PICC与输液港留置全程总成本的核算及比较研究

目的核算和比较PICC与植入式静脉输液港从置管到拔管全程的总成本,为两种中长期静脉输液通路的选取提供参考。方法通过横断面调查和回顾性队列研究,采用基于倾向性评分匹配法的成本分析和项目成本阶梯分摊法,从卫生服务提供者角度,对置管成本、维护成本、拔管成本和并发症处理成本进行核算并比较PICC和输液港留置全程的总成本。结果回顾性队列研究共纳入1050例患者,匹配后在总留置时间、留置3~个月、留置6~个月和留置9~12个月纳入分析的患者分别为504例、276例、106例和35例。在4个留置时间亚组中,PICC的总成本显著低于输液港(均P<0.01)。各亚组中PICC置管成本和拔管成本显著低于输液港(均P<0.01),而PICC的并发症处理成本显著高于输液港(均P<0.05)。两者的维护成本除在总留置时间中PICC显著高于输液港(P<0.01),其余亚组中差异无统计学意义(均P>0.05)。结论当导管留置时间≤12个月时,PICC留置全程的总成本显著低于输液港,从卫生资源投入的角度,推荐优先采用PICC作为中长期中心静脉输液通路。     

植入式静脉输液港用于乳腺癌根治术患者辅助化疗的效果分析

目的 探讨植入式静脉输液港(VPA)用于乳腺癌根治术患者辅助化疗的效果。方法 回顾性分析2019-10—2021-09郑州市第三人民医院收治的76例乳腺癌根治术辅助化疗患者的临床资料，分为VPA组和经外周静脉穿刺中心静脉置管组(PICC组),各38例。比较2组置管成功率、导管留置时间、置管后并发症发生率。置管后当天和化疗结束后，采用乳腺癌患者生命质量测定量表(QLICP-BR)评价患者的生活质量。结果 2组一次性置管成功率差异无统计学意义(P>0.05)。VPA组导管留置时间长于PICC组，置管后并发症发生率低于PICC组，QLICP-BR生活质量评分优于PICC组，差异均有统计学意义(P<0.05)。结论 VPA与PICC均有较高的一次性置管成功率，但VPA患者置管后的并发症发生率、意外拔管率均低于PICC,生活质量高于PICC,是乳腺癌根治术患者进行辅助化疗的理想静脉通道。     

PICC无针输液系统在ICU病人中的应用

对100例ICU病人采用经外周静脉置入中心静脉导管(PICC)无针输液系统进行置管给药。结果置管成功率为99．0％；操作时间平均13．0min；留置导管时间平均95．0d，无并发症发生。提示PICC无针输液系统安全、省时，应用效果肯定。     

PICC导管与静脉留置针在血液病患者化疗中的应用比较

目的:通过经外周静脉穿刺中心静脉置管(PICC)与静脉留置针在白血病患者静脉化疗中的应用比较,探讨如何减少化疗患者静脉炎及并发症的发生率,从而提高患者在患病期间的生活能力和生活质量。方法:105例血液病患者分为两组,50例PICC置管组,55例静脉留置针组,记录静脉炎及置管后并发症的发生情况。结果:PICC置管组留置时间60-240天,静脉留置针组留置时间2～10天。结论:PICC管置管组静脉炎发生3例(6%),疼痛等其他相关并发症6例(12%),留置针组静脉炎发生18例(32.7%),疼痛等其他相关并发症20例(36.3%)。结论:在临床应用中对血液病患者静脉化疗中,选用PICC输液的效果明显优于静脉留置针输液的效果。     

颈外静脉穿刺置管在大量输液中的应用

目的探讨颈外静脉穿刺置管用于大量输液患者的效果，以寻找最佳输液途径。方法将需大量输液（每日补液量≥2500m1）的100例患者随机分为观察组和对照组各50例，观察组采用颈外静脉留置针输液，对照组采用四肢浅静脉留置针输液。结果两组患者一次置管成功率比较，差异无显著性意义（P〉0．05）；两组平均留置时间，导管脱落、导管堵塞、液体渗漏、静脉炎、补钾疼痛的发生率比较，差异有显著性意义（P〈0．05，P〈0．01）。结论颈外静脉穿刺置管用于大量输液，可减少静脉置管并发症，且可延长留置时间。     

