彩色多普勒超声实时引导经外周静脉穿刺置入中心静脉导管的实用价值

目的 探讨彩色多普勒超声实时引导下,经上肢静脉穿刺置入中心静脉导管的方法与临床实用价值.方法 选择需要长期静脉输液、给药,采用传统穿刺置管方法无法实施或穿刺失败的患者197例,在彩色多普勒超声实时跟踪引导下,选择上肢最合适穿刺静脉,确立最佳穿刺点及穿刺角度进行穿刺置管,将静脉导管置入中心静脉内,要求导管尖端位于上腔静脉中下1/3处.结果 本组197例患者穿刺成功率为100%,穿刺血管的选择：左上肢静脉95例,右上肢静脉102例;选择贵要静脉150例,肱静脉24例,头静脉14例,肘正中静脉9例;穿刺时间为20 s～22 min;仅有5例出现穿刺局部血肿,无神经损伤等其他并发症发生;超声对导管尖端定位的准确性达96.95%（191/197）.结论 彩色多普勒超声引导经上肢静脉穿刺置入中心导管的方法安全可靠,成功率高,并发症少,可明显缩短穿刺间,具有很高的临床实用价值,值得推广应用.     

超声引导下老年患者外周静脉穿刺中心静脉置管术的临床价值

目的:探讨超声引导下老年患者外周静脉穿刺中心静脉置管术的临床价值。方法:选择2016年5月至2019年9月本院收治的老年住院患者80例为研究对象,按照随机数字表法分为两组,各40例。所有患者均进行经外周静脉穿刺中心静脉置管术,其中对照组实施常规肉眼盲探操作,观察组行超声引导下操作,比较两组准备耗时及穿刺操作耗时;统计两组1次穿刺成功率及发生的并发症。结果:观察组穿刺操作耗时显得短于对照组(P<0.05),观察组1次穿刺成功率显著高于对照组(P<0.05),观察组发生渗漏、堵管、感染及尖端异位的比例显著低于对照组(P<0.05)。结论:超声引导下老年患者PICC置管,具有操作时间短,成功率高,并发症少等特点,值得临床推广。     

彩色多普勒超声对早产儿外周穿刺中心静脉置管术可行性的探讨

目的通过彩色多普勒超声,对已行外周穿刺中心静脉导管术(PICC)的早产儿上肢静脉血流进行观察,探讨PICC的可行性。方法以腋静脉为观察对象,应用彩色多普勒检测56例拔管前和26例拔管后早产儿置管侧与对侧收缩期最大流速Vs、舒张期最大流速Vd及管径D。并按置管时间分为≤15d,1530d3组,将置管侧与对侧相比较。结果置管侧Vs明显低于对侧(14.37±4.43Vs20.71±4.81,P<0.01),Vd明显低于对侧(9.80±2.83Vs13.52±3.04,P<0.01),管径明显粗于对侧(0.24±0.02Vs0.19±0.02,P<0.01),各时间组上述各参数均P<0.01。拔管后各参数差异无显著性意义。结论PICC可引起上肢静脉血流速度的减慢,但拔管后无不良影响,不失为一种很好外周给药方法,但必须在临床和彩色多普勒的密切监视下。     

超声引导下经外周静脉穿刺中心静脉置管的临床价值

经外周静脉穿刺中心静脉置管（PICC）在临床上应用越来越广泛,如何提高穿刺置管成功率是临床面临的一个新的课题.本研究对20例在超声引导下经贵要静脉穿刺中心静脉置管的病例进行回顾性分析,总结如下.……     

超声引导下经肘上外周穿刺置入中心静脉导管的效果观察

目的探讨超声引导下经肘上外周穿刺置入中心静脉导管（peripherally inserted central venous catheters．PICC）的应用效果。方法将108例需行PICC置管的患者随机分为观察组和对照组,对照组行常规PICC,观察组在超声引导下经肘上行PICC。比较两组患者的置管成功率、并发症（血栓形成、穿刺部位渗血、脱管堵管和机械性静脉炎）的发生情况以及患者的满意度、舒适度。结果两组患者置管成功率、相关并发症总发生率、患者置管满意度和舒适度方面的差异具有统计学意义（均P〈0．05）。其中观察组置管成功率为94．4％（51／54）,高于对照组的74．1％（40／54）;并发症总发生率为11．8％（6／51）,低于对照组的42．5％（17／40）;满意度和舒适度分别为94．1％（48／51）、88．2％（45／51）,高于对照组的75．0％（30／40）、62．5％（25／40）。结论与常规PICC相比,超声引导下经肘上外周穿刺中心静脉置管可提高置管成功率,降低患者并发症,提高其满意度和舒适度。     

