不同静脉通路建立方式的比较

目的 探讨脐静脉置管(UVC)联合经外周静脉中心静脉导管(PICC)在极低出生体重儿(VLBWI)救治的作用.方法 选取2005年1月至2007年1月入住本院的VLBWI 89例,分为联合导管组(联合UUC和PICC)28例、PICC组31例和外周静脉(PIN)组30例,观察患儿住院期间静脉穿刺次数、呼吸暂停发生次数、体重增长情况、低血糖持续时间和部分生化、感染指标.结果 联合导管组患儿脐静脉插管一次操作均能成功,成功率高于PICC组(77%),导管留置时间更长;与PIV组比较,联合导管组患儿的静脉穿刺次数(13.2±3.3)次、呼吸暂停发生次数(61.1±7.5)次明显减少(P<0.05),恢复至出生体重时间(12.0±3.0)d和低血糖持续时间(1.5±1.3)h明显缩短(P<0.05);而感染指标差异无统计学意义(P>0.05).结论 联合UVC和PICC具有穿刺成功率高,留置时间长,减少刺激,且不增加感染等优点,值得VLBWI救治中推广.     

经外周置入中心静脉导管在高危新生儿应用的临床评估

目的：观察新生儿应用经外周置入中心静脉导管（peripherally inserted central catheters, PICC）的优缺点,为需要长期使用静脉治疗的患儿寻找稳定有效的手段。方法：采用回顾性队列研究方法,以2006年4月至2008年2月间在该科住院,使用PICC的65例新生儿和使用外周静脉留置针(peripheral intravenous catheters, PIV)的80例新生儿为研究对象,分别对两组患儿导管留置时间、导管机械性并发症、败血症以及死亡情况进行比较。结果：PICC的置留时间为18.75±7.62 d（7~62 d）;PIV为1.49±0.57 d（0.5 h至4 d）,PICC明显长于PIV（P<0.01）;PICC组机械性并发症发生率为27.7%,PIV组为63.8%,PICC组明显低于PIV组（P<0.01）;PICC与 PIV组的败血症发生率以及死亡率比较差异无显著性意义。结论：PICC对新生儿是一项安全有效的治疗措施,能够明显减少静脉穿刺次数。［中国当代儿科杂志,2009,11（2）：100-103］     

经外周静脉穿刺中心静脉置管患儿相关性血源感染的危险因素分析北大核心CSCD

目的对新生儿重症监护室(neonatal intensive care unit,NICU)患儿经外周静脉穿刺中心静脉置管(peripherally inserted central catheterization,PICC)后发生导管相关血源感染(catheter-related bloodstream infection,CRBSI)或中心静脉伴随血源感染(central line-associated bloodstream infection,CLABSI)进行特征分析并评估CRBSI或CLABSI的危险因素。方法回顾性收集2018年6月1日至2020年5月1日在浙江大学医学院附属儿童医院NICU需要PICC置管的患儿临床资料。同时采集导管数据,包括置管时间、置管部位、拔除日期和PICC抗生素锁等。采用多因素logistic回归模型分析PICC患儿发生CRBSI或CLABSI的危险因素。结果NICU患儿中共446例需要PICC置管,平均胎龄为(30.8±4.0)周;平均出生体重为(1580±810)g;中位年龄为9 d;PICC留置的中位持续时间为18 d。CLABSI和CRBSI的发生率分别为每1000导管日5.6和1.46。PICC致CLABSI的常见病原菌为表皮葡萄球菌(n=19)和肺炎克雷伯菌(n=11),CRBSI的常见病原菌为肺炎克雷伯菌(n=6)。PICC致CLABSI的风险随着PICC置管持续时间和抗生素的持续使用时间延长而显著增加,头颈部位置管的感染概率低于上下肢置管(P<0.05),且上述情况在出生体重<1500 g的患儿中更加显著。PICC致CRBSI的风险随着胎龄增加而降低(P<0.05)。结论CRBSI和CLABSI仍然是NICU医院感染中的重要问题。识别导致CRBSI和CLABSI的危险因素可为临床治疗及管理质量改进提供依据。     

