心电图引导PICC导管心房内定位的规范化流程管理

目的提高恶性肿瘤化疗患者PICC置管成功率和维护质量,确保化疗顺利进行。方法成立循证护理小组,制定心电图引导PICC导管心房内定位置管标准化操作与管理流程;对60例恶性肿瘤患者行PICC置管化疗。结果 60例患者均一次置管成功,PICC留置35～129d,平均69.0d,无一例发生PICC置管相关并发症;患者满意率100%。结论循证后制定的规范化流程用于心电图引导PICC导管心房内定位置管,可提高PICC置管成功率和维护质量,提高患者满意度。     

超声探头颈内静脉阻断法减少PICC置管异位

目的探讨减少PICC置管术中导管颈内静脉异位的有效方法。方法选择符合纳入标准需行PICC置管治疗的106例患者作为研究对象,按照随机数字表法分为对照组与观察组各53例。对照组给予常规的患者上肢外展与躯干呈90°体位,当导管头端到达肩部时采用偏头法阻断颈内静脉;观察组采用视锐Ⅴ超声探头压迫法阻断颈内静脉,比较两组异位发生率。结果观察组导管异位发生率3.77%,显著低于对照组的20.75%(P0.01),两组胸廓内静脉异位、奇静脉异位、锁骨下静脉返折发生率比较,差异无统计学意义(均P0.05)。结论 PICC置管操作中,采用视锐Ⅴ超声探头压迫法可显著提高导管一次到位率,降低术中导管颈内静脉异位发生率,减少置管过程中调管次数。     

End-stage vascular access: direct intra-atrial insertion of a dialysis catheter

Central venous occlusions are a frequent problem in hemodialysis patients. We describe the case of a patient with end-stage vascular access in whom we successfully inserted a direct intra-atrial dialysis line during coronary artery bypass grafting. This technique could be a significant contribution to patients in whom alternative vascular access options are exhausted.     

Right intra-atrial catheter insertion at the end stage of peripheral vascular access for dialysis

The number of patients with end-stage renal failure requiring dialysis keeps increasing every year. Many of these patients also suffer from peripheral arterial disease. We report the case of a middle age woman receiving dialysis who had undergone amputation of both lower limbs and suffered multiple deep venous thrombosis. Therefore, peripheral accesses for venous dialysis were not available. A catheter had to be implanted right into the right atrium.     

心电图对PICC尖端最佳位置定位及置管并发症的影响

目的探讨心电图定位技术对PICC尖端最佳位置及置管并发症的影响。方法将120例行PICC置管的成年肿瘤患者,按随机数字表分为对照组和观察组各60例。对照组在彩色多普勒超声机引导下使用改良塞丁格技术进行PICC置管。观察组在此基础上加用心电图引导PICC尖端定位。结果两组PICC置管到位率比较,差异有统计学意义(P0.05);观察组最佳位置到位率(83.33%),高于对照组(60.00%)。两组穿刺点渗血和机械性静脉炎发生率比较,差异有统计学意义(均P0.05)。结论心电图定位法可以提高PICC尖端最佳位置的到位率,减少置管相关并发症发生。     

Depth of a central venous catheter tip: length of insertion guideline for pediatric patients

BACKGROUND: In pediatric patients, several studies have been undertaken to establish central venous catheter (CVC) tip optimal depth. Assessments of catheter tip position using chest radiographs may be misleading, whereas transesophageal echocardiography (TEE) has been shown to accurately monitor catheter tip placement at the superior vena cava-right atrial (SVC-RA) junction. The aim of this study was to issue a guideline for ideal catheter insertion depth, from the right internal jugular vein (IJV) using TEE to confirm the position of the catheter tip at the SVC-RA junction. METHODS: Over a 6-month period, we studied 60 right internal jugular vein catheterizations in infants and children undergoing surgery for congenital heart disease. Positions of CVC tips were confirmed to be at the SVC-RA junction by TEE. Distance from the skin puncture site to the SVC-RA junction, height, weight, and age were recorded. RESULTS: Distances measured were found to be highly correlated with patient height. The following guideline allows the CVC tip to be positioned above the RA in 97.5% of patients with an accuracy of 95%: optimal depth of insertion (cm) = 1.7 + (0.07 x height) in patients whose height is between 40 and 140 cm. CONCLUSION: The model proposed for the insertion of the CVC tip in pediatric patients could be used to prevent inadvertent catheter tip placement into the atrium.     

