4种深静脉置管的护理方法及应用比较

目的 对比颈内静脉置管、锁骨下静脉置管、股静脉置管和PICC置管方法在恶性肿瘤患者中的临床应用情况及利弊。方法 30例颈内静脉置管组，68例锁骨下静脉置管组，45例股静脉置管组，14例PICC置管组。分别记录穿刺成功率，操作所需时间及并发症发生情况。结果一次穿刺成功率，颈内静脉组为86．6％，锁骨下静脉组为89．7％，股静脉组为88．8％，PICC组为92．8％（P〉0．05）；4组深静脉置管的平均操作时间相似，没有明显差异（P〉0．05），PICC静脉置管的并发症高于其它3组，与颈内静脉组比较，有显著性差异（P〈0．05），与锁骨下静脉组比较有非常显著性差异（P〈0．01），但与股静脉组比较无明显差异（P〉0．05）。结论4种深静脉穿刺技术均为成熟的深静脉置管技术，在临床上可以互补。建立良好的深静脉置管的管理方法，掌握正确的置管技术、封管技术和换药技术，可以降低并发症的发生。

Nursing and Comparing of Four Patterns of Deep-vein Catheter Placement

Objective To compare the clinical advantages and disadvantages of four patterns of catheter placing to jugular vein,subclavical vein,femoral vein and central vein(peripheral inserted central catheter,PICC) respectively.Methods 30,68,45 and 14 cases were enrolled into jugular vein,subclavical vein,femoral vein and central vein group,respectively.The success rate of puncture,operating time and complications were documented during the whole process.Results The success rate on the first time were 86.6%,89.7%,88.8% and 92.8% corresponding to the four groups(P>0.05).The mean operating times of four groups were similar(P>0.05).The occurrence rate of complication of PICC group was higher than the other groups.Conclusion The four patterns of catheter placing are all successful and mutual complimentary techniques in clinical usage.Well establishing of deep-vein placing management,grasping correct puncturing,enveloping and wound changing technique may avoid the occurrence of complication.