Lower extremity peripherally inserted central catheter placement ectopic to the ascending lumbar vein:A case report

BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.

Clues for diagnosing misplaced central venous catheter in the right ascending lumbar vein during right femoral venous access

The right ascending lumbar vein is difficult to detect on anteroposterior abdominalradiographs because it overlaps with the inferior vena cava on anteroposteriorradiographs.Intensive observation by medical providers may be a cue fordiagnosis.However,knowledge of catheter misplacement of the right ascendinglumbar vein is also necessary,because misplacement cannot be suspected withoutthat awareness.

Central venous catheterization-related complications in a cohort of 100 hospitalized patients:An observational study

Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

Clinical Application of Newborn Umbilical Vein Catheterization Combining with PICC

Purpose: Research on clinical application effect of combining very low birth weight newborn (VLBWN) umbilical vein catheterization (UVC) with peripherally inserted central catheter (PICC). Method: 60 cases of VLBWN checked in our hospital’s ICU are selected and divided into combination group (n = 30) and PICC group (n = 30) according to the random number table. Combination of UVC and PICC is applied on newborn of combination group while only PICC is applied on newborn of PICC group. These two groups’ newborn’s PICC catheterization operation time, PICC indwelling time, weight gain, hospital stays, hospital infection, planned extubation, successful single puncture, adverse events and other indexes are observed. Result: Newborns in combination group have less PICC catheterization operation time and less hospital stays than newborns in PICC group while newborns in combination group have longer PICC indwelling time and greater weight gain than newborns in PICC group. The difference here has statistical significance (p < 0.05). Combination group’s hospital infection ratio (3.33%) is lower than that of PICC group (23.33%). The difference here has statistical significance (p < 0.05). Newborns in combination group have a planned extubation rate of 93.33% and a successful single puncture rate of 93.33%, which are greater than those of newborn in PICC group (respectively 73.33% and 70.00%). The difference here has statistical significance (p < 0.05). Newborns in combination group have an adverse event occurrence rate of 43.33%, lower than that of PICC group (70.00%). The difference here has statistical significance (p < 0.05). Conclusion: Application of combination of UVC and PICC on VLBWN can greatly improve PICC catheterization efficiency and newborn patients’ nutriture and reduce rate of complications, thus, it is worthy of clinical application.

Thoracic duct cannulation during left internal jugular vein cannulation:A case report

BACKGROUND Central venous catheter insertion is an invasive procedure that can cause complications such as infection,embolization due to air or blood clots,pneumothorax,hemothorax,and,rarely,chylothorax due to damage to the thoracic duct.Herein,we report a case of suspected thoracic duct cannulation that occurred during left central venous catheter insertion.Fortunately,the patient was discharged without any adverse events related to thoracic duct cannulation.CASE SUMMARY A 46-year-old female patient presented at our department to undergo cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.During anesthesia,we decided to insert a central venous catheter through the left internal jugular vein because the patient already had a chemoport through the right central vein.During the procedure,blood reflux was observed when the needle tip was not within the ultrasound field of view.We did not try to find the tip;however,a guide wire and a central venous catheter were inserted without any resistance.Subsequently,when inducing blood reflux from the distal port of the central venous catheter,only clear fluid,suspected to be lymphatic fluid,was regurgitated.Further,chest X-ray revealed an appearance similar to that of the path of the thoracic duct.Given that intravenous fluid administration was not started and no abnormal fluid collection was noted on preoperative chest X-ray,we suspected thoracic duct cannulation.CONCLUSION It is important to use ultrasound to confirm the exact position of the needle tip and guide wire path.

