经周围静脉插入中心静脉导管行肠外营养

目的：探讨经周围静脉插入中心静脉导管（PICC）进行肠外营养的方法及意义。方法：回顾分析近6年115例采用PICC施行肠外营养技术的临床资料。结果：经PICC进行肠外营养技术成功102例（88.7%）。13例插管失败，但无严重并发症。结论：采用PICC施行肠外营养技术简便，安全可行。     

经外周中心静脉置管进行肠外营养的研究

目的研究经外周中心静脉置管(PICC)进行肠外营养(PN)的有效性、安全性.方法观察50例经PICC进行PN病例的置管时间、治疗完成率和置管并发症,并与同期中心静脉插管(CVC)进行比较.结果平均置管时间PICC组为17.56d;CVC组为18.24d;治疗完成率PICC组为 92.0%;CVC组为96.0%. 平均置管时间、治疗完成率两组比较均无显著性差异.并发症发生率PICC组为18.0%;CVC组为14.0%.PICC并发症为血栓性静脉炎、导管堵塞、感染、导管异位及渗血,但无气胸、误穿动脉等严重并发症,PICC静脉炎发生率高于CVC组(P<0.05).结论 PICC用于PN是安全、有效的方法,可代替CVC成为PN输注的主要途径.     

外周静脉置入中心静脉导管病人的家庭健康教育

目的探讨家庭健康教育在外周静脉置入中心静脉导管（PICC）置管患者中的重要性。方法运用回顾性对比研究的方法,比较一般的出院健康教育与系统的家庭健康教育对PICC置管病人的影响。结果两组病人在管道留置时间、并发症发生数量间有统计学差异,P≤0．05。结论系统的家庭健康教育对延长PICC置管病人管道留置时间．减少并发症发生有重要意义。     

Long term central venous access catheters: review of 134 catheters inserted in 100 patients

The first 100 patients at Westmead Centre who received long term central venous access catheters were reviewed. The indication for insertion in 77% of the patients was administration of chemotherapy, 15% had insertion for parenteral nutrition and 8% for blood product administration or anti-microbial therapy. Catheter manipulations were carried out under strict aseptic conditions by a limited group of nursing staff. Of the catheters, 73.1% functioned satisfactorily and were removed electively or were functioning at death or time of review. The main reason for removal was suspected infection, but this was proven in only 4.5% although strongly suspected in another 5.2%. The infection rate was 13 episodes per 13 987 catheter days. The duration of function of catheters was analysed by the life table method, demonstrating a 50% catheter survival rate of 300 days.     

Outcome of peripherally inserted central venous catheters in surgical and medical neonates

Background/Purpose

Peripherally inserted central venous catheters (PICCs) are commonly used for neonatal vascular access. The aim of this study was to look at PICC line complication rates and possible predictors of PICC infection in a neonatal intensive care unit.

Method

This was a prospective study of 226 neonates who had PICCs on our neonatal intensive care unit between January 2006 and June 2009. Complete data was available on 218 neonates who had 294 PICC lines. Criteria for catheter-related sepsis was positive blood cultures (peripheral/central) and/or a positive catheter tip culture after removal in the presence of a clinical suspicion of line sepsis.

Results

Of 218 neonates, 132 (169 lines) were medical, and 86 (125 lines) were surgical. Our PICC line infection rate was 17 infections per 1000 catheter-days. Surgical neonates had infection rates of 24.8% compared with 18.3% of medical neonates (P < .18). The odds ratio for a PICC infection was 3.1 (95% confidence interval, 1.64-5.87) if the catheter was in situ for 9 days or more, P < .01. Coagulase-negative staphylococcus was isolated from 55 (89%) of 62 blood cultures.

Conclusions

Our PICC infection rate was 17 per 1000 catheter-days. The length of catheter stay was the only predictor of PICC infection.     

Peripherally inserted central venous catheters in preterm newborns: two unusual complications

This report describes the case of two newborns who suffered unusual complications after peripheral insertion of a central venous catheter. In one baby a fragment of the catheter tip became embolized in a peripheral branch of the left pulmonary artery. In the other baby, the catheter perforated a peripheral branch of the pulmonary artery, giving rise to chemical pneumonitis with extensive pleural effusion. The outcome was positive for both babies. A large clinical series is necessary to establish the complications of this procedure, their prevention and management.     

Broviac central venous catheters inserted via the saphenous or femoral vein in the NICU under local anesthesia.

We present our experience with 92 Broviac central venous catheters inserted into 84 infants over a 31-month period. Our technique specifies placement in the neonatal intensive care unit under local anesthesia, with insertion to the inferior vena caval-atrial junction via the saphenous or femoral vein, with a subcutaneous tunnel to an exist site on the anterior thigh. We conclude this technique to be safe, efficient, convenient, cost-effective, and minimally uncomfortable to the infant, with no increase in morbidity or mortality in comparison to previously described methods.     