经外周静脉置人中心静脉导管在极低出生体质量儿中的应用

目的 评估经外周静脉置人中心静脉导管(PICC)在极低出生体质量儿(VLBWI)救治中的作用.方法 选取2004年6月至2008年5月入住我院的VLBWI 86例,分为PICC 46例和外周静脉穿刺(PIV)组40例,观察患儿住院期间静脉穿刺次数、呼吸暂停发生次数、体质量增长情况、低血糖持续时间和感染指标.结果 PICC组静脉穿刺次数为1.4±0.2,呼吸暂停发生次数为61.2±8.7,恢复到出生体质量的时间为(12.8±2.8)d,低血糖持续时间为(1.9±1.4)h,与PIV组比较均明显减少,差异有显著性(P＜0.05);而感染指标阳性率和静脉炎发生率两组差异无显著性(P＞0.05).结论 PICC是一种安全可靠的静脉置管术,是有效地应用于VLBWI的长期通畅的静脉通道.     

脐静脉联合外周中心静脉置管在极低出生体重儿中的应用

目的：研究脐静脉联合外周中心静脉置管在极低出生体重儿中的应用。方法：回顾性分析新生儿重症监护病房极低出生体重儿脐静脉联合外周中心静脉置管的应用,比较导管组（63例）与非导管组（38例）在院内感染、体重增长情况及住院天数方面的差异。结果：导管组院内感染率（17%）与非导管组感染率（24%）差异无统计学意义;导管组体重增长（11.7±2.0 g/kg?d）明显高于非导管组（10.6±2.3 g/kg?d）;导管组的住院天数（40±11 d）明显短于非导管组（45±14 d）;导管组早产儿相关并发症的发生率与非导管组的差异没有统计学意义。结论：脐静脉联合外周中心静脉置管在极低出生体重儿的应用中,早产儿体重的增长显著优于非导管组,住院天数明显缩短,而且院内感染有下降的趋势。     

地塞米松溶液预处理外周静脉置入中心静脉导管预防早产儿静脉炎随机双盲对照试验

目的 探讨地塞米松溶液预处理导管在预防早产儿经外周静脉置入中心静脉导管（PICC）所致静脉炎中的可行性及安全性。方法 186例需行PICC置管术的低出生体重儿随机分为两组。两组均采用标准操作规范置入PICC,地塞米松组92例置管前使用地塞米松0.08 mg·mL-1稀释液50 mL浸泡PICC导管,生理盐水组94例使用生理盐水50 mL浸泡PICC导管,浸泡时间均为5 min。比较两组患儿置管术后静脉炎的发生率、出现时间、严重程度及其他导管相关并发症发生情况。结果 地塞米松组静脉炎发生率14.1%（13/92）,平均出现时间为（4.4±1.0）d,生理盐水组分别为33.0%(31/94)和(2.8±0.8)d,地塞米松组静脉炎严重程度低于生理盐水组,两组间差异均有统计学意义（P<0.05）。两组其他置管相关并发症发生率差异无统计学意义（P>0.05）。结论 在早产儿PICC置管前,使用地塞米松溶液预处理导管,能降低PICC所致静脉炎发生率及其严重程度,且能延缓静脉炎出现时间,未增加其他导管相关并发症。     

极低出生体重早产儿经不同静脉途径留置中心静脉导管的应用评价

目的探讨极低出生体重早产儿经外周中心静脉置管(PICC)时选择不同静脉穿刺的临床效果。方法选择2004年4月至2011年3月本院新生儿重症监护病房进行PICC的极低出生体重早产儿,回顾性分析经不同外周静脉置入中心静脉导管的一次穿刺成功率及并发症发生率,分析并发症的原因及防治。结果共有238例极低出生体重早产儿进行PICC,一次穿刺成功227例,成功率95.4%,不同静脉一次穿刺成功率差异无统计学意义(P>0.05)。经贵要静脉置管的并发症最少,并发症发生率3.4%,应作为首选,其次为腋静脉和肘正中静脉。当肘部静脉被破坏时可选择腋静脉或下肢静脉途径。结论为极低出生体重早产儿行PICC时,应综合分析各种静脉途径利弊选择最合适的血管,首选贵要静脉。     