Upper body peripherally inserted central catheter in pediatric single ventricle patients

BACKGROUND There is risk of stenosis and thrombosis of the superior vena cava after upper extremity central catheter replacement.This complication is more serious among patients with single ventricle physiology,as it might preclude them from undergoing further life-sustaining palliative surgery.AIM To describe complications associated with the use of upper extremity percutaneous intravenous central catheters(PICCs)in children with single ventricle physiology.METHODS A single institution retrospective review of univentricular patients who underwent superior cavopulmonary anastomoses as their stage 2 palliation procedure from January 2014 until December 2018 and had upper body PICCs placed at any point prior to this procedure.Clinical data including ultrasonography,cardiac catheterization,echocardiogram reports and patient notes were used to determine the presence of thrombus or stenosis of the upper extremity and cervical vessels.Data regarding the presence and duration of upper extremity PICCs and upper extremity central venous catheter(CVC),and use of anticoagulation were recorded.RESULTS Seventy-six patients underwent superior cavopulmonary anastomoses,of which 56(73%)had an upper extremity PICC at some point prior to this procedure.Median duration of PICC usage was 24 d(25%,75%:12,39).Seventeen patients(30%)with PICCs also had internal jugular or subclavian central venous catheters(CVCs)in place at some point prior to their superior cavopulmonary anastomoses,median duration 10 d(25%,75%:8,14).Thrombus was detected in association with 2 of the 56 PICCs(4%)and 3 of the 17 CVCs(18%).All five patients were placed on therapeutic dose of low molecular weight heparin at the time of thrombus detection and subsequent cardiac catheterization demonstrated resolution in three of the five patients.No patients developed clinically significant venous stenosis.CONCLUSION Use of upper extremity PICCs in patients with single ventricle physiology prior to super cavopulmonary anastomosis is associated with a low rate of catheterassociated thrombosis.

Massive hemothorax following internal jugular vein catheterization under ultrasound guidance:A case report

BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SUMMARY A 75-year-old male patient was admitted for laparoscopic radical nephrectomy.Under ultrasound guidance,right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt.Sudden hypotension developed after surgical positioning and persisted until the end of the operation,lasting for about 4 h.In the recovery room,a massive hemothorax was identified on chest radiography and computed tomography.The patient recovered following chest tube drainage of 1.6 L blood.CONCLUSION Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance.So the proper use of ultrasound is important.

Analysis of Use and Outcomes of Peripherally Inserted Central Catheter (PICC-Line) in Hemato-Oncological Patients

Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rate of complications in PICC line;studying the cause of early removal of PICC line. Methods: All PICCs inserted in adult hemato-oncological patients in Hematology and Medical Oncology Department of Health Care Global (HCG) Hospital were studied prospectively, as per the proforma, till PICCs were removed or patient expired and the pattern of complications were noted. Results: Eighty-four PICCs were inserted over a period of initial nine months and followed for a total of 1 year with three months post insertion duration for a total of 10,868 catheter-days (mean of 129 days i.e. 4.3 months, range: 1 to 288 days). The most common indication for PICC was chemotherapy (100%). Among them 19 (22%) PICCs had complications and 12 were removed at the rate of 1.1/1000 PICC-days. Complications with haematologic malignancies were more as compared to those with solid tissue malignancies. Conclusions: Despite significant complication rates, PICCs are a relatively safe and cost effective mode of establishing central venous access.