彩色超声在引导经外周静脉置入中心静脉导管病例中的应用价值

经外周静脉置入中心静脉导管 （peripherally inserted central catheters,PICC）是将外周中心静脉导管由肘窝静脉沿血管送入上腔静脉的一种方法,已发展成为一种方便、有效、安全的置管技术[1,2].但因肥胖、反复插管所致血管条件差及血管硬化等因素影响,部分患者的置管成功率很低.     

彩色多普勒超声在中心静脉穿刺置管术中的应用

<正>中心静脉穿刺置管术常用于长期输液、营养治疗或危重症患者。中心静脉穿刺置管术的传统操作采用盲探式,主要借助患者自身的解剖标志进行定位,但穿刺风险较高,如误穿动脉、造成气胸、血肿形成、导管易位及死亡等,晚期可并发感染、导管失效、导管或静脉血栓形成和肺栓塞等,给患者带来痛苦,甚至引起医疗纠纷[1]。依靠解剖标志定位行中心静脉穿刺置管术也存在一定的局限性,如肥胖、多次置管、解剖变异、躁动等常导     

超声引导下行锁骨下静脉穿刺置入中心静脉导管的效果分析

摘要 目的 分析超声定位引导下锁骨下静脉穿刺置管的成功率、并发症和置管后感染率。方法对360例患者分别采用超声定位引导术和解剖标志点盲探穿刺置管术两种方法进行锁骨下静脉穿刺置管,观察对比其效果。结果超声组与对照组对比,穿刺成功率、长期留置感染率和并发症发生率三项指标的差异均有统计学意义（P＜0.05）,超声组显著优于对照组。结论超声引导下锁骨下静脉穿刺成功率高、感染率低、安全性好,对于静脉穿刺困难患者有重要的临床应用价值。     

38例超声引导下留置经外周置入中心静脉导管的体会

经外周置入中心静脉导管（peripherally inserted central Catheters ,PICC ）穿刺成功的首要条件是有可视或可触及的置管静脉,而对于肥胖、反复化疗、水肿等病人来说,常规PICC置管方法成功率会明显降低.超声引导下PICC穿刺因其具有可以直观地显示血管的解剖结构、实时引导、缩短穿刺时间、减少并发症等优势[1,2],不仅能减轻穿刺病人的痛苦,同时为病人提供了一种安全有效的输液途径.我院于2012年2月引进了超声引导下PICC置管技术,共为38例置管困难病人成功置管,其中有3例置管存在不足.现将超声引导下留置PICC体会介绍如下.     

经外周静脉穿刺置入中心静脉导管的置管护理新进展

经外周静脉穿刺置入中心静脉导管(peripherally inserted central catheters,PICC)是一种从周围静脉导入且末端位于中心静脉的深静脉置管技术,适用于中长期静脉输液、肿瘤化疗、肠外营养、老年患者输液[1],也可用于大面积烧伤、大手术、危重患者的抢救治疗.为了提高PICC置管操作技能,笔者收集国内外同行已经取得的宝贵经验,结合本科室近3年98例血液病患者置管的操作体会进行研究、总结,现综述如下.     

外周中心静脉导管与周围静脉留置针在肿瘤化疗中应用的效果比较

目的 评价外周中心静脉导管(PICC)和周围静脉留置针(PIV)在肿瘤化疗中的应用效果.方法 将180例静脉化疗的肿瘤患者随机分为观察组(PICC组)108例和对照组(PIV组)72例.比较2组留置时间及并发症发生情况.结果 观察组并发症发生率明显低于对照组,留置时间却长于对照组.2组细菌培养阳性率比较无显著差异.结论 PICC安全可靠,可减少静脉导管相关并发症的发生率和静脉穿刺的次数,值得临床推广.

