慢性意识障碍患者PICC相关上肢静脉血栓形成的危险因素分析

目的:分析慢性意识障碍(DOC)患者经外周置入中心静脉导管(PICC)后发生PICC相关上肢静脉血栓的危险因素,为预防及降低其发生提供参考依据。方法:选取2019年1月至2020年12月解放军总医院第六医学中心高压氧科要求PICC置管治疗的127例慢性DOC患者。按照是否发生上肢静脉血栓,将其分为血栓组( ...     

经外周静脉中心静脉置管导管感染并发症相关因素分析

目的分析消化内科患者经外周静脉中心静脉置管(peripherally inserted central catheter,PICC)导管感染并发症的相关因素,为PICC导管的护理及并发症的预防提供参考。方法收集142例消化内科行PICC患者的临床资料,记录性别、年龄、原发疾病、PICC穿刺方法、穿刺部位、导管护理频率、穿刺血管、是否合并心血管疾病及糖尿病等资料,采用单因素分析PICC导管感染并发症发生的相关因素,采用Logistic回归分析PICC导管感染的影响因素。结果导管相关感染并发症发生率为18.3%,其中是否合并心血管疾病、穿刺部位、穿刺方法及护理频率是PICC导管相关感染并发症发生的相关因素;合并心血管疾病、低护理频率是PICC导管相关感染并发症发生的危险因素,肘上部位穿刺是保护性因素。结论 PICC导管感染并发症多与穿刺部位、护理频率及内科合并症有关,要采取针对性的护理措施,降低PICC导管相关感染并发症的发生。     

经皮下隧道法行外周静脉留置中心静脉导管预防并发症的作用

目的比较两种不同的穿刺方法,探讨减少经外周静脉留置中心静脉导管（PICC）穿刺后并发症发生率的有效措施。方法将46例不同病种行PICC置管患者分为常规组（23例）和观察组（23例）,常规组按常规方法由静脉上方穿刺直入血管行PICC,观察组则在血管下方或侧方2～3cm左右进针,不直接刺入血管,先皮下潜行2～3cm后刺入血管,再将导管插入行PICC。两组穿刺成功后,均用弹力绷带加压包扎固定24h。结果观察组渗血、导管相关性感染发生率均显著低于常规组（P〈0．05）。结论改进PICC穿刺方法后,可减少渗血、导管相关性感染等PICC并发症的发生。     

植入式静脉输液港与PICC导管在恶性肿瘤患者化疗中的效果比较

目的比较植入式静脉输液港(VAP)与经外周静脉穿刺中心静脉置管(PICC)导管在恶性肿瘤化疗患者中的效果。方法 287例恶性肿瘤患者根据治疗意愿分为两组,PICC组(n=140例)经PICC化疗治疗,VAP组(n=147例)经VAP化疗治疗,比较两组患者不同时间导管留置率、意外拔管率、留置时间、生活质量及导管并发症发生情况。结果 VAP组患者置管后第6、12个月导管置管率及留置时间、生活质量评分均明显高于PICC组(P<0.05),而意外拔管率明显低于PICC组(P<0.05);VAP组患者导管堵塞、导管相关性血流感染等并发症发生率均明显低于PICC组(P<0.05)。结论 VAP具有并发症发生率低、留置时间长、对恶性肿瘤患者生活质量影响小等优点,可作为化疗理想的深静脉通道。     

青海地区血液高凝患者中心静脉导管血栓性堵塞中个体化肝素封管策略的研究与应用

目的:探讨个体化肝素封管策略在青海地区血液高凝患者中心静脉导管血栓性堵塞中的应用效果.方法:收集2019年1月-2020年11月收住我院给予经外周静脉置入中心静脉导管(PICC)、中心静脉导管(CVC)置入的476例患者作为观察组,收集2017年1月-2018年12月收住我院并给予PICC、CVC导管置入的518例患者...     

PICC并发症堵塞的预防及护理

目的降低PICC堵塞的发生率，使PICC发挥预期的使用效果，探讨护士对PICC护理专业能力与导管堵塞的相关性。方法通过查阅文献并结合多年的护理经验，得出要降低PICC常见并发症如导管相关性感染、导管堵塞，导管脱出，机械性静脉炎等，落实严格的预防措施是关键。观察分析导管堵塞发生率，堵塞程度，处理的转归情况和护士对堵管并发症的评估能力和处理能力。结果患者经及时处理后，效果明显。结论PICC堵管不容忽视，护士对PICC护理专业能力与导管堵塞的发生情况密切相关。     