颈静脉、锁骨下静脉汇入无名静脉区的影像解剖分型研究及其在中心静脉置管中的应用

目的 研究双侧颈静脉、锁骨下静脉汇入无名静脉“三岔口”区的局部影像解剖并进行分型,初步探讨其在中心静脉置管中的应用。方法 河南科技大学第一附属医院2020年10月至2022年11月中心静脉置管病例389例,根据锁骨下静脉、颈静脉汇入无名静脉区局部影像解剖特点进行分型,右侧分为5型,左侧分为4型,结合置管后胸部X线片、CT检查、腔内心电及超声等资料明确中心静脉管位置,采用统计学方法分析“三岔口”区影像解剖分型与中心静脉导管异位的关系。结果 389例病例右侧“三岔口”区影像解剖分型中Ⅰ型占44.7%、Ⅱ型占24.7%、Ⅲ型占10.3%、Ⅳ型占17.2%、Ⅴ型占3.1%;左侧“三岔口”区影像解剖分型中Ⅰ型占29.3%、Ⅱ型占59.9%、Ⅲ型占9.8%、Ⅳ型占1.0%。经外周置入中心静脉导管(PICC)共271例,右侧入路180例中导管异位共24例,其中Ⅰ型3例、Ⅱ型5例、Ⅲ型4例、Ⅳ型7例、Ⅴ型5例,左侧入路91例中导管异位共3例,其中Ⅱ型2例、Ⅲ型1例;中心静脉导管异位发生率PICC右侧入路各型比较差异有统计学意义(χ^(2)=11.796,P=0.019),左侧入路各型比较差异无统计学意义(χ^(2)=2.073,P=0.557)。CVC置管118例,右侧入路104例中导管异位5例,其中Ⅱ型2例、Ⅲ型2例、Ⅳ型1例,左侧入路14例中导管异位3例,其中Ⅱ型2例、Ⅳ型1例,中心静脉导管异位发生率CVC右侧入路各型比较差异无统计学意义(χ^(2)=7.403,P=0.116),左侧入路各型比较差异无统计学意义(χ^(2)=4.497,P=0.213)。结论 颈静脉、锁骨下静脉汇入无名静脉区的影像解剖分型右侧Ⅰ型最多见,左侧Ⅱ型最多见,局部影像解剖分型与中心静脉导管异位存在一定关系。

Venous thromboembolism in patients with liver cancer:a retrospective study

Background:Little is known about the association between venous thromboembolism(VTE)and tumors.In this study,we identified the clinical features of patients with liver cancer who presented with at least 1 VTE episode.Methods:This was a retrospective case-control study of a single-institution database with univariate and multivariate analyses usingχ^(2)and Fisher exact tests.Statistical significance was set at P<0.05.Results:The overall incidence of VTE in the patients with liver cancer was 1.2%.More than half(53.8%)of the 13 patients with liver cancer and venous thrombosis died within 2 months.The thrombus in 12 patients(92.3%)was located within the deep veins,whereas the other patient(7.7%)was diagnosed with a pulmonary embolism.Of the 11 patients,9(69.2%)had swelling and/or pain symptoms.All 6 patients with peripherally inserted central catheters(PICCs)had thrombosis,accounting for 46.2%of all patients with liver cancer and venous thrombosis.Compared with the controls,liver cancer patients with PICC tubes,thrombosis-related symptoms such as swelling and pain,traumatic stimulation such as fracture,acute respiratory distress syndrome,and interventional therapy or hemostasis drugs were prone to be diagnosed with VTE(P<0.05).Conclusions:Liver cancer and thrombosis are rare and have poor prognoses.Liver cancer with thrombosis may be associated with PICC catheterization,traumatic stimulation,or hemostatic drugs.Patients with liver cancer and thrombosis often present with swelling and pain.

无痛诊疗技术在超声PICC置管患儿中的应用效果研究

目的探讨无痛诊疗技术在超声引导下儿童经外周静脉穿刺中心静脉置管术(peripherally inserted central catheter,PICC)中的应用效果。方法选取笔者医院2021年1月至2023年1月拟行PICC的患儿82例,用随机数字表法将其分为对照组、观察组,每组41例;对照组行常规超声引导下PICC置管术,观察组行无痛诊疗技术超声引导下PICC置管术;对比两组置管成功率、置管完成时间,患儿疼痛程度[儿童疼痛行为量表(children’s pain behavior scale,FLACC)],耐受度[Houpt行为量表(Houpt behavior scale,HBS)],依从性[Frankl量表(Frankl scale,FCS)]及家属满意度。结果观察组置管成功率较对照组高,置管时间较对照组短,差异有统计学意义(P<0.05);观察组FLACC评分较对照组低,HBS评分、FCS评分较对照组高,差异有统计学意义(P<0.05);观察组家属总满意度较对照组高,差异有统计学意义(P<0.05)。结论无痛诊疗技术用于超声引导下儿童PICC置管术可提高置管成功率,缩短置管时间,减轻患儿疼痛程度,增强耐受性、依从性,提升家属满意度。

