改良钝性分离技术在血小板减少病人PICC置管中的应用

目的探讨改良钝性分离技术在血小板减少病人PICC置管中的应用效果。方法选择行PICC置管且血小板 < 100×109/L、凝血功能正常的44例住院病人，随机分为2组，对照组21例病人采用可撕裂外鞘与扩张器组装后钝性扩皮置管，观察组23例病人采用改良钝性分离扩皮技术置管。比较2组一次送鞘成功率、置管后第1、3、5天穿刺部位疼痛程度以及置管后24h出血量和7d内维护次数。结果观察组一次性送鞘成功率为95.65%（22/23），对照组一次性送鞘成功率为85.71%（18/21），2组比较差异无统计学意义（P>0.05）。观察组疼痛程度较对照组低（P < 0.05）。观察组置管后24 h穿刺点渗血纱布层数及置管后7 d内换药次数均较对照组少（P < 0.05和P < 0.01）。结论采用改良钝性分离技术，对于血小板减少病人可明显减少穿刺点出血量及导管维护次数，减轻疼痛与紧张，提高病人满意度，值得临床推广使用。

Application value of the improved blunt separation technique in peripherally inserted central catheter in thrombocytopenia patients

ObjectiveTo investigate the application effects of the improved blunt separation technique in peripherally inserted central catheter(PICC) in thrombocytopenia patients.MethodsA total of 44 normal clotting function patients with platelet count less than 100×109/L treated with PICC were randomly divided into the observation group(23 cases) and control group(21 cases).The control group was cathetered with the tearable sheath and dilator to assemble blunt separation method to expand the skin, and the observation group was cathetered with the improved blunt separation technique.The success rate of primary sheath delivery, pain degree at the puncture site after 1, 3 and 5 days of cathetering, bleeding volume after 24 h of cathetering and maintenance times within 7 days were compared between two groups.ResultsThe success rates of primary sheath delivery in observation group and control group were 95.65%(22/23) and 85.71%(18/21), respectively, and the difference of which was not statistically significant(P>0.05).The pain degree in observation group was lower than that in control group(P < 0.05).The number of layers of errhysis gauze at puncture point within 24 h of cathetering and times of dressing change within 7 d of cathetering in observation group were less than those in control group(P < 0.05 and P < 0.01).ConclusionsImproved blunt separation technique can significantly reduce the bleeding volume at the puncture point and number of catheter maintenance, relieve the pain and tension, and improve satisfaction of thrombocytopenia patients.It is worthy of promotion.