床旁超声动态监测早产儿脐静脉置管位置的研究

Study on dynamic monitoring of tip migration of umbilical vein catheterization in premature infants by point-of-care ultrasound

目的探讨床旁超声动态监测早产儿脐静脉置管(umbilical venous catheterization,UVC)后导管尖端移动情况及其临床意义。方法选择河北省衡水市人民医院新生儿科2022年5月至2023年8月收治并行UVC的早产儿进行前瞻性研究。应用床旁超声动态监测UVC导管尖端位置,目标区域为下腔静脉和右心房(inferior vena cava and right atrium,IVC-RA)交界处。置管后2 h内确认尖端是否位于目标区域内,并测量其与IVC-RA交界处的距离;置管后第3天、第5天分别测量尖端距上次定位的距离。根据尖端相对于上次定位的移动方向,将第3天和第5天监测结果分别分为向内移动组(移动距离用正数表示)和向外移动组(移动距离用负数表示)。位置过浅的导管下次不再监测。比较第3天和第5天各组移动距离的差异,记录导管相关并发症情况。结果在胸部X线验证下,95例早产儿成功留置UVC。置管后2 h内,床旁超声显示59例导管尖端位于目标区域(62.1%),经调整后,增至79例。第3天、第5天导管移动率分别为67.5%(52/77)、35.3%(24/68);因移动引发的错位率分别为17.3%(9/52)、16.7%(4/24)。向内移动组置管后第3天、第5天移动距离差异无统计学意义(P>0.05),向外移动组第5天移动距离比第3天明显[-3.20(-4.70,-3.00)mm比-2.80(-3.20,-2.20)mm],差异有统计学意义(P<0.05)。监测期间,共13例发生错位,其中7例发生导管相关并发症。结论应用床旁超声可动态监测UVC尖端位置。导管尖端在置管后可能发生移动,并可能存在一定的规律,导管尖端错位易引起并发症。有必要使用床旁超声动态监测导管尖端位置,减少并发症的发生。

Objective To study the movement of the catheter tip after umbilical venous catheterization(UVC)in preterm infants and its clinical significance.Methods A prospective study was conducted on preterm infants who underwent UVC from May 2022 to August 2023 in the neonatal department of Hengshui People's Hospital,Hebei Province.Point-of-care ultrasound(POCUS)was employed for dynamically monitoring of the UVC tip position,with the target area being from the inferior vena cava(IVC)to the junction of IVC and the right atrium(IVC-RA).Within 2 hours post-catheterization,the position of the tip was confirmed to be within the target area,and the distance from the IVC-RA junction was measured.The distance was also measured on the 3rd and 5th days after catheterization.Based on the movement direction of the tip relative to the previous position,the results on the 3rd and 5th days were divided into inward movement group(positive movement distance)and outward movement group(negative movement distance).Catheters positioned too shallow were excluded from subsequent monitoring.The differences in movement distances on the 3rd and 5th days were compared,and catheter-related complications were recorded.Results Under X-ray verification,UVC was successfully placed in 95 preterm infants.Within 2 h after catheterization,POCUS revealed that the catheter tip was in the target area in 59 cases(62.1%),which increased to 79 cases after adjustment.The catheter movement rates on the 3rd and 5th days were 67.5%(52/77)and 35.3%(24/68),respectively,with displacement rates caused by movement being 17.3%(9/52)and 16.7%(4/24).There was no statistically significant difference in the movement distances on the 3rd and 5th days in the inward movement group(P>0.05).In the outward movement group,the movement distance on the 5th day[-3.20(-4.70,-3.00)mm]was significantly greater than on the 3rd day[-2.80(-3.20,-2.20)mm],with a statistically significant difference(P<0.05).During the monitoring period,13 cases of displacement occurred,with 7 cases resulting in catheter-related complications.Conclusions POCUS can dynamically monitoring the UVC tip position.The position of the catheter tip may undergo post-placement movement,and potentially following certain patterns.Displacement of the catheter tip can give rise to complications,underscourin the necessity of using POCUS for dynamic monitoring of the catheter tip position to reduce the incidence of complications.