颈外静脉留置针通道在上消化道大出血患者输液中的应用

目的 提高上消化道大出血患者静脉输液护理质量.方法 将64例上消化道大出血患者随机分为观察组和对照组各32例.采用22 G静脉留置针,观察组行颈外静脉穿刺置管.对照组行前臂静脉穿刺置管.观察两组留置针穿刺效果和留置效果.结果 观察组一次穿刺成功率及经留置针采血成功率显著高于对照组(均P＜0.01),穿刺时间显著短于对照组(P＜0.01),留置时间显著长于对照组(P＜0.01),外渗及并发症总发生率显著低于对照组(P＜0.05,P＜0.01),单通道1 h液体补充量显著多于对照组(P＜0.01).结论 应用颈外静脉留置针通道能有效提高上消化道大出血患者静脉输液护理质量,有利于患者的救治.     

急性白血病患儿使用两种长效深静脉通路的效果比较

目的比较经外周静脉穿刺中心静脉置管(PICC)和中心静脉置管(CVC)在白血病患儿中的临床应用效果。方法回顾性分析PICC置管92例与CVC置管44例,综合比较两者的试穿次数、操作时间、导管留置时间等。结果 PICC置管的试穿次数、操作时间少于/短于CVC置管,导管留置时间长于CVC置管(均P<0.01);并发症发生情况明显低于CVC组。结论 PICC因置管损伤小、并发症少、使用价值高、患儿及家属易于接受成为白血病患儿较理想的长效静脉通路,CVC适合年龄较小或血管条件较差的患儿。     

PICC与锁骨下静脉置管的比较研究

目的比较经肘部外周静脉穿剌中心静脉置管(PICC)与锁骨下静脉穿剌中心静脉置管的利弊。方法将180例肿瘤患者随机分为观察组(88例)和对照组(92例)。观察组采用PICC置管,对照组采用锁骨下静脉置管,观察两组穿剌时间、穿剌成功率、穿刺异常及不良反应发生率,以及导管留置时间等。结果观察组较对照组平均操作时间短(P<0.01);总穿剌成功率高(P<0.01);不良反应发生率低(P<0.05),其中观察组静脉炎发生率为11.36%,对照组为零,两组比较,P<0.01,差异有显著性意义;两组导管留置时间比较,差异无显著性意义(P>0.05)。结论PICC置管用于输液优于锁骨下静脉置管,而锁骨下静脉置管用于化疗优于PICC置管。     

颈外静脉穿刺置管在大量输液中的应用

目的 探讨颈外静脉穿刺置管用于大量输液患者的效果,以寻找最佳输液途径.方法 将需大量输液(每日补液量≥2 500 ml)的100例患者随机分为观察组和对照组各50例,观察组采用颈外静脉留置针输液,对照组采用四肢浅静脉留置针输液.结果 两组患者一次置管成功率比较,差异无显著性意义(P＞0.05);两组平均留置时间,导管脱落、导管堵塞、液体渗漏、静脉炎、补钾疼痛的发生率比较,差异有显著性意义(P＜0.05,P＜0.01).结论 颈外静脉穿刺置管用于大量输液,可减少静脉置管并发症,且可延长留置时间.     