脐静脉置管在极低或低出生体重儿的应用

目的 探讨脐静脉置管在极低或低出生体重儿的应用.方法 对我科新生儿重症监护病房2011年6月至2013年1月进行脐静脉置管术的极低或低出生体重儿置管术后的临床情况进行总结.结果 63例患儿均成功置管,其中成功置管于下腔静脉41例(65.1％).留置时间4～21 d,平均12.9d.留置导管期间非计划拔管11例,其中置管于脐静脉非计划拔管8例,不同置管位置的非计划拔管发生率差异有统计学意义(x2=8.38,P＜0.01).本组均在生后36 h内插管,插管时间不同的患儿置管于下腔静脉成功率差异无统计学意义(x2=0.223,P＞0.1).置管期间5例发生疑似导管相关感染,感染率为6.2/1000血管内导管日,63例拔管后同时行导管末端培养和血培养,结果导管末端细菌培养阳性1例(1.6％),酵母样真菌阳性1例(1.6％),导管留置时间不同的患儿导管相关感染发生率的差异无统计学意义(x2 =0.075,P＞0.95).结论 脐静脉置管术可以在早产(极)低出生体重儿出生后早期应用.     

周围中心静脉导管在极低体重儿运用的临床对照观察

目的　探讨经皮插入中心静脉导管 (PICC)在极低体重儿 (VLBW )运用的临床价值。方法　采用经皮插入中心静脉导管治疗 40例极低体重儿 ,并与同期运用外周静脉穿刺术 (PIV)治疗的 3 7例极低体重儿进行临床观察。结果　PICC组与PIV组比较 :穿刺次数、住院时间减少 ,结果具有显著性差异 ;静脉运用时间、血培养阳性率及病死率无显著性差异。入院 3 0d两组体重比较 ,结果具有显著性差异 ;两组肝功能、肾功能、血电解质、血脂异常及高血糖的发生率无显著性差异 ,而低血糖的发生率具有显著性差异 ;PICC组 40例拔管的原因 ,其中不再需要 2 1例、感染 5例、机械并发症 6例、死亡 4例及其它 4例。结论　PICC可以方便的提供极低体重儿静脉营养 ,顺利过渡到胃肠道喂养 ;PICC减少了极低体重儿静脉穿刺的次数 ,从而减少人为的过度刺激 ,降低氧和能量的消耗 ;PICC可以使极低体重儿体重增长迅速 ,减少住院时间 ,而并发症的发生率低     

经外周静脉置入中心静脉导管在早产儿中的应用

目的探讨经外周静脉置入中心静脉导管(PICC)在早产儿中应用的价值。方法胎龄(31.0±2.17)周、出生体质量为(1430±200)g早产儿41例经肘正中静脉、贵要静脉、头静脉置入中心静脉导管,术后及时X线检查确定和调整导管的位置。结果经右上肢静脉穿刺30例,左上肢静脉穿刺11例,右肘正中静脉穿刺成功率最高(43.9%)。导管顶端到达位置上腔静脉20例,锁骨下静脉12例,右心房2例,颈静脉4例,腋静脉3例。导管置入长度(12.45±2.34)cm,经右侧上肢置入长度(11.87±1.96)cm,经左侧上肢置入长度(14.05±2.63)cm。导管留置时间(17.95±7.92)d,左右侧上肢留置时间无显著差异。穿刺时日龄(7.39±3.79)d,体质量(1320±180)g,拔管时体质量(1720±320)g。24例计划性拔管,其他原因拔管4例导管感染,2例脱管,2例导管折断,3例静脉炎,6例堵管。治愈37例,4例自动出院。结论应用PICC能安全、有效地用于低出生体质量早产儿。提高置管水平,加强导管护理,是减少PICC术后并发症的关键。     

