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.

An Unusual Peripherally Inserted Central Catheter (PICC) Fractured <i>in Vivo</i>with Embolization Happened in a Child: A Case Report

We report a case of a 7-year-old child who received a peripherally inserted central catheter (PICC) for chemotherapy. He suffered from an unusual PICC fracture in vivo with pulmonary embolism after eight circles of chemotherapeutic agents administered. In this case report, we review the literatures for the underlying pathophysiology of this uncommon phenomenon. IV nurses should consider the possibility of the infusion dysfunction deriving from the PICC line fractured. Accurate tip catheter placement and specific care may reduce morbidity.

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.

Focus on peripherally inserted central catheters in critically ill patients

Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.

Arterial embolism caused by a peripherally inserted central catheter in a very premature infant:A case report and literature review

BACKGROUND Extremely premature infants have poor vascular conditions.Operators often choose deep veins such as the femoral vein and axillary vein to peripherally insert central catheters,and these vessels are often accompanied by arteries;thus,it is easy to mistakenly enter the artery.CASE SUMMARY The case of an extremely premature infant(born at gestational age 28+3)in whom the left upper extremity artery was accidentally entered during peripheral puncture of the central venous catheter is reported.On the 19th day of hospitalization,the index finger,middle finger and ring finger of the left hand were rosy,the left radial artery and brachial artery pulse were palpable,the recovery was 95%,and the improvement was obvious.At discharge 42 d after admission,there was no abnormality in fingertip activity during the follow-up period.CONCLUSION Arterial embolization in preterm infants requires an individualized treatment strategy combined with local anticoagulation and 2%nitroglycerin ointment for local tissue damage caused by arterial embolism in the upper limb.Continuous visualization of disease changes using image visualization increases the likelihood of a good outcome.

Delayed cardiac tamponade diagnosed by point-of-care ultrasound in a neonate after peripherally inserted central catheter placement: A case report

BACKGROUND Peripherally inserted central catheters(PICCs)have been increasingly applied worldwide owing to many advantages.Even with these advantages,the related complications should not be ignored,especially in neonates.The available evidence about PICC-related thrombosis was manifold,but the cardiac tamponade,an emergency and life-threatening complication,has been rarely reported.Early recognized cardiac tamponade by ultrasound may reduce mortality.CASE SUMMARY A neonate weighting 2.8 kg was born at 40 wk of gestation.He was admitted to the Surgery Intensive Care Unit due to suspected congenital megacolon.A PICC line was inserted via the left antecubital fossa for the administration of total parenteral nutrition.Three days later,the patient was still on total parenteral nutrition.Cardiac tamponade caused by PICC was found on ultrasound.The patient recovered spontaneously after an emergency pericardiocentesis.CONCLUSION Proficiency in the use of point-of-care ultrasound may save the life of patients,since it enables clinicians to treat patients faster,more accurately,and in a noninvasive way at the point of care.

Peripherally inserted central catheter placement in neonates with persistent left superior vena cava: Report of eight cases

BACKGROUND Reports on peripherally inserted central catheter(PICC)placement in neonates with persistent left superior vena cava(PLSVC)are rare.The majority of PLSVC patients have no clinical symptoms or hemodynamic changes,which are usually detected during cardiac catheterization,cardiac pacemaker implantation,or PICC placement.However,in neonates with PLSVC,PICC placement can be challenging.Here,we report PICC placement in eight neonates with PLSVC.CASE SUMMARY This article introduces the concept of the“TIMB”bundle.After PICC implantation,we found PLSVC in all eight patients.The key points of care regarding PICC placement in neonates with PLSVC included“TIMB”,where“T”indicates a reasonable choice of the catheterization time,“I”refers to a retrospective analysis of imaging data before catheterization,“M”refers to correct measurement of the body surface length,and“B”indicates that the tip of the PICC is placed in the middle and lower 1/3 of the left superior vena cava under the guidance of B-ultrasound.CONCLUSION“TIMB”is a bundle for PICC placement in neonates,especially for those with PLSVC.Using this new approach can improve the first-attempt success rate of PICC placement,reveal cardiovascular abnormalities in advance,allow the selection of different measurement methods reasonably according to the puncture site,and finally,improve the accuracy of catheter positioning through the use of B-ultrasound guidance.

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.