乳腺癌患者外周中心静脉导管相关上肢深静脉血栓形成的抗凝治疗

目的总结分析乳腺癌患者发生外周中心静脉导管(PICC)相关上肢深静脉血栓(DVT)形成的诊治经验。方法收集2021年6月至2023年3月北京市海淀医院收治的发生PICC相关上肢DVT的134例乳腺癌患者的临床资料,根据抗凝治疗方案的不同将患者分为低分子肝素组(n=65)和利伐沙班组(n=69)。比较两组患者的乳腺癌专科信息和启动抗凝治疗后3个月的随访结果。结果两组患者的临床分期、肿瘤部位、手术情况、放疗情况比较,差异均无统计学意义(P﹥0.05)。治疗后3个月随访结果显示,两组患者的导管功能失用率、上肢DVT复发率、出血发生率比较,差异均无统计学意义(P﹥0.05)。两组患者均发生了轻微出血。治疗前,两组患者的D-二聚体水平比较,差异无统计学意义(P﹥0.05);治疗后4、12周,两组患者的D-二聚体水平均较本组治疗前下降,差异均有统计学意义(P﹤0.05),但两组患者的D-二聚体水平比较,差异均无统计学意义(P﹥0.05)。结论低分子肝素与利伐沙班治疗乳腺癌患者PICC相关上肢DVT的疗效与安全性相当,但利伐沙班可能更方便患者出院后使用。

手术室护士行超声引导下疑难外周静脉穿刺置管内心体验的质性研究

目的:深入了解手术室护士对超声引导下疑难外周静脉穿刺置管术的实施态度和真实体验,为此项技术能够在临床上精准化操作、广泛应用提供参考依据。方法:采用目的抽样法,选取南京某三级甲等医院11名手术室护士为研究对象,采用现象学研究方法对其进行半结构式访谈,根据Colaizzi七步分析法分析资料。结果:共提炼出4个主题、11个亚主题:超声是可视化静脉穿刺的重要辅助工具,包括超声在血管穿刺方面具有独特的优势,使用超声的外在及内在资源;超声引导下疑难外周静脉穿刺置管精准操作的影响因素,包括超声引导穿刺相关知识技能的掌握,留置针导管型号的选择,手眼协调能力,平时操作练习;护士职业成就感,包括护士面对疑难外周静脉穿刺时的自信、底气,得到同行称赞,得到病人认可;对新知识、新技能学习和应用的意愿与热情,包括希望得到更多培训和学习交流的机会,希望此项技术能够得到广泛应用。结论:护士能够在超声引导下疑难外周静脉穿刺置管操作中获得积极体验,且将解决临床问题转化为对新技术、新技能学习的内在动力。护理管理者应该通过培训考核,营造科室组织氛围等方法提高护士此项技术掌握程度,推进其在临床广泛应用,精准实施。

PICC带管出院患者导管居家维护模式的可行性研究分析

目的 观察PICC带管出院患者导管居家维护模式的可行性。方法 将我院2021年1月至2022年12月收治的60例PICC带管肿瘤患者随机分为观察组30例,对照组30例。对照组(n=30)给予常规返院导管维护,观察组(n=30)给予导管居家维护,对比两组的单次维护费用及时间、平均留置时间、导管相关并发症发生情况及维护依存性。结果 观察组单次维护费用为(58.17±5.64)元,低于对照组的(132.78±9.85)元,两组单次维护费用比较,差异具有统计学意义(t=-36.004,P=0.000);观察组单次维护时间(81.13±7.62)min,较对照组的(203.34±15.67)min更短,差异具有统计学意义(t=-38.416,P=0.000)。观察组PICC平均留置时间为(141.82±13.56)d,对照组PICC平均留置时间为(137.43±14.08)d,两组PICC平均留置时间比较,差异未见统计学意义(t=1.230,P=0.224)。观察组导管相关并发症发生率36.67%,对照组26.67%,两组导管相关并发症比较,差异没有统计学意义﹙χ^(2)=0.693,P=0.405﹚。观察组能按时进行PICC导管维护者为28例,按时维护依存率为93.33%,高于对照组的70.00%,差异存在统计学意义﹙χ^(2)=5.455,P=0.020﹚。结论 PICC带管出院患者导管居家维护模式具有一定可行性,在不增加导管相关并发症及延长留置时间的前提下,可以有效地减少维护费用、缩短维护时间,提高患者维护依存性。