静脉营养液中加入小剂量肝素预防新生儿中心静脉置管相关感染

目的：经外周导入中心静脉置管（PICC）是危重新生儿长期静脉营养的有效途径之一,但导管相关性感染（CRI）是其常见并发症。本研究对全合一静脉营养液中加入微量肝素持续输注对PICC相关感染的预防作用进行观察,探讨减少CRI的有效措施。方法：83例行PICC置管的患儿分为两组,肝素组（n=43）在营养液中加入肝素0.5 U/mL,对照组（n=40）不加肝素,观察两组CRI的发生情况。结果：肝素组发生导管堵塞2例（5%）,对照组8例（20%）;肝素组导管内细菌定植1例（2%）,对照组7例（18%）;肝素组无一例发生导管相关血流感染,对照组5例（13%）,两组相比差异均有显著性（P＜0.05）。结论：静脉营养液中加入小剂量肝素可减少PICC堵管,预防CRI的发生。［中国当代儿科杂志,2009,11（12）：983-985］     

新生儿上肢静脉与下肢静脉PICC置管效果比较的Meta分析

目的 通过Meta分析方法比较新生儿经上肢静脉和经下肢静脉行经外周置入中心静脉导管（PICC）的置管效果。方法 检索中国知网、万方、维普中文科技期刊、中国生物医学文献以及PubMed、Web of Knowledge、EMBASE、Medline、Cochrane图书馆、Google Scholar等数据库中有关新生儿经上肢静脉行PICC与经下肢静脉行PICC置管效果比较的对照研究,采用RevMan 5.3软件对符合要求的研究进行Meta分析。结果 共纳入18项研究,其中8项为随机对照研究,10项为队列研究,包含研究对象4 890例。经下肢静脉行PICC组的并发症发生率（RR=0.83,95% CI：0.75~0.92,P < 0.05）、感染发生率（RR=0.77,95% CI：0.60~0.99,P < 0.05）、导管异位发生率（RR=0.28,95% CI：0.18~0.42,P < 0.05）、液体渗漏发生率（RR=0.52,95% CI：0.40~0.70,P < 0.05）、非计划性拔管率（RR=0.82,95% CI：0.69~0.98,P < 0.05）均低于经上肢静脉PICC组,一次穿刺成功率高于上肢静脉PICC组（RR=1.17,95% CI：1.05~1.30,P < 0.05）,留置时间短于上肢静脉组（MD= -0.93,95% CI：-1.26~0.60,P < 0.05）。结论 目前证据表明,新生儿经下肢静脉行PICC优于上肢静脉。     

Randomized controlled trial of heparin for prevention of blockage of peripherally inserted central catheters in neonates

Aim: To determine whether the addition of heparin to total parenteral nutrition (TPN) fluid would prevent blockage of peripherally inserted central catheters (PICCs) in neonates. Methods: This was a randomized, double-blind, controlled study of 66 eligible neonates with PICCs inserted for the administration of TPN. Infants were randomized to receive TPN containing either 1 IU ml 31 of heparin (n = 35) or no heparin (n = 31). Results: There was no significant difference in the incidence of blocked catheters between the two groups of infants (heparin: 14.3%; no-heparin: 22.6%, p = 0.4). Although a higher percentage (62.9%) of infants in the heparin group received a complete course of TPN successfully via PICC than those in the no-heparin group (48.4%), the difference was not statistically significant ( p = 0.3). There were no significant differences in the incidence of catheter-related sepsis, hypertriglyceridaemia, hyperbilirubinaemia, coagulopathy or intraventricular haemorrhage between the two groups. Conclusion: Addition of heparin to TPN fluid was not associated with a significant reduction in the incidence of blocked PICCs. However, the sample size of this study was too small to exclude even rather marked differences between the groups.     