A comparative study of peripherally inserted silicone catheters for parenteral nutrition.

One hundred patients receiving parenteral nutrition with lipids and hypertonic amino acids and glucose were divided into five groups of 20, depending on the type of intravenous catheter used for the infusion. Least satisfactory were the short Butterfly needles (average 3.3 days in place) and the long peripherally inserted polyvinyl central venous catheters (average 6.2 days in place). Subclavian catheters of polyvinyl (average 15.3 days) or silicone elastomer (average 17.5 days) were equally efficacious. A new long silicone elastomer catheter inserted peripherally was most satisfactory (average 29.5 days). Problems common with polyvinyl catheters (phlebitis, thrombosis, and sepsis) rarely occurred with either the long or short silicone elastomer catheter.     

Frequent malpositions of peripherally inserted central venous catheters in patients undergoing head and neck surgery

Purpose

Peripherally inserted central venous catheters (PICCs) do not interfere with surgical access during neck dissection and are used in patients undergoing head and neck surgery. However, severe complications associated with malpositioning of PICCs have been reported in these patients. We conducted a retrospective study to determine the incidence of aberrant positioning of PICCs in patients undergoing free flap reconstructive (FFR) surgery for head and neck malignancies.

Methods

We analyzed a database of 269 patients undergoing FFR surgery. After induction of general anesthesia, a PICC was inserted successfully in 130 patients (48%) at bedside without image guidance. A PICC was not used in 139 patients (52%). A chest x-ray was performed at admission to the postanesthetic care unit, stored digitally, and reviewed retrospectively by two independent observers. Based on the chest x-ray findings, the PICC position was classified as proper, suboptimal, or aberrant and defined according to the position of the PICC tip, i.e., proper, if situated in the ipsilateral innominate vein or in the superior vena cava; suboptimal, if situated in the subclavian vein; and aberrant, if situated in any other location.

Results

Proper, suboptimal, and aberrant PICC positions were found in 68 (52%), 17 (13%), and 45 (35%) patients, respectively. The proper position was confirmed more frequently with a left- than with a right-sided approach: 23/29 (79%) vs 45/101 (44%) patients, respectively (P < 0.001).

Conclusions

There is a high incidence of aberrant positioning when PICCs are inserted without image guidance. The left-sided approach might be preferable due to a lower incidence of malpositions. The risk-benefit ratio should be estimated carefully before using a PICC in patients undergoing FFR procedures.     

经股静脉置入PICC堵管现状及影响因素分析

目的 了解经股静脉置入PICC堵管现状及其影响因素,为开展相关护理措施提供参考。 方法 回顾性分析241例经股静脉置入PICC患者临床资料,经单因素和logistic回归分析发生导管堵管的影响因素。 结果 24.07%患者发生了导管堵管,回归分析结果显示,导管堵管的独立危险因素为伴有导管脱出、首次置管、经常行走以及导管类型为耐高压材质（均P＜0.05）。 结论 经股静脉置入PICC堵管发生率较高,临床实践中应加强关注导管堵管的独立风险因素,并开展针对性干预或相关健康教育,降低堵管发生率。     

A randomized trial comparing peripherally inserted central venous catheters and peripheral intravenous catheters in infants with very low birth weight

BACKGROUND/PURPOSE: To determine whether percutaneously inserted central venous catheters (PICC) and peripheral intravenous catheters (PIV) in infants with very low birth weight (VLBW) differ with respect to (1) incidence of sepsis, (2) number of insertion attempts and catheters required for total intravenous therapy, (3) courses of antibiotics, and (4) total duration of intravenous (IV) use. METHODS: A randomized comparative trial was conducted involving 63 VLBW infants (<1,251 g) who required IV therapy. Infants were assigned randomly at 1 week of age to either a PIV or a PICC catheter and followed up prospectively until an IV was no longer required or the infant was transferred out of the neonatal intensive care unit. RESULTS: Data were analyzed on an intention-to-treat basis. There was no difference in the incidence of sepsis (P = .64), number of courses of antibiotics (P = .16), or total duration of IV use (P= .34) between the 2 groups. The number of insertion attempts required for total IV therapy was significantly lower in the PICC group than in the PIV group (P = .008). There also was a significantly lower number of total catheters utilized in the PICC group (P = .002). When data were controlled for birth weight strata the results were similar. CONCLUSION: PICC lines reduced the number of painful IV procedures in VLBW infants without additional morbidity.     

Temporary access and central venous catheters.

The use of central venous catheters for temporary vascular access is a vital part of modern medicine and has an important role in the management of patients with renal failure. Attention to detail when addressing issues relating to temporary venous access, will pay dividends, with significant reductions in morbidity and mortality in both the short and long term.