胃肠外科行PICC置管化疗胃癌患者实施思维导图导向的FFC干预效果评价

目的:探究实施思维导图导向的前馈控制(FFC)干预对行经外周导入中心静脉置管(PICC)化疗胃癌患者的效果情况。方法:选取2022年1月至2023年12月厦门大学附属中山医院胃肠外科收治的行PICC置管化疗胃癌患者252例,按照入院先后顺序将其分为对照组(2022年1月至2022年12月)与研究组(2023年1月至2023年12月),各126例。对照组给予常规护理,研究组在对照组基础上给予思维导图导向的FFC干预,比较两组心理状态[采用汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)评估]、并发症发生率及护理满意度。结果:干预第30 d,与对照组比较,研究组HAMD、HAMA评分偏低(t_(1)=44.154,t_(2)=27.970,P均<0.05)。干预30 d内,研究组并发症发生率较对照组偏低(χ^(2)值校正=4.288,P<0.05)。干预第30 d,研究组护理满意度较对照组偏高(χ^(2)=7.504,P<0.05)。结论:在行PICC置管化疗胃癌患者中实施思维导图导向的FFC干预,可有效改善其心理状态、并发症发生率及护理满意度。

基于失效模式-效应分析模式的护理干预对宫颈癌经外周静脉穿刺中心静脉置管化疗患者的护理效果

目的探讨基于失效模式-效应分析(HFMEA)模式的护理干预在宫颈癌患者接受外周静脉穿刺中心静脉置管(PICC)化疗中的应用效果。方法采用前瞻性随机对照研究设计,选取2023年1月-12月于南京医科大学附属妇产医院接受PICC化疗的120例宫颈癌患者,随机分为观察组和对照组,每组60例。对照组接受常规护理,观察组在此基础上采用基于HFMEA模式的护理干预。比较两组患者PICC相关并发症发生率、化疗期间舒适度及护理满意度。结果观察组PICC相关并发症发生率显著低于对照组,差异具有统计学意义(P<0.05)。观察组化疗期间VAS评分显著低于对照组,差异具有统计学意义(P<0.05)。观察组患者护理满意度显著高于对照组,差异具有统计学意义(P<0.05)。结论基于HFMEA模式的护理干预可有效降低宫颈癌患者在接受PICC化疗过程中相关并发症发生率,提高患者舒适度及护理满意度,是一种值得推广的护理模式。

