多学科联合会诊1例老年高龄患者PICC拔管困难及护理体会

Multidisciplinary consultation with regards to the difficulty for removing peripherally inserted central catheters in a senior elderly patient

探讨老年高龄患者经外周静脉穿刺置入中心静脉导管(PICC)拔管困难的原因和护理对策。对1例老年高龄患者PICC拔管困难进行综合分析。导管头端黏附于上腔静脉壁、静脉解剖结构改变、反复牵拉导管至导管失去弹性是此患者拔管困难的主要原因。老年高龄群体有一些不同于普通患者群体的特点,如长期卧床、肢体失功、长期静脉高营养等特点,PICC使用期间应关注导管异常变化,及时请专科护士会诊,必要时联合多学科会诊解决问题,以避免因维护不当以及拔管操作不当导致的拔管困难以及因拔管失败造成的严重并发症。

To explore the causes and nursing strategies of peripherally inserted central cathe⁃ters(PICC)removal difficulty in senior elderly patients.A senior elderly patient with PICC diffi⁃culty for removing was analyzed comprehensively.The main reasons for the difficulty of removal were the adhesion of the catheter tip to the wall of superior vena cava,the change of anatomical structure of the vein and the loss of elasticity of the catheter after repeated pulling.The senior el⁃derly group has some characteristics different from the general patient group,such as long-term bed rest,limb loss,long-term intravenous parenteral nutrition and so on,During the use of PICC,attention should be paid to abnormal changes of catheter,consult with specialist nurses in time,and solve problems with multidisciplinary consultation when necessary,so as to avoid diffi⁃culties in removal caused by improper maintenance and improper removal operation and serious complications caused by removal failure.