超声引导外周置入中心静脉导管失败的5年回顾性研究

Failure in ultrasound-guided PICC placement:A five-year retrospective study

目的探讨超声引导外周置入中心静脉导管(PICC)失败的原因及对策,提高PICC置管成功率。方法法选择2015年1月至2019年12月在青岛市市立医院接受超声引导PICC中置管失败患者32例,其中男性16例,女性16例;年龄43~85岁,平均年龄60.12岁;身体质量指数(BMI)16.55~31.26 kg/m^(2),平均BMI 22.56 kg/m^(2);恶性肿瘤32例,消化系统疾病12例,血管疾病8例,高血压5例,心脏病4例,糖尿病2例;置管原因,化学治疗19例(59.4%),静脉营养15例(46.9%);病变位置,颈胸部18例(56.3%),其他部位14例(43.7%);既往相关治疗,肿瘤切除21例(65.6%),放化疗19例(59.4%)。置管失败后移至介入手术室接受数字减影血管造影(DSA)辅助PICC复位/重置者。统计PICC相关指标。评估超声引导PICC失败原因,并分析失败原因与其他指标[年龄、性别、身体质量指数、血管病史、病变位置(颈胸部)、既往相关治疗、侧别和穿刺靶静脉]的相关性。结果左臂置入失败占56.3%(18/32)。穿刺贵要静脉者占65.6%(21/32),多于头静脉和肱静脉(P<0.001)。并发损伤仅为轻度痉挛或少量血栓占12.5%(4/32)。导管异位是置管失败主要原因占84.4%(27/32)。腋静脉最易发生异位(46.9%),贵要静脉(12.5%)、颈内静脉(9.38%)亦较常见。在DSA辅助下全部病例均复位/重置成功。导管异位与年龄、性别、BMI、血管病史、病变位置(颈胸部)、既往相关治疗、侧别和穿刺靶静脉指标均无显著相关性(P>0.05)。结论导管异位是超声引导PICC失败的首要原因,主要为血管变异所致。DSA辅助复位技术是解决超声引导PICC失败的有效方法,可显著提高置管成功率。

Objective To explore the causes and countermeasures of failure in ultrasound(US)-guided peripherally inserted central catheter(PICC),and elevated the success rate of PICC placement.Methods From January 2015 to December 2019,a total of 32 patients with failed placement in ultrasound-guided PICC were enrolled,which included 16 males and 16 females,aged 43-85 years old with mean age of 60.12 years old;body mass index(BMI)was 16.55-31.26 kg/m^(2) with mean BMI of 22.56 kg/m^(2).There were 32 cases of malignant tumor,12 of digestive system disease,8 of vascular disease,5 of hypertension,4 of heart disease and 2 of diabetes.The reason of placement were chemotherapy in 19 cases(59.4%)and intravenous nu-trition in 15(46.9%).The lesion was located at cervicothorax in 18 cases(56.3%),and at other parts in 14(43.7%).Tumor resection was performed in 21 cases(65.6%)and chemoradiotherapy in 19(59.4%).After failure placement,all of them were transferred to interventional operating room for digital subtraction angiography(DSA)to assist PICC reset/reset.The PICC-relat-ed indicators were counted to evaluate causes of ultrasound-guided PICC failure,and correlation between causes of failure and other indicators[age,gender,BMI,vascular history,lesion location(cervicothorax),previous related treatment,side and puncture target vein]was analyzed.Results The failure rate of left arm placement was 56.3%(18/32).The puncture of basilic vein ac-counted for 65.6%(21/32),which was more than cephalic vein and brachial vein(P<0.001).The complicated injury with only mild spasm or small amount of thrombosis was 12.5%(4/32).The catheter misplacement was the main cause of catheter failure(84.4%,27/32).The axillary vein was the most displacement site(46.9%),the basilic vein(12.5%)and internal jugular vein(9.38%)were also common.All of them were replacement successfully with assistance of DSA.There was no significant corre-lation between catheter misplacement and age,gender,BMI,vascular history,lesion location(cervicothorax),previous related treatment,side and puncture target vein index(P>0.05).Conclusion It is demonstrated that catheter misplacement is the pri-mary cause of US-guided PICC failure,mainly due to vascular variation.DSA-assisted reduction technique is an effective method to solve the failure of US-guided PICC,which significantly improves the success rate of placement.