Viabahn Stent Graft for Inadvertent Insertion of a Central Venous Catheter in the Subclavian Artery

Subclavian artery (SCA) injuries associated with central venous catheter (CVC) insertion are uncommon yet lethal complications that typically require surgical treatment. This case report presents the case of a 94-year-old man with an iatrogenic right SCA injury resulting from a misplaced CVC. Computed tomography revealed the catheter piercing the right internal jugular vein to enter the right SCA and then reaching the aortic arch. Emergent endovascular treatment was performed, and a 13-mm × 50-mm self-expanding Viabahn stent graft (W.L. Gore & Associates, Flagstaff, AZ, USA) was placed via the right brachial artery. The misplaced catheter was successfully removed under simultaneous postdeployment balloon dilatation. This case highlights the utility of the Viabahn stent graft for iatrogenic right SCA injury caused by a misplaced CVC and presents some insights and tips for a safer procedure.

Establishment and validation of a predictive model for peripherally inserted central catheter-related thrombosis in patients with liver cancer

BACKGROUND Peripherally inserted central catheters(PICCs)are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy,nutrition,and other medications.However,PICC-related thrombosis is a serious complication that can lead to morbidity and mortality in this patient population.Several risk factors have been identified for the development of PICC-related thrombosis,including cancer type,stage,comorbidities,and catheter characteristics.Understanding these risk factors and developing a predictive model can help healthcare providers identify high-risk patients and implement preventive measures to reduce the incidence of thrombosis.AIM To analyze the influencing factors of PICC-related thrombosis in hospitalized patients with liver cancer,construct a predictive model,and validate it.METHODS Clinical data of hospitalized patients with liver cancer admitted from January 2020 to December 2023 were collected.Thirty-five cases of PICC-related thrombosis in hospitalized patients with liver cancer were collected,and 220 patients who underwent PICC placement during the same period but did not develop PICC-related thrombosis were randomly selected as controls.A total of 255 samples were collected and used as the training set,and 77 cases were collected as the validation set in a 7:3 ratio.General patient information,case data,catheterization data,coagulation indicators,and Autar Thrombosis Risk Assessment Scale scores were analyzed.Univariate and multivariate unconditional logistic regression analyses were performed on relevant factors,and the value of combined indicators in predicting PICC-related thrombosis in hospitalized patients with liver cancer was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Univariate analysis showed statistically significant differences(P<0.05)in age,sex,Karnofsky performance status score(KPS),bedridden time,activities of daily living impairment,parenteral nutrition,catheter duration,distant metastasis,and bone marrow suppression between the thrombosis group and the non-thrombosis group.Other aspects had no statistically significant differences(P>0.05).Multivariate regression analysis showed that age≥60 years,KPS score≤50 points,parenteral nutrition,stage III to IV,distant metastasis,bone marrow suppression,and activities of daily living impairment were independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer(P<0.05).Catheter duration of 1-6 months and catheter duration>6 months were protective factors for PICC-related thrombosis(P<0.05).The predictive model for PICC-related thrombosis was obtained as follows:P predictive probability=[exp(Logit P)]/[1+exp(Logit P)],where Logit P=age×1.907+KPS score×2.045+parenteral nutrition×9.467+catheter duration×0.506+tumor-node-metastasis(TNM)staging×2.844+distant metastasis×2.065+bone marrow suppression×2.082+activities of daily living impairment×13.926.ROC curve analysis showed an area under the curve(AUC)of 0.827(95%CI:0.724-0.929,P<0.001),with a corresponding optimal cut-off value of 0.612,sensitivity of 0.755,and specificity of 0.857.Calibration curve analysis showed good consistency between the predicted occurrence of PICC-related thrombosis and actual occurrence(P>0.05).ROC analysis showed AUCs of 0.888 and 0.729 for the training and validation sets,respectively.CONCLUSION Age,KPS score,parenteral nutrition,TNM staging,distant metastasis,bone marrow suppression,and activities of daily living impairment are independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer,while catheter duration is a protective factor for the disease.The predictive model has an AUC of 0.827,indicating high predictive accuracy and clinical value.