基于随机森林模型的抗肿瘤化疗患者经外周静脉植入中心静脉导管置管后导管相关感染及影响因素

目的 基于随机森林模型分析化学治疗患者经外周静脉置入中心静脉导管(PICC)置管后导管相关感染的影响因素。方法 选取接受化学治疗并留置PICC的400例肿瘤患者,采用计算机产生随机数法将就诊患者以3∶1的比例分为训练集(300例)和测试集(100例)。根据感染发生情况将训练集患者分为无感染组和感染组,比较两组的临床资料,采用多因素logistic回归模型及随机森林的集成分类算法分析患者PICC置管后出现导管相关感染的影响因素,并对比二者的预测效能。结果 训练集300例化学治疗患者中,32例患者出现导管相关感染(10.67%),与无感染组比较,感染组患者单次置管穿刺次数更多,PICC留置时间更长,导管移动比例、合并糖尿病比例及换药频次更高,白细胞计数(WBC)水平及免疫功能更低(均P<0.05)。PICC留置时间、导管移动情况、合并糖尿病情况、换药频次、WBC及免疫功能均为患者PICC置管后导管相关感染的独立影响因素(均P<0.05)。随机森林模型显示不同影响因素的重要程度排序结果依次为:PICC留置时间、导管移动情况、合并糖尿病情况、WBC、换药频次及免疫功能。随机森林模型的集成分类算法预测化学治疗患者发生导管相关感染的受试者工作特征(ROC)曲线下面积(AUC)为0.872,与logistic回归模型(AUC=0.791)相比预测效能更优。结论 PICC留置时间、导管移动情况、合并糖尿病情况、换药频次、WBC水平及免疫功能是化学治疗患者发生导管相关感染的独立影响因素,随机森林模型的集成分类算法可用于对化学治疗患者发生导管相关感染的预测分析,其预测性能优于logistic回归模型。

超声引导下改良塞丁格技术在肘上PICC置管应用分析

目的 探讨超声引导下改良塞丁格技术在肘上经外周静脉穿刺中心置管(PICC)应用价值分析。方法 选取340例接受超声引导下改良塞丁格技术行肘上PICC置管患者,按照穿刺部位分为贵要静脉组204例、肱静脉组82例、头静脉组54例,对三组穿刺成功率及并发症发生情况进行分析。结果 贵要静脉组置管成功率96.08%,高于肱静脉组95.12%、头静脉组87.04%,异位导管率3.92%,低于肱静脉组4.88%、头静脉组12.96%,差异有统计学意义(P<0.05);贵要静脉组并发症率3.43%,低于肱静脉组3.66%,头静脉组12.96%,差异有统计学意义(P<0.05);贵要静脉组穿刺次数、置管时间低于肱静脉组、头静脉组,差异有统计学意义(P<0.05)。结论 超声引导下改良塞丁格技术经肘上PICC置管后成效显著,对于无法将贵要静脉作为穿刺静脉者,可选择肱静脉、头静脉为备选。

早产儿经大隐静脉行PICC置管最佳置管深度的临床研究

目的分析早产儿经大隐静脉(great saphenous vein,GSV)行经外周静脉穿刺的中心静脉导管(peripherally inserted central venous catheter,PICC)置管最佳置管深度(optimal placement depth,OPD)与体格测量参数之间的相关性,以期建立经GSV PICC置管OPD的预测公式。方法回顾性选取2022年12月—2024年2月在中南大学湘雅三医院新生儿重症监护室经GSV PICC置管的早产儿为研究对象。按穿刺部位不同[膝关节(knee joint,KJ)或踝关节(ankle joint,AJ)GSV],分为GSV-KJ置管组(38例)和GSV-AJ置管组(33例)。测量置管时体重(body weight,BW)、身长、上部量、下部量、头围、腹围,应用Pearson相关分析评估上述变量与OPD的相关性,构建早产儿经GSV PICC置管OPD的预测公式,比较传统预估公式和新预测公式的预测深度与理想的OPD之间的预测残差。结果Pearson相关分析显示,GSV-KJ置管组和GSV-AJ置管组PICC OPD与BW、身长、上部量、下部量、头围、腹围呈显著正相关(均P<0.05),两组中其与BW的相关性均最高;一元线性回归分析显示,GSV-KJ置管组和GSV-AJ置管组PICC置管OPD与BW呈线性关系。OPD预测方程分别为:GSV-KJ PICC置管OPD(cm)=13.1+2.7×BW(kg),GSV-AJ PICC置管OPD(cm)=13.4+6.0×BW(kg);新预测公式的预测残差显著小于传统预估公式(P<0.05)。结论早产儿经GSV PICC置管OPD与BW呈正相关,依据BW构建的新预测公式的预测结果更接近理想的OPD。