Abstract：

Objective To investigate the clinical effectiveness of peripherally inserted central catheters(PICC) and peripheral intravenous catheters(PIV) in tumor chemotherapy. Methods A total of 180 patients with intravenous chemotherapy were randomly divided into two groups. 108 patients in the PICC group, 72 patients in the PIV group. The holding time and complications were observed and compared. Results The rate of complication in the PICC group were much lower than the PIV group, however was much longer than the PIV group in holding time. But there was no statistical difference in the positive culture rate of bacteria of two groups. Conclusions It is very safe to use PICC which can reduce the rate of complication of catheters and venipuncture times and is worthy of spreading in practice.     

Long-term use of peripherally inserted central venous catheters for cancer chemotherapy in children

Background Peripherally inserted central venous catheters (PICCs) have been increasingly used in pediatric patients. However, little is known about the incidence and risk of complications when using this device in children with cancer. The purposes of this study are to assess the feasibility of PICCs and to determine the risk factors for PICC-related complications in pediatric patients with various types of malignancies.Patients and methods We attempted to place PICCs in 53 patients with a median age of 5 years ranging from 2 months to 20 years. PICCs were used to administer fluid, parenteral nutrition, anticancer agents, antibiotics, and blood products and also for the through-line blood sampling. The duration of catheterization and the incidence of PICC-related complications requiring removal were retrospectively evaluated in association with the diagnosis, sex, age and body weight of the patients, size, insertion site and tip location of the catheters, type of treatment, and duration of leukopenia.Results PICCs were successfully placed in 109 of 112 attempts (97.3%) in 53 patients, and they were followed for a total of 11,797 catheter days (median placement, 87 days; range, 3 to 512 days). Fifty five PICCs (50.5%) were removed as a result of PICC-related complications with a rate of 4.66 per 1,000 catheter days. The most common reasons for catheter removal were occlusion (n=18), breakage/leakage (15), and infection (10). More than 70% of such complications occurred more than 30 days after placement. The catheter tip location in the superior vena cava or the right atrium might decrease the risk of complications. Other parameters did not influence the incidence of complications.Conclusions PICCs were found to provide a reliable access for prolonged intravenous administration and blood sampling in children intensively treated for hematologic and solid malignancies, thus leading to a reduction of physical pain and psychological stress in such patients. However, the long-term placement of PICCs may also be related to an increased risk of complications.     

两种导管在外周中心静脉置管中的应用

目的探讨两种导管在外周中心静脉置管中应用的效果。方法选取肿瘤患者65例,按单双日随机分成中心静脉导管组(35例)和PICC导管组(30例),观察两种导管置管的应用情况。结果两种导管置管在操作时间、操作中渗血量、一次置管成功率等方面的比较具有统计学意义(P<0.05),并发症的发生及平均置管天数无统计学意义(P>0.05)。结论中心静脉导管组置管可用于肿瘤手术患者较长时间的补液和术后常规化疗的患者,而对于非手术、需长时间化疗、需大剂量使用刺激性强的化疗药物的患者,则应选用PICC导管置管。     

Complications of upper extremity versus lower extremity placed peripherally inserted central catheters in neonatal intensive care units: A meta-analysis

ObjectiveTo compare the risks of catheter-related complications between peripherally inserted central catheters placed via the upper and lower extremities in neonatal intensive care units.Research methodologyPUBMED, EMBASE, SCOPUS, and the Cochrane Library databases were searched from inception to 3 January 2019. All studies were of patients in neonatal intensive care units who underwent insertion of peripherally inserted central catheters and were published in English.ResultsEight studies covering 4405 peripherally inserted central catheters were included. The upper extremity group was associated with a higher risk of non-elective removal (OR = 1.41; 95% 1.16–1.72; p = 0.0007) and malposition (OR = 4.52, 95% CI 2.16–9.47; p < 0.0001) and a lower risk of thrombosis (OR = 0.23, 95% CI 0.07–0.77; p = 0.02) compared with the lower extremity group. There was no significant difference in mechanical complications, catheter-related infection, or phlebitis.ConclusionThis meta-analysis showed that the lower extremity group was not associated with worse outcomes compared with the upper extremity group in the neonatal intensive care unit, with the exception of thrombosis. However, further prospective randomised controlled studies are needed to ensure the quality of the results.     

