PICC继发性导管异位的观察与处理

Spontaneous catheter migration of peripherally inserted central catheter:observation and management

目的分析经外周置入中心静脉导管(PICC)继发性异位的临床表现,并介绍异位的处理与结局,为临床PICC继发性导管异位的识别与处理提供参考。方法采用回顾性调查研究方法,以某三级甲等肿瘤专科医院血管通路护理门诊2015年至2017年134例PICC继发性导管异位作为研究对象,对异位患者一般资料、置管信息及异位情况(临床指征、导管尖端位置与形态、处理及结局)进行回顾性分析。结果导管反复回血、导管滑脱≥3 cm及持续导管功能障碍为导管异位的主要临床表现,且导管内反复回血能显著预测导管异位至同侧颈部静脉(χ~2=37.931,P<0.001)。颈部静脉(47.8%)是最常见的导管尖端异位部位,63例(47.0%)异位导管发生形态改变。导管调整方法主要包括快速冲管法(配合患者活动、深呼吸等)、拉出部分导管(同时持续检查导管功能)及DSA下复位。134例异位处理结果:74例(55.2%)调整成功,导管尖端仍位于上腔静脉;26例(19.4%)导管尖端调整至上腔静脉外,当作中长导管使用;34例(25.4%)因患者主动要求、调整失败或无治疗需求等拔管。结论护理人员应高度警惕PICC继发性导管异位的临床体征。导管异位需同时评估导管尖端位置与导管形态,患者意愿、治疗需求、导管以往维护情况及异位状况等是PICC继发性导管异位综合判断及处理的重要参考。

Objective To analyze the clinical manifestations of spontaneous catheter migration of peripherally inserted central catheter(PICC)and to introduce the management and outcome of catheter migration in order to provide reference for the recognition and treatment of this disorder.Methods A total of134 patients with spontaneous catheter migration after PICC,who were encountered at a vascular access nursing clinic of a certain gradeⅢA Specialized Cancer Hospital during the period from 2015 to 2017,were enrolled in this study.By using retrospective investigation and research method,the general information,the catheterization information and the situation of catheter migration,including clinical indications,location and shape of catheter tip,treatment and outcome,were retrospectively analyzed.Results Repeated blood returning in catheter,catheter slippage≥3 cm and persistent catheter dysfunction were the main clinical findings of spontaneous catheter migration after PICC.Repeated blood returning in catheter could well predict that the catheter tip was displaced into the ipsilateral cervical vein(χ~2=37.931,P<0.001),where was the most common place of catheter tip migration.Morphological change of displaced catheter was seen in 63 patients(47.02%).The catheter adjustment methods mainly included bolus injection of saline together with proper patient’s movement,deep breathing,etc.,pulling out part of catheter meanwhile continuously checking catheter function,and resetting catheter under DSA monitoring.The management results of catheter migration in 134 patients were as follows:the catheter was successfully adjusted to the correct position(the catheter tip being placed in the superior vena cava)in 74 patients(55.2%);the catheter tip was pulled back to subclavian vein in 26 patients(19.40%)and used as a medium-long catheter;retrieval of catheter had to be carried out in 34 patients(25.4%)due to patient’s own will,failure of adjustment,or no more need for treatment.Conclusion The nursing staff should be on high alert in observing the clinical manifestations of spontaneous catheter migration after PICC.Once the catheter migration occurs,the catheter tip position,the catheter morphology,the patient’s will,the treatment need,the previous catheter maintenance,the migration situation,etc.are important references for comprehensive judgment and treatment of spontaneous catheter migration after PICC.(J Intervent Radiol,2019,28:390-393)