中长导管在血管加压药治疗中的临床应用研究

Clinical application study of midline catheter in vasopressor therapy

目的评价经中长导管输注血管加压药的安全性及必要性。方法采用便利抽样法进行对照研究,选择2022年6月至2023年6月山西省汾阳医院呼吸重症监护病房(RICU)收治的88例使用血管加压药的成人患者作为研究对象。将2022年6月至12月经外周中心静脉导管(PICC)输注血管加压药的44例患者纳入PICC组,2023年1月至6月经中长导管输注血管加压药的44例患者纳入中长导管组。两组患者均采用B超引导下改良赛丁格技术穿刺置管,均选择肘窝与腋窝之间中间1/3部位,所用导管型号均为5 Fr双腔。放置导管后,对患者进行随访,直到移除导管、死亡或30 d(以先到者为准)。以美国输液护理协会(INS)修订的《静脉治疗实践标准》为标准,结合前期预试验结果,对两组患者导管不全堵塞、导管相关性血流感染(CRBSI)、静脉炎、拔管时导管内血栓、穿刺点发红(但无感染)、穿刺点渗液进行安全性评价。结果两组患者性别、年龄、导管留置时间、原发病差异均无统计学意义,说明两组基线资料均衡,有可比性。两组患者置管后观察期间均无CRBSI或静脉炎发生;两组各有1例患者发生穿刺点渗液〔均为2.27%(1/44)〕;中长导管组导管不全堵塞、拔管时导管内血栓、穿刺点发红(但无感染)的发生率均低于PICC组〔导管不全堵塞:4.55%(2/44)比6.82%(3/44),拔管时导管内血栓:0%(0/44)比2.27%(1/44),穿刺点发红(但无感染):0%(0/44)比4.55%(2/44)〕,总体发生率明显低于PICC组〔6.82%(3/44)比15.91%(7/44),P<0.01〕。结论经中长导管输注血管加压药可减少RICU患者导管相关并发症的发生,降低中心静脉插管率,减轻患者的经济负担。

Objective To evaluate the safety and necessity of vasopressor infusion through midline catheter.Methods A convenient sampling method was used for a controlled study.A total of 88 adult patients who used vasopressors admitted to respiratory intensive care unit(RICU)of Fenyang Hospital in Shanxi Province from June 2022 to June 2023 were enrolled as the research subjects.A total of 44 patients who were infused with vasopressors through peripherally inserted central venous catheter(PICC)from June to December 2022 were enrolled as the PICC group,and 44 patients who were infused with vasopressors through midline catheter from January to June 2023 were enrolled as the midline catheter group.Both groups of patients used the modified Sedinger technique under the guidance of B-ultrasound for puncture and catheter placement.The middle 1/3 site between the cubital fossa and the axilla was selected.The catheters were 5 Fr double lumen.After catheter placement,the patients were followed until catheter removal,death,or 30 days(whichever came first).Based on the Infusion therapy standards of practice revised by American Infusion Nurses Society(INS),and combined with the results of previous preliminary tests,the safety evaluation was conducted on incomplete catheter obstruction,catheter-related bloodstream infection(CRBSI),phlebitis,thrombus within the catheter during extubation,redness of the puncture site(but no infection),and exudation of the puncture site in the two groups of patients.Results There were no statistical differences in gender,age,catheter indwelling time,and primary disease between the two groups,indicating that the baseline data of the two groups were balanced and comparable.No CRBSI or phlebitis occurred in both groups during the observation period after catheterization.One patient in both groups had exudation at the puncture site[both were 2.27%(1/44)].Compared with the PICC group,the incidence of incomplete catheter obstruction,thrombus within the catheter during extubation,redness of the puncture site(but no infection)in the midline catheter group were lowered[incomplete catheter obstruction:4.55%(2/44)vs.6.82%(3/44),thrombus within the catheter during extubation:0%(0/44)vs.2.27%(1/44),redness of the puncture site(but no infection):0%(0/44)vs.4.55%(2/44)],the overall incidence was significantly decreased[6.82%(3/44)vs.15.91%(7/44),P<0.01].Conclusion Administering vasopressor through a midline catheter can reduce the incidence of catheter-related complications,decrease the rate of central venous catheterization,and reduce the financial burden on patients.