颈外静脉留置针穿刺置管在危重患者抢救中的应用

目的:提高危重患者静脉输液质量。方法:将200例危重患者随机分为观察组和对照组各100例。采用22G静脉留置针,观察组行颈外静脉穿刺置管,对照组行四肢浅表静脉穿刺置管。观察两组留置针穿刺效果和留置效果。结果:观察组一次穿刺成功率及留置时间显著高于对照组(均P<0.01),静脉置管异常情况发生率显著低于对照组(P<0.01)。结论:应用颈外静脉留置针穿刺置管能有效提高危重患者静脉输液护理质量,有利于患者的救治。     

不同输液速度对中心静脉压测量值的影响

目的探讨不同输液速度对中心静脉压(CVP)测量值的影响。方法将59例深静脉置管患者分别在常规中断输液(对照组)和以50mL/h(观察1组)、100mL/h(观察2组)、200mL/h(观察3组)、300mL/h(观察4组)速度连续输液5min后监测并记录CVP。结果五组CVP监测值比较,差异无统计学意义(P>0.05)。结论深静脉置管输入普通液体的患者,输液速度在300mL/h以内对中心静脉压测量值无显著影响。     

Does Central Venous Pressure Reflect the Circulating Blood Volume for the Decrement of Compliance Just After Esophagectomy?

(Received for publication on Oct. 30, 1998; accepted on July 13, 1999)     

Usefulness of a central venous catheter during hepatic surgery

Aim: Central venous catheter (CVC) is often inserted during liver resection because a low central venous pressure (CVP) reduces blood loss and the procedure may be associated with circulatory impairment. The aim of the study was to evaluate the usefulness of a CVC besides the measurements of CVP, and whether peripheral venous pressure (PVP) measurement could be used reliably in place of CVP.
Methods: We conducted an observational study during a 16-month period. Number of CVC inserted, expected surgical difficulties, and intraoperative complications which could lead to treatment involving a CVC were prospectively recorded and analysed. Measurements of CVP and PVP were simultaneously obtained at different times during surgery. Bias and limits of agreement with their 95% confidence interval (95% CI) were calculated.
Results: Of the 101 patients included, 28 had expected surgical difficulties. Of the 75 CVCs inserted, only six (8%) were used for another purpose that CVP measurement in patients with expected surgical difficulties. A total of 124 measurements in 23 patients were recorded. Mean CVP was 4.8 ± 2.9 mmHg and mean PVP was 6.9 ± 3.1 mmHg ( P <0.0001). The bias was −2.1 ± 1.1 mmHg (95% CI: −2.3 to −1.9). When adjusted by the average bias of −2 mmHg, PVP predicted a CVP≤5 mmHg with a sensitivity and a specificity of 93% and 87%, respectively.
Conclusion: Routine insertion of a CVC should be discussed in patients without expected surgical difficulties. Thus, PVP monitoring may suffice to estimate CVP in uncomplicated cases.     

Percutaneous central access in patients younger than 5 years: size does matter

Purpose

The purpose of this study was to determine, in a pediatric population less than 5 years of age, which size catheter is ideal for central venous access via the subclavian and internal jugular vein based on the children’s age, weight, and height.

Methods

This was a retrospective chart review of children less than 5 years of age at The Children’s Hospital in Denver, Colorado who underwent subclavian or internal jugular central venous catheter placement from January 1, 1998 through December 31, 2001. Age, height, weight, primary disease, access site, type of central venous catheter, size of central venous catheter, and complications were recorded. Age, weight, and height were stratified and compared with catheter size to determine any correlation between age, weight, height, and complications.

Results

There were 430 central venous catheters placed via the subclavian or internal jugular vein in 331 patients less than 5 years old. One hundred ninety-five catheters (45.4%) were less than 6F in size, and 235 (54.6%) catheters were ≥6F in size. Children, who were between 0.5 and 0.99 years old, 5 to 7.49 kg in weight, 7.5 to 9.99 kg in weight, and 60 to 74.9 cm in height had higher complication rates (P < .05) when catheters ≥6F were inserted. Children who were greater than 1 year of age, greater than 10 kg in weight, and longer than 75 cm in height did not experience a significant difference (P > .05) in complications versus catheter size.

Conclusions

The choice of central venous catheter size should be predicated, not only on the primary disease, but also on the child’s age, weight, and height. Insertion of central venous catheters larger than 6F in children less than 1 year of age, less than 10 kg in weight, or less than 75 cm in height, was associated with higher complications compared with other settings.     