Use of double-lumen umbilical vein catheters in a neonatal intensive care unit]

BACKGROUND: The aim of the study was to compare the success/failure rate and complications of insertion into the umbilical vein, of either double-lumen catheters (Charrière diameter 04, length 13 and 30 cm) or single-lumen catheters (Charrière diameter 05, length 40 cm) in a population of neonates admitted to a neonatal intensive care unit. The numbers of insertions of additional peripheral venous catheters were also compared. PATIENTS AND METHODS: The population was divided into two groups according to the severity of the respiratory failure. Group 1 (n = 52): normal hemodynamic parameters and moderate respiratory failure (FiO2 < 0.6): only single-lumen catheters were used. Group 2 (n = 56): low systemic pressure requiring vascular filling and/or inotropic drugs infusion and/or severe respiratory failure (FiO2 > 0.6): in this group, either single-lumen catheters or double-lumen catheters were inserted. RESULTS: The success rate of insertion of double-lumen catheters and of single-lumen catheters were similar (61% vs 71%: P = 0.7). Nineteen double-lumen catheters were inserted in the group 2. The average duration of double-lumen umbilical catheterization was not significantly different from simple-lumen catheterization (4.9 +/- 2.2 vs 4.6 +/- 2.2 days). Complications relating to the umbilical venous catheterization were uncommon: three catheter obstructions (two with single-lumen catheter, one with double-lumen catheters), two nosocomial infections (both with single-lumen catheter), one hydropericardium (with single-lumen catheter). In group 2, more peripheral venous catheters were required during the first 72 hours of life after insertion of single-lumen catheter than after insertion of double-lumen catheters (average number of peripheral venous catheters per infant: 1.6 +/- 0.83 vs 1 +/- 0.35 respectively; P < 0.01). CONCLUSION: Feasibility and complication rate of umbilical double-lumen catheters were similar to those of single-lumen catheters. The use of umbilical double-lumen catheters reduces the need of peripheral venous catheters.     

Retained central venous lines in the newborn: report of one case and systematic review of the literature

The use of percutaneously inserted central catheters (PICCs) is an established practice in most NICUs. With the widespread use of these catheters, an increasing number of PICC complications has been reported in neonates. We present one case of a PICC retained and tethered in the vein in a very low birth weight infant, as well as a systematic review of PICC retention cases. Ten previous cases of PICC retention in neonates were found. Among those cases, the most common associated factors were coagulase-negative staphylococcus catheter colonization/bactcremia and long duration of catheterization. Occlusion was not a usefiul sign for predicting catheter retention. Once retention was established, heparin or urokinase instillations were ineffective. Although surgical exploration was sometimes required, firm, continuous traction applied to the catheter over several hours or intermittent, moderately strong pulling maneuvers were successful in 44.4 percent of the cases in which they were performed. Traction did not show major side effects. Our case provides additional support for use of traction as the initial approach in the management of this rare complication.     

Papaverine prolongs patency of peripheral arterial catheters in neonates

OBJECTIVE: To test the hypothesis that the continuous infusion of papaverine-containing solutions in peripheral arterial catheters would decrease the catheter failure rate and increase the functional duration of the catheter in neonates. STUDY DESIGN: In a prospective, randomized, placebo-controlled, masked trial, 82 catheters were placed in 70 neonates in the papaverine group and 98 catheters were placed in 71 neonates in the placebo group. RESULTS: The catheters in the papaverine group remained functional for a significantly longer duration than those in the placebo group. The median (25th%, 75th%) time before catheter failure was 16.6 (9.5, 24.3) days in the papaverine group and 12 days (6.1, 18.2) in the placebo group ( P = .023; Cox proportional hazards model). There was no significant difference in the incidence of intraventricular hemorrhage (IVH) between groups, and there was no evidence of hepatic toxicity. CONCLUSIONS: The continuous infusion of papaverine-containing fluids prolongs the patency of peripheral arterial catheters in neonates. In this small number of infants, we found no difference in the incidence of IVH or hepatic toxicity.     

基于中国新生儿协作网的极早产儿中心血管导管使用情况的横断面调查

背景 近年来中国极早产儿救治数量显著增加,中心血管导管已成为国内NICU的常用技术,极早产儿救治中可能存在中心血管导管的不合理使用,但目前尚缺乏其使用现况数据.目的 通过回顾采集和分析中国新生儿协作网(CHNN)数据库正式运行第1年极早产儿中心血管置管现况,并对各医院进行问卷调查,以期发现当前极早产儿中心血管导管使用中...