血液系统疾病患者置入中心静脉导管发生血栓相关危险因素的Meta分析

目的 分析血液系统疾病患者经外周静脉穿刺置入中心静脉导管相关血栓(PICC-RT)形成的独立风险因素。方法 使用计算机系统对PubMed、Web of Science、Medline、中国知网、维普及万方等数据库进行主题词检索，搜集血液系统患者置入PICC导管相关血栓的病例对照研究。检索时间设置为建库至2022年6月，通过2名研究员分别独立对检索到的血液系统患者PICC-RT影响因素的文献进行筛选，评估文献质量并提取相关数据。对提取的数据采用Revman5.3软件进行Meta分析，以筛选出血液系统患者PICC-RT的危险因素。结果 共纳入14篇文献，涉及3127例患者，分析了38项影响因素，根据是否发生PICC-RT将患者分为研究组(n=297)和对照组(n=2830)。根据Meta及统计分析结果，将OR≥1且P≤0.05的10项影响因素列为血液系统患者PICC-RT危险因素：年龄≥60岁、合并感染、危险度分层为中高危、BMI≥25、ECOG评分≥2分、既往手术史、PICC导管尖端位置异常、非隧道式PICC、血小板水平≥350×10⁹/L、置管时间≥6个月。结论 ...     

肿瘤PICC置管处患者继发皮肤损害的菌群耐药性及复方黄柏液涂剂治疗对并发症和炎性反应的影响

目的 研究肿瘤经外周穿刺中心静脉导管置入术（peripherally inserted central catheter, PICC）置管处患者继发皮肤损害的菌群耐药性及复方黄柏液涂剂治疗对导管相关并发症和炎性反应的影响。方法 本研究采用回顾性研究,主要以2020年12月至2021年12月海安市人民医院收治的40例PICC置管处继发皮肤损害患者作为研究对象,根据患者治疗手段的差异分为两组,各20例。对照组根据药敏情况采取相应的抗生素治疗,观察组联合采用复方黄柏液涂剂。分析肿瘤患者PICC置管处继发皮肤损害菌群的分布,研究两组患者的导管相关并发症及炎性反应之间的差异。结果 PICC置管处继发皮肤损害病原菌感染主要以革兰阳性菌和革兰阴性菌为主,真菌感染较少。凝固酶阴性葡萄球菌、肺炎链球菌、金黄色葡萄球菌主要对青霉素、苯唑西林及氨苄西林耐药。鲍曼不动杆菌、阴沟肠杆菌、大肠埃希菌主要通过对亚胺培南以及阿米卡星耐药。观察组患者发生导管相关血流感染、穿刺口感染、导管移位和脱出、管端细菌定植情况低于对照组（P<0.05）。两组患者经过治疗后,白细胞介素-1β、肿瘤坏死因子-α和白细胞介素-6水...     

外科手术患者深静脉置管术后导管相关感染的临床特点及危险因素分析

目的 探讨外科手术患者深静脉置管术后导管相关感染的临床特点及危险因素分析.方法 分析2019年5月-2020年4月收治的193例外科手术需深静脉置管患者临床资料,根据所有患者资料,将可能影响深静脉置管术后导管相关感染的因素纳入自变量并为其赋值,经多项logistic回归分析找出影响术后导管相关感染的危险因素.结果 19...     

颅脑损伤致昏迷患者并发下呼吸道感染的危险因素分析

目的对颅脑损伤致昏迷患者并发下呼吸道感染的危险因素进行研究,予以护理防控手段。方法回顾分析2013年1月~2014年12月诊治的120例颅脑损伤致昏迷患者资料,选取发生下呼吸道感染的35例为研究组,在未发生呼吸道感染的患者中按1∶1比例选取35例作为对照组。分析两组患者的危险因素并予以护理。结果患者所感染的致病菌以革兰阴性菌为主,研究组患者在年龄、实施侵入性操作、合并性意识障碍、抗生素的使用、格拉斯哥昏迷评分(GCS)等方面与对照组存在统计学差异(P0.05)。结论颅脑损伤致昏迷患者并发下呼吸道感染受到年龄高、实施侵入性操作多、存在意识障碍、使用抗生素等危险因素的影响,针对性实施相应的预防措施可达到较好的护理防控效果。     

不同深静脉置管方式在乳腺癌术后化疗中的应用

目的比较不同深静脉置管方式在乳腺癌术后化疗中的临床使用效果及相关并发症。方法分别采用经锁骨下静脉、颈内静脉或外周静脉插入中心静脉导管（PICC）,为患者留置深静脉导管于上腔静脉进行乳腺癌术后辅助化疗。结果分别经锁骨下静脉、颈内静脉或外周静脉置管患者为6、9、26例,所有患者均成功置管,三组导管平均留置时间分别为（24.00±2.95）d、（27.17±5.42）d、（145.45±14.45）d,颈内静脉组发生1例置管感染,无一例发生药物渗漏性血管损伤、皮肤损伤及导管堵塞等并发症,均顺利完成化疗。结论经锁骨下静脉或颈内静脉留置时间短,平均费用低,长期使用需定期换管,适用于外周静脉插管困难患者,PICC置管保留时间长,通常一次置管可完成乳腺癌术后6次辅助化疗,定期导管护理可减少导管堵塞、感染等并发症发生,值得临床推广应用。     