心电图引导中心静脉导管置管与传统置管法效果比较的系统评价

目的比较心电图引导下的中心静脉置管法与传统穿刺置管法的效果。方法系统检索Cochrane图书馆、PubMed、Web of Science、EMBASE、CINAHL、ACP Journal Club、中国生物医学文献数据库、中国知网、万方数据库、维普期刊全文数据库及随机对照实验注册网站中比较心电图引导中心静脉置管法与传统穿刺置管法的随机对照试验。采用RevMan5.2软件对数据进行分析。结果共纳入4项随机对照试验,Meta分析结果显示,心电图引导下的中心静脉置管法能显著增加导管尖端到位率(RR=1.45,95%CI=1.20~1.74,P0.01),置管深度尚难以作出比较,心电图引导法置管操作时间较传统穿刺置管法操作时间略长。在并发症发生率方面,两种置管法未显示出差异。结论与传统穿刺置管法相比,心电图引导的中心静脉置管法对提高导管尖端到位率有明显益处,是一种经济、安全、有效的中心静脉置管方法。     

The peripherally inserted central catheter (PICC): a prospective study of its natural history after cubital fossa insertion

A prospective cohort study was undertaken to describe the natural history of the cubital fossa peripherally inserted central catheter (PICC), determine which factors influenced the hazard of complication and develop a standard methodology for evaluation of a PICC service. A total of 4349 patient days of PICC observation were analysed using survival analysis techniques. The median time to PICC removal for a complication was 60 days. The most common complications were phlebitis, malposition and tip migration. Complications usually occurred during the first week. There was only one episode of line-related sepsis. Size 3 French gauge catheters had a complication rate of 7.3 per 1,000 line days compared to 14.2 for 4 French catheters (hazard rate 1.26 90% CI 1.02 to 1.55). PICCs requiring two or more attempts at insertion were more likely to develop complications than those inserted at the first attempt: 20 per 1,000 line days vs 10.5 but the confidence intervals were wide (hazard rate 1.91, 90% CI 0.90 to 4.05). Operator (amongst the four experienced operators who inserted all PICCs), arm of placement, or medial or lateral placement in the cubitalfossa did not influence PICC survivaL     

应用留置针修补PICC体外断管

采用留置针修补1例PICC体外断管,修补术后导管留置98d,在此期间血培养3次,均无细菌生长。提出24G直行BD留置针套入3FrPICC松紧度适中,固定牢固。修补导管过程中严格无菌技术操作;导管修补成功后加强导管的护理,防止药液外漏造成皮肤坏死,可延长PICC的使用寿命。     

Continuous ambulatory peritoneal dialysis: Technique of catheter insertion and management of associated surgical complications

Fifty-seven patients initiated continuous ambulatory peritoneal dialysis. All patients were generally pleased with this form of dialysis and particularly enjoyed the greater mobility and decreased dietary restriction. Complications associated with continuous ambulatory peritoneal dialysis include peritonitis, pericatheter infection, catheter malfunction, dialysate leak, and hernias of the abdominal wall.     

Anterograde insertion of ureteral catheter

We report twenty-four patients with urinary obstruction, in which twenty-seven antegrade ureteral stent (double J) insertions were attempted (in six patients the obstruction was bilateral and in three other patients we failed). In all of them access to the urinary tract was through a nephrostomy catheter, in seventeen cases we proceeded to insert the antegrade catheter immediately after percutaneous nephrostomy and in ten remaining cases we achieved in a second try after carrying nephrostomy and failing a conventional retrograde approach to ureteral stent insertion. We got a 90-per cent success rate. A case of perirrenal hematoma occurred after applying a nephrostomy. It was the only relevant complication. In conclusion we consider that the antegrade ureteral stent insertion is a good alternative when, under several circumstances, the conventional retrograde insertion fails.     

Simple process of management of central venous catheter]

In our institution, central venous catheterization is a routine procedure in terms of keeping the veins in terminal cancer patients and postoperative patients, as well as on purpose to perform high calorie transfusion. Here we describe our efforts to simplify the process. The process is characterized by the intermittent transfusion with filling up of 100-fold diluted heparin; no use of filter at the usage; but free side infusion from a trigonal active plug, which is also used for blood transfusion. These patients are permitted to bathe and stay out. During a recent 2 years, a total of 111 patients was managed with this process. Duration of catheterization ranged from the shortest of 5 days to longest of 96, with a mean of 27.5 and total days of 3058. Catheter-induced fever as a complication was observed in only 3 cases (2.7%). This procedure has a considerably simplified process, which can be said to depart from the conventional ones in terms of keeping clean, however, in actual clinical routine, it is extremely safe and valuable.     

Evaluation of epidural catheter tip position

Canadian Journal of Anesthesia/Journal canadien d'anesthésie -     

PICC置管术后导管堵塞的危险因素与护理进展

本文综述了PICC置管术后导管堵塞的危险因素包括血栓性因素和非血栓性因素及护理干预措施,即评估危险因素制定护理路径,心里干预健康教育等以期降低堵塞率。1 PICC导管堵塞的危险因素1.1血栓性因素:1.1.1患者情况:多为一般情况差,需长期卧床,大手术患者手术时间>60min,年龄>40岁,肥胖,肿瘤,心衰或呼吸功能衰竭,肾病综合征,化疗药物注射等因素,导致血流缓慢,血管内膜损伤,血液高凝     

Ureteral catheter tip separation: potential risk using the open-end Flexi-Tip ureteral catheter

Ureteral catheters are a vital part of the urological armamentarium. We report 2 cases in which the flexible tip portion of an open-end Flexi-Tip ureteral catheter became disjointed from the shaft within the renal collecting system during endourological procedures. The etiology, prevention and management of this complication are discussed.