Tip orientation under real-time point-of-care neck ultrasonic monitoring is advantageous in peripherally inserted central catheter procedures:a retrospective cohort study

Background:We analyzed the success and catheter tip malposition rates of peripherally inserted central catheter(PICC)placement using ultrasonic monitoring.Methods:A total of 564 patients were recruited and assigned to either the intervention or control group.In the intervention group,282 patients underwent ultrasound-guided PICC insertion,which helped to identify the position and depth of the catheter tip.From a total of 9000 patients,282 were selectively chosen to receive the traditional method using body surface measurements(control group).The primary endpoint was the success rate;the secondary endpoint was the catheter tip malposition rate as detected by postprocedure chest radiography.Results:In the intervention group,a total of 94 catheters were in a suboptimal position;26 were too deep,68 were too shallow,and 1 was inserted into the subclavian vein,with success and malposition rates of 66.3%and 0.4%,respectively.In the control group,139 catheters were in a suboptimal position;88 were too deep,51 were too shallow,9 were inserted into the jugular vein,and 2 were inserted into the subclavian vein,with success and malposition rates of 46.8%(P<0.001)and 3.9%(P=0.004),respectively.Significant differences were observed in success and malposition rates between the 2 groups.Conclusion:Ultrasound-guided PICC procedures achieved higher success rates and lower malposition rates.

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。

多学科协作风险管控预防肿瘤病人PICC相关性静脉血栓的效果观察

目的:探讨多学科协作(MDT)风险管控预防肿瘤病人经外周静脉置入中心静脉导管(PICC)相关性静脉血栓的效果。方法:选取2020年6月—2022年6月在本院留置PICC的肿瘤病人190例,采用随机数字表法分为观察组和对照组,各95例。对照组给予常规护理,观察组在对照组基础上给予MDT风险管控护理,比较两组PICC穿刺、维护质量、相关性静脉血栓及腋下静脉最大血流速度(Vmax),平均血流速度(Vmean)情况。结果:观察组PICC一次穿刺成功率、维护质量优良率高于对照组(P<0.05);两组护理后腋下静脉Vmax、Vmean快于护理前,观察组护理后腋下静脉Vmax、Vmean快于对照组(P<0.05);观察组PICC相关性静脉血栓发生率为2.11%,低于对照组的11.58%(P<0.05)。结论:MDT风险管控可提高肿瘤病人PICC穿刺、维护质量,改善腋下静脉循环,有利于改善PICC相关性静脉血栓的预防效果。

针对性沟通对PICC患者用药依从性、心理状态的影响

目的 探讨针对性沟通干预对经外周静脉置入中心静脉导管(peripherally inserted central catheter, PICC)患者用药依从性、心理状态的影响。方法 2022年1~12月治疗的PICC患者130例采用随机法分为常规组和针对性沟通组,每组65例。常规组的研究对象行常规干预,针对性沟通组研究对象采用针对性沟通进行干预,对比2组干预前与干预后用药依从性、心理状态、生活态度、自我效能、并发症及满意度的变化。结果 与常规组相比,针对性沟通组HAMA评分、HAMD评分、恐惧情绪自测表明显下降(P<0.05);且HERTH评分及自我效能、用药依从性、满意度明显提升,差异均有统计学意义(P<0.05)。结论 通过针对性沟通干预的开展,能有效提高PICC患者用药依从性、心理状态,改善患者生活态度。

适于胎龄与小于胎龄的极低出生体重儿身长增长对PICC尖端移位的影响及比较

目的探讨极低出生体重儿(very low birth weight,VLBW)中适于胎龄儿(appropriate for gestational age,AGA)和小于胎龄儿(small for gestational age,SGA)身长增长对经外周中心静脉置管(peripherally inserted central catheter,PICC)尖端移位的影响,并横向比较影响程度,帮助医护人员更好地把握导管尖端位置监测的时机。方法回顾性分析2021年1月—2022年6月在医院NICU住院并使用PICC的VLBW,按出生体质量和胎龄关系分为AGA组45例和SGA组19例,记录首次置管当日身长(Ht_(1))以及PICC尖端位置、置管期间胸片检查当日身长(Ht_(n))以及PICC尖端位置,并计算相应的身长增长率。身长增长率与PICC尖端移位的相关性用Spearman秩相关分析。将AGA和SGA的身长增长率分别与PICC尖端移位进行简单线性回归分析,构建回归模型,用协方差分析比较两组回归直线。结果VLBW中AGA组97.8%患儿出现移位,SGA组所有的患儿都出现移位,占比最多的均为移位3个椎体。Spearman秩相关分析结果显示,两组患儿身长增长率与PICC尖端移位均具有相关性(AGA组rs=-0.719,P<0.001;SGA组rs=-0.769,P<0.001),随着VLBW身长增长,PICC尖端逐渐移位远离心脏。简单线性回归分析结果显示,AGA组回归模型(R^(2)=0.517,调整后R^(2)=0.513,F=129.487,P<0.001),SGA组回归模型(R^(2)=0.591,调整后R^(2)=0.585,F=95.385,P<0.001)。协方差分析结果显示,由于回归系数检验没有统计学意义,两条直线平行,说明身长增长率对两组患儿位移的影响一致。截距比较有统计学意义(F=9.265,P=0.003),说明两组患儿位移的起点不同(即增长率为零时的位移位置),说明位移与是否为AGA、SGA有关。结论随着VLBW中AGA和SGA身长增长,PICC尖端逐渐移位远离心脏,但相同的身长增长率,SGA引起的导管尖端移位幅度更大。建议AGA身长增长率12.4%、SGA身长增长率9.5%可作为监测导管尖端位置的重要时机,以免导管尖端进一步移位至非中心静脉,导致相关并发症发生。