肿瘤科连续护理小组对PICC置管患者连续护理的效果评价

目的：探讨采用连续护理方法对PICC置管肿瘤患者实施连续护理的效果。方法：抽取2012-03-2013-02住院行PICC置管的肿瘤患者116例为观察组,以2011-01-2012-02行PICC置管的肿瘤患者102例为对照组。观察组由连续护理小组实施连续护理干预,对照组实施常规护理。结果：观察组对护士满意度及导管留置时间高于对照组,组间比较差异均具有统计学意义（P〈0.05）。观察组干预前后健康知识掌握程度明显提高,组间比较差异均具有统计学意义（P〈0.01）。结论：对PICC置管肿瘤患者实施连续护理方法,有利于患者对健康知识的理解,延长导管留置时间,提高护理工作满意度,值得借鉴。     

Long-Term Central Venous Access in Pediatric Patients at High Risk: Conventional versus Antibiotic–Impregnated Catheters

PurposeTo study selective use of antibiotic–impregnated catheters in children at increased risk of venous catheter–related infections (CRIs).Materials and MethodsFrom December 2008 to June 2009, 428 peripherally inserted central catheters (PICCs) were placed by the interventional radiology service of a large metropolitan children’s hospital. This retrospective study analyzed demographic and outcome data for the 125 patients in this group at high risk for venous CRI. Patients at high risk were those with active systemic infection, previous complicated central venous access, intensive care unit (ICU) admission, intestinal failure, transplantation, complex congenital heart disease, or renal failure. Patients (age, 7.6 y ± 7.0; 73 male and 52 female) received a conventional or antibiotic-impregnated PICC, with 17 receiving more than one catheter.ResultsOf the 146 of 428 qualifying patient encounters (34%), 53 patients received an antibiotic-impregnated PICC and 93 received a conventional PICC, representing 5,080 total catheter-days (CDs). The rates of CRIs per 1,000 CDs, including catheter exit site infections and catheter-related bloodstream infections, were 0.86 for antibiotic-impregnated PICCs and 5.5 for conventional PICCs (P = .036). A propensity-based model predicts 15-fold greater infection-free survival over the lifetime of the catheter in patients who receive an antibiotic-impregnated PICC (P < .001). Antibiotic-impregnated PICC recipients with active infection or ICU admission at the time of insertion had no catheter-associated infections, compared with 3.42 and 9.46 infections per 1,000 CDs, respectively, for patients who received conventional PICCs. Patients with intestinal failure had 1.49 and 10 infections per 1,000 CDs with antibiotic-impregnated versus conventional PICCs, respectively.ConclusionsAntibiotic-impregnated long-term PICCs significantly improve infection-free catheter survival in pediatric patients at high risk.     

脑损伤昏迷患者术后PICC与锁骨下静脉置管的疗效观察

目的：探讨PICC与锁骨下静脉置管在脑损伤昏迷患者术后置管输液治疗的疗效。方法回顾性分析79例行PICC及63例行锁骨下静脉置管输液治疗的脑损伤昏迷患者的临床资料,比较2种治疗方法的一次性置管成功率及导管置入相关并发症的发生率。结果 PICC一次穿刺成功率94.9％（75／79）,锁骨下静脉置管一次穿刺成功率为74.5％（47／63）,差异有统计学意义（P＜0.05）;PICC组发生机械性静脉炎、堵管高于锁骨下静脉组（P＜0.05）,而导管脱落、非计划性拔管的机率小于锁骨下静脉组（P＜0.05）,两组在导管位、导管相关性感染的发生率上差异无统计学意义（ P＞0.05）。结论 PICC与锁骨下静脉置管在脑损伤昏迷患者术后输流治疗中有简单易行、护理方便,留置时长等优点,相比较而言,PICC更具有优势。     

Prospective randomized comparison of valved versus nonvalved peripherally inserted central vein catheters.