A Short History of Central Venous Catheterization

The history of central venous catheterization is reviewed. Attention is drawn to the clinical problems that can occur with central venous catheters, and how these problems have been overcome.     

中心静脉导管室医护一体急救管理模式的构建与实施

目的构建中心静脉导管室的急救管理模式，保障中心静脉置管过程的安全。方法成立中心静脉导管室急救小组，从健全各种急救制度、急救人员统一培训等方面构建一个全方位、多学科参与的“医护一体”急救管理模式。结果2012年1月至2013年10月共置管30674例次，置管过程中共进行61例次急救，抢救成功率100％，且患者转归良好。2013年置管并发症低于2012年。结论对医院中心静脉导管室实施“医护一体”急救管理模式提高了置管人员的风险防范能力，提升了护理专业水平，保障了患者安全。     

Preventing venous thrombosis in critically ill children: what is the right approach?

Background: The incidence of venous thromboembolic (VTE) events in children has increased in recent years (J Neurosurg, 101, 2004, 32; J Thromb Haemost, 1, 2003, 1443) yet there is currently no consensus as to what VTE prophylaxis, if any, should be applied to the pediatric population. Objectives/Aims: Our aim was to audit current practice in pediatric VTE prophylaxis across England and Wales and to advocate simple measures for prevention. We illustrate the importance of the condition with a series of cases from the South West Paediatric Burns and Neurosurgical Services based in Bristol. Methods: Every pediatric intensive care unit (PICU) and burns center admitting children in England and Wales was invited to participate in a structured telephone questionnaire designed to find out how VTE in children were being prevented. We performed a literature review of specific risk factors and management of these factors. Results: Only one of the 24 units surveyed had written guidelines specific for children. Four other units used modified adult guidelines in older children. In the remaining 19 units that had no written guidelines, decisions regarding prophylaxis were based on individual cases and consultant‐led. Conclusion: There is no consensus in England and Wales as to which VTE prophylactic measures should be applied in patients <18 years of age. The National Institute for Health and Clinical Excellence (NICE) guidelines apply to adults only. Given the rarity of VTE events in children, it is unlikely that randomized controlled trials will provide the answer. We therefore propose that simple empirical measures be formally implemented in critically ill children to reduce the risk of developing this important but under‐recognized condition.     

Complications of short term multilumen central venous cannulation in children—a prospective study

A prospective study of the incidence of complications, when using multiple lumen central venous catheters in a paediatric intensive care unit, undertook to survey the normal practice of central venous cannulation at the Birmingham Children's Hospital, using a variety of devices and approaches over a period of a year from May 1991. Ninety five percent of the total of 252 devices used were triple lumen, the rest being double lumen catheters. There were 19 failures to secure access at the initial site chosen, but central venous access was secured in all cases. The complication rate during insertion was 18.5%. There were three major and 20 minor non-infective complications with a total incidence of 7.9%. Twenty seven cases (10.8%) suffered infective complications. The incidence of all complications were comparable to those obtained in studies involving the use of single lumen devices. This fact, coupled with the high success rate in catheter placement by operators of varying experience, suggests that multiple lumen central venous devices can be considered as a safe alternative to single lumen catheters for short term use in children.     

CVP catheter electrocardiography: an alternative to radiographic control after cannulation of central veins?

We evaluated 160 electrocardiograms taken after placement of central venous catheters (CVC) to determine their locations. Usable recordings were obtained in 154 patients. Subsequent radiographs revealed 30 misplaced catheters. Twenty-five of those were detected by CVC electrocardiograms. There were five false positive and five false negative traces. The sensitivity of CVC electrocardiography was 96%, the specificity 83.3%, and the total predictive power 93.5%. Electrocardiograms obtained from guide-wires were of significantly better quality than those from 0.9% NaCl filled catheters. The technique is accurate, safe and easy to learn. It may reduce the need for routine radiographic control to less than 10% of patients.