超声引导下经上臂贵要静脉和肱静脉穿刺行PICC的并发症比较研究

目的探讨超声系统引导下的改良塞丁格技术（MST）选择肱静脉行经外周静脉穿刺置入中心静脉导管（PICC）置管术在临床患者中应用的可行性和并发症的发生率。方法回顾分析本院超声引导下经上臂贵要静脉和经肱静脉穿刺行PICC患者的临床资料,比较2种穿刺途径在并发症发生率上的差异,并试图找出并发症发生的独立危险因素。结果2种置管途径在各种并发症发生率上均无统计学差异;非1次成功置管和非恶性肿瘤患者是PICC并发症发生特别是感染发生的独立危险因素。结论超声引导下PICC穿刺可以避开血管内的不良因素,避开静脉瓣,从肘上较粗的肱静脉穿刺置管,减少了肘部运动时导管对血管壁的刺激以及导管在血管内外的进出,从而减少了血管相关性感染、机械性静脉炎等并发症的发生,尤其可以直接选择深静脉——肱静脉行PICC置管,既提高了PICC置管成功率,也保障了置管的安全性和有效性,值得临床推广应用。     

Focus on peripherally inserted central catheters in critically ill patients

Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings (emergency, intensive care, surgery) and for different purposes (fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device (CVAD) (mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe -due to their placement into peripheral veins of the arm- and the advantage of a central location of catheter tip suitable for all osmolarity and pH solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as well as the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs (i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD (CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.     

经外周静脉置入中心静脉导管免缝式固定装置研究进展

随着PICC在临床的广泛应用,其固定装置在患者带管期间起着至关重要的作用.思乐扣在临床使用中取得了良好的临床效果,近年来,皮下锚定装置和组织粘合剂的不断发展,给PICC免缝式固定装置注入了新的活力.本文将对免缝式导管固定装置的研究进展进行综述,以期在临床中为PICC导管的有效固定提供新的思路,将新式免缝固定装置逐渐应用...     

外周置入中心静脉导管异常拔管的原因分析

目的探讨外周置入中心静脉导管（PICC）异常拔管原因，分析并发症的预防。方法对83例次PICC异常拔管原因进行分析。结果异常拔管的因素分别是肢体肿胀61例，导管堵塞11例，静脉炎3例，导管脱落3例，可疑导管相关血液感染2例，静脉血栓形成2例，穿刺处持续严重渗血1例。结论肢体肿胀和导管堵塞是导致异常拔管的主要原因，防护重点在于各项护理操作的规范。     

肿瘤病人留置PICC导管的安全管理

目的建立并实施经外周置入中心静脉导管的安全管理制度。方法2001~2005年对骨肿瘤科300例住院化疗病人进行PICC导管置入术,并实施了PICC导管安全使用的认知、操作、维护、出院教育等各项安全管理制度。结果留置PICC导管的护理安全管理程序化、专业化。结论安全管理制度的建立与实施,保证了留置PICC导管的安全使用,提高了病人的生活质量。     

B超引导下 PICC置管与常规肉眼穿刺的比较与分析

目的 比较并分析B超引导下PICC置管与常规肉眼穿刺的效果,以选择更低风险的穿刺方法,减轻患者痛苦,提高护理质量.方法 采用回顾性调查进行资料收集,选取我科2008年10月至2009年9月乳腺癌术前及术后置PICC管进行化疗患者167例,按穿刺方法不同分为B超引导下置管组为实验组共58例,常规肉眼穿刺组为对照组共109例,观察并比较两组穿刺后并发症、腋下回折、穿刺次数、深静脉栓塞、穿刺操作用时、换药护理用时.结果 两组患者穿刺部位并发症、穿刺次数、穿刺操作用时、换药护理用时比较均有统计学意义（P＜0.01）,穿刺后感染的发生率比较有统计学意义（P＜0.05）,腋下回折比较无统计学意义（P＞0.05）,两组均无机械性静脉炎和深静脉栓塞发生.结论 应用B超引导进行PICC置管优于常规肉眼穿刺.