PICC置管中延迟撤除支撑导丝对颈内静脉导管异位复位成功率的影响

目的探讨经外周静脉置入中心静脉导管（PICC）时延迟撤离支撑导丝对颈内静脉导管异位复位成功率的影响。方法将2013年1月至2014年1月行PICC的316例患者随机分为对照组和观察组各158例。对照组在导管置入预测长度后撤离支撑导丝,再用超声探头探查颈静脉,确认导管无异位后修剪导管并连接正压接头,如发现导管异位立即在无菌条件下行复位;观察组在导管置入至预测长度后立即用超声探头探查颈静脉,如导管无异位再撤离支撑导丝,修剪导管并连接正压接头,如发现导管异位及时在支撑导丝作用下行复位。对比两组患者在置管过程中颈内静脉导管异位的发生率、复位成功率以及平均复位时间的差异。结果观察组发生导管异位30例,其中颈内静脉导管异位29例;对照组发生导管异位32例,其中颈内静脉导管异位27例。观察组颈内静脉导管异位发生率（18.35%）与对照组（17.09%）比较,差异无统计学意义（P〉0.05）;但复位成功率（96.55%,28/29）高于对照组（77.78%,21/27）,平均复位时间（5.70±1.22）min]短于对照组（8.90±2.53）min],差异均有统计学意义（χ2=4.51,t=6.10,P〈0.05）。结论在超声引导下应用赛丁格技术行PICC术中,导管送至预测长度后常规探查颈静脉,排除颈内静脉导管异位后撤除支撑导丝,有利于颈内静脉导管异位的复位。

Influence of delaying removal of bracing guide wire on successful rate of catheter misplacement restoration during catheterization of PICC

Objective To investigate the effect of delaying removal of bracing guide wire on successful rate of catheter misplacement restoration in the process of peripherally inserted central catheter（PICC）. Methods A total of 316 patients,who were with PICC from January 2013 to January 2014,were randomized into control group and observation group,158 cases in each group. After arriving prediction length,the bracing guide wire was withdrew in the control group,the ultrasonic probe was used to detect jugularvein to trim the catheter and connect bonding head of positive pressure after confirming the catheter was not mis-placed,but if the catheter was misplaced,it should be restored in sterile conditions as soon as possible. After arriving prediction length,the jugularvein was ultrasonic detected by probe immediately in the observation group,the bracing guide wire was with-drew to trim the catheter and connect the positive bonding head after confirming the catheter was not misplaced ,but if the catheter was misplaced,it should be restored under bracing guide wire timely. The incidence rate,restoration rate and mean time-consum-ing of catheter misplacement in jugular vein during catheterization of the two groups were compared. Results The incidence rate of catheter misplacement in jugular vein between the observation group（18.35%） and control group（17.09%） had no statistically significant difference（P〉0.05）,but the difference on successful rate and between the observation group（96.55%,28/29） and the control group（77.78%,21/27） mean time（5.70＆#177;1.22）min,（8.90＆#177;2.53）min] had statistical significance（χ2=4.51,t=6.10,P〈0.05）. Conclusion In the application of modified Seldinge technique（MST） under the guidance of ultrasound in PICC,convention de-tection after the catheter arriving prediction length and removal of bracing guide wire after excluding phlebectopia are beneficial to the restoration of catheter misplacement in jugular vein.