经外周静脉置入中心静脉导管在危重患者中的常见并发症及护理

目的 探讨神经外科危重患者经外周静脉置入中心静脉导管（PICC）的常见并发症发生原因，同时总结并发症有效预防措施及护理对策。 方法 纳入2009年9月－2012年9月期间行PICC的190例神经外科重症住院患者，统计并发症发生率，对其原因进行分析，并开展针对性预防和护理。 结果 本组患者PICC置管后有75例发生不同类型并发症，其中置管时并发症17例，包括导管异位8例，送管困难6例，穿刺失败3例，发生率为9%；导管留置期间并发症58例，包括穿刺点渗血、渗液16例，意外拔管12例，静脉炎10例，导管部分脱出9例，导管堵塞7例，导管相关性感染3例，导管相关性静脉血栓1例，发生率为30.5%。根据其发生的不同原因，采取积极的治疗和护理措施，并发症得以治愈，降低了并发症发生率。 结论 规范护理流程，加强临床培训，熟悉和掌握PICC并发症的预防和护理措施，可提高PICC置管、使用的安全性。

Causes,Prevention and Nursing of the Complication in Critically Ill Neurosurgical Patients with Peripherally Inserted Central Catheter

Objective To investigate how to reduce common complications of the critically ill neurosurgical patients with peripherally inserted central catheter （PICC）, analyze the reasons, and summarize effective preventive measures and nursing cares for the complications. Methods Critically ill neurosurgical patients from treated with PICC between September 2009 and September 2012 were included in our study. The incidence of complication was statistically studied, and the causes were analyzed for taking corresponsive prevention and nursing measures. Results Among the 190 patients with PICC, 75 had various complications. Among them, 17 （9%） had catheter placement complications, including ectopic catheter in 8 cases, difficult pipe sending in 6 cases, puncture failure in 3 cases. Fifty-eight （30.5%） patients had complications during catheter indwelling, including puncture site bleeding and exudate in 16 cases, accidental extubation in 12 cases, phlebitis in 10 cases, partial catheter prolapse in 9 cases, catheter blockage in 7 cases, catheter-related infections in 3 cases, and catheter-related venous thrombosis in 1 case. Based on different causes of the complications, we took positive measures for treatment and nursing care. The complications of the patients with PICC were effectively controlled, and its incidence was observably decreased, and ultimately, the patients with complications were cured. Conclusion We can improve security of use and placement of PICC catheter through the method of specifying care process, strengthening clinical training, and mastering skillfully effective preventive measures and nursing cares for complications.