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。

植入式静脉输液港与PICC在血液肿瘤患者中的临床价值

目的 比较植入式静脉输液港(VPA)与经外周静脉穿刺置入中心静脉导管(PICC)在血液肿瘤患者护理中的临床应用价值,为临床血液肿瘤患者化疗期间选用合适的中心静脉给药方法提供参考。方法 选取河北工程大学附属医院2021年3月至2023年2月就诊的血液肿瘤患者80例,根据置管方法不同随机分为VPA组38例和PICC组42例,比较2组并发症、舒适度、生活质量评分。结果 VPA组并发症发生率5.26%,低于PICC组的26.19%,VPA组未发现导管阻塞、血流感染、皮肤过敏等并发症,2组差异有统计学意义(P<0.05);生活质量6个维度的比较中,1个社会关系功能无差异,其余5个VPA组均高于PICC组,2组生活质量评分比较差异有统计学意义(P<0.05);VPA组舒适度更高(P<0.05)。结论 相比于PICC静脉给药方法,VPA并发症少,舒适度好,更能提高患者生活质量,满足血液肿瘤患者长期治疗需求,值得临床推广。

PICC病人医用粘胶相关性皮肤损伤预防的最佳证据总结

目的:总结经外周静脉置入中心静脉导管(PICC)置管病人医用粘胶相关性皮肤损伤(MARSI)的相关证据,为临床循证实践提供依据。方法:应用循证的方法,根据金字塔“6S”证据模型系统检索关于预防PICC病人MARSI的相关文献。检索时限为2010年1月1日—2023年1月30日,由2名研究者对证据进行质量评价和推荐级别的评定。结果:共纳入12篇高质量文献,提取到19条最佳证据,包含对病人评估、操作方法、敷料的选择及使用、培训与教育4个方面的内容。结论:总结了预防PICC置管病人MARSI的最佳证据,为医护人员在临床工作中预防提供循证依据。

失效模式和效应分析在降低PICC导管移位管理中的应用

目的:探讨失效模式和效应分析(FMEA)在降低经外周静脉置入中心静脉导管(PICC)导管移位管理中的应用效果。方法:选取2023年1月—3月PICC置管治疗的104例病人作为对照组,实施常规护理;选取2023年4月—6月采用PICC置管治疗的110例病人作为观察组,实施FMEA管理模式,比较两组风险优先指数(RPN)、治疗间歇期导管移位率及护理满意度。结果:两组干预后5个失效模式的RPN值、PICC导管移位率、护理满意度比较,差异均有统计学意义(P<0.05)。结论:FMEA模式管理可以发现管理流程中潜在的问题和漏洞,降低PICC导管移位率,从而提高护理质量和护理满意度,保证病人安全。

以危机预防理论为指导的新生儿PICC置管风险管理方案的构建及应用

目的构建以危机预防理论为指导的新生儿经外周静脉穿刺的中心静脉导管(PICC)置管风险管理方案,并探讨其应用效果。方法前瞻性选取郑州大学第一附属医院新生儿重症医学科2021年3月至2022年2月收治的66例拟行PICC置管的新生儿为对象,按照收治时间顺序分为对照组和观察组,各33例。对照组患儿接受常规护理干预,观察组患儿在对照组基础上接受以危机预防理论为指导的风险管理干预措施。对比两组患儿PICC置管1个月内风险事件(导管堵塞、液体外渗、皮下血肿、感染)发生情况。对比穿刺时疼痛情况[新生儿急性疼痛行为评分量表(NIAPAS)及脸、腿、活动、哭闹、安抚评估量表(FLACC)]。结果观察组风险事件总发生率低于对照组(P<0.05)。观察组穿刺时NIAPAS、FLACC评分均低于对照组(P<0.05)。结论以危机预防理论为指导的风险管理干预措施可减轻新生儿PICC置管穿刺痛感,降低置管后风险事件发生率。