence of catheter prolapse within a month after operation and the incidence of allergic dermatitis in the experimental group were lower than those in the control group(P<0.05),but the incidence of mechanical phlebitis within a month after operation in the 2 groups was not statistically significant(P=0.484);a month after operation,the arm comfort of the experimental group was higher than that of the control group,and the difference was statistically significant(P<0.001).Conclusion The improved subcutaneous tunnel needle and subcutaneous tunnel establishment method can reduce the incidence of blood and fluid leakage,catheter prolapse and allergic dermatitis at the puncture point,and improve the postoperative arm comfort of patients,but they could not increase the incidence of mechanical phlebitis.