心电监护仪在新生儿PICC导管尖端定位中的应用

目的: 探讨心电监护仪辅助判断经外周静脉置入中心静脉导管(PICC)在新生儿导管尖端定位的准确性。方法: 对40例符合PICC指征的新生儿, 在置管前接心电监护, 调心电监护仪至Ⅱ导联, 所显示的心律为正常心电图。抽取0.9%氯化钠注射液10 ml 的注射器接5.5号头皮针并连接肝素帽, 排尽空气后, 与PICC的导管体外末端连接待用, PICC导管送至预订长度后, 将右胸导联夹与PICC的导管连接处头皮针相连接, 根据心电监护仪P波的变化, 判断导管尖端是否在上腔静脉, 并以胸部X线片结果作为判断利用心电监护仪辅助判断PICC的导管头端位置的准确度。结果: 40例中32例心电图有P波及P波特征性改变, 胸部X线片显示均在上腔静脉中或下段;4例不在位, 胸部X线片显示不在位;4例不确定, 胸部X线片显示3例不在位, 位于右心房下部1例。心电监护仪判断PICC头端位置的准确度92.5%。2种方法检查结果差异无统计学意义(P>0.05)。结论: 当心电监护显示有特征性P波时, 可判断导管头端位于上腔静脉中下段。无特征性P波或判断不确定时, 多提示导管头端异位。

The application of electrocardiography monitor in locating the tip of peripherally inserted center catheter in neonates

Objective:To investigate the locating tip accuracy of peripherally inserted center catheter ( PICC ) using electrocardiography( EKG) monitor in neonates. Methods:The EKG monitor in 40 neonates accorded with the PICC indications was implemented before the tube placement,the lead Ⅱ of EKG monitor was regulated to show normal EKG. The 10 ml syringe connecting with 5. 5 scalp needle and heparin cap was connected to the end of PICC. The prediction length of PICC was connected with the right chest clip. The catheter tip in the superior vena cava was judged by P wave of EKG monitor,the accuracy of locating tip of PICC was judged by chest X-ray. Results:Among the 40 cases, the characteristic changes of P wave in 32 patients were identified, which was showed in the middle and low segment of superior vena cava by chest X-ray. The chest X-ray showed that 4 cases were off position,3 cases in 4 uncertainty cases were off position,and 1 case located in the lower of right atrium. The accuracy of the locating tip of PICC using EKG monitor was 92. 5%. Conclusions:The characteristic P wave can judge the PICC tip locating in the middle and low segment of upper venous cavity. No characteristic P wave or uncertain judgment hint that the tube tip is heterotopia.