OBJECTIVE: The purpose of this study was to evaluate whether a valved peripherally inserted central catheter (PICC) design would result in a lower incidence of occlusion, infection, and malfunction than a clamped catheter. SUBJECTS AND METHODS: Three hundred sixty-two study patients (233 men, 129 women; mean age, 44 years) were randomized to receive a clamped (n = 182) or valved (n = 180) 5-French single-lumen PICC. Catheters were placed under fluoroscopic (n = 331) or sonographic guidance (n = 31). The valved PICC was flushed with saline solution, and the clamped PICC was flushed with a heparin-saline solution. All patients were prospectively followed up at least weekly for catheter status and complications. RESULTS: Percutaneous placement with the catheter tip in the central veins was successful in 99% of patients. Mean dwell time was 34 days. Twenty-six occlusive or infectious complications occurred in the clamped catheter group and 12 in the valved catheter group (p = .02). The clamped and valved catheter groups had 13 and five occlusions, respectively (p = .06), and 12 and five catheter-related blood stream infections, respectively (p = .09). Most occlusions (68%) were treated successfully with urokinase, and site infection or sepsis was treated by catheter removal. CONCLUSION: We found a statistically significant difference in the complication rate for the valved PICC compared with the clamped PICC. With the valved PICC, occlusion and infection were reduced, and patients having these catheters did not require heparin flushes.     

Outcomes of Venoplasty-Assisted,Peripherally Inserted Central Catheter Placement in Patients with Upper-Arm Venous Stenosis: Comparison with Midlines and Contralateral Placement

PurposeTo compare the effectiveness and safety of percutaneous transluminal angioplasty and peripherally inserted central catheter (PTA + PICC), contralateral PICC, and midline catheterization (MC) in patients with venous stenosis.Materials and MethodsA total of 7,327 PICC procedures were performed in 5,421 patients at a single institution between 2013 and 2019. Among them, 87 patients had upper-arm venous stenoses and were managed with PTA + PICC, contralateral PICC, or MC. Data on catheter-dwell time, clinical success rate, and adverse events were recorded. The procedure was considered to have clinically succeeded when a PICC was removed from the patient just before discharge or after the completion of therapy. Catheter survival time and the chance of adverse events were compared among the groups using the Kaplan-Meier method and log-rank test.ResultsPTA + PICC, contralateral PICC, and MC procedures were performed for 57 (65.5%, 57/87), 10 (11.5%, 10/87), and 20 (23.0%, 23/87) patients, respectively. The mean catheter-dwell time in the PTA + PICC, contralateral PICC, and MC groups was 49.7, 28.7, and 15.1 days, respectively, and the clinical success rate of each group was 86.0% (49/57), 80.0% (8/10), and 50.0% (10/20). The PTA + PICC group had a significantly longer catheter survival time than the MC group (P < .001). The chance of a catheter-related infection (P = .008) was significantly lower in the PTA + PICC group than in the MC group.ConclusionsPTA + PICC or contralateral PICC should be considered prior to ipsilateral MC when venous stenosis is encountered during PICC procedures.     

Complications of percutaneous transaxillary catheterization for arteriography and selective chemotherapy.

This report enumerates and analyzes the complications of percutaneous transaxillary catheterization encountered in 200 consecutive patients undergoing diagnostic arteriography, and 20 consecutive patients who had catheter placement for selective chemotherapy. Diagnostic arteriography led to minor complications in eleven percent and major complications in two percent. Risk correlated with the type of procedure, number of catheter exchanges and particularly, the presence of arteriographic risk factors, such as hypertension, bleeding tendencies, and advanced atherosclerosis. Therapeutic catheter placements had a 15 percent incidence of minor and a 20 percent incidence of major complications. Here, also, complications were more likely in the presence of the arteriographic risk factors. Suggested means for decreasing the hazards of the transaxillary catheterization include: exclusion of high risk patients, use of a proper puncture site, careful catheter manipulation, the fewest possible catheter exchanges, correct manual hemostatis following catheter withdrawal, and close observation of the patient after the procedure. Early surgical intervention is indicated in the presence of a progressively developing neural defect.     

新型耐高压PICC作为CT增强检查对比剂注射通路的临床应用研究

目的本研究探讨新型耐高压PICC导管用于CT增强检查对比剂通路的应用效果。 方法选取2019年7月1日至2020年6月30日在中山大学孙逸仙纪念医院已完成新型耐高压PICC管（Power PICC SOLO）置管且需要行CT增强检查的患者60例。采用信封法随机分组,其中选用新型耐高压PICC管作为对比剂注射通路的患者30例为PICC管组,其余30例患者为常规组,采用放射科常规耐高压静脉留置针作为对比剂通路。进行CT增强扫描,对比分析两组患者影像检查图片质量,包括总体和肝脏、肺血管质量以及侧支、伪影情况。 结果两组间基线资料和图片总体质量没有统计学差异;但在两组伪影评价中,PICC管组的锁骨下动脉、上腔静脉和右心房的分值显著低于常规组（P<0.01）;常规组的侧支血管及反流情况显著低于PICC组（P<0.01）。 结论新型耐高压PICC作为影像增强检查对比剂注射通路安全高效,不良反应少,图像质量好。     

改良式病员裤在行股动脉穿刺置管患者中的应用

目的：研究改良式病员裤在行股动脉穿刺置管患者术后护理中的应用效果。 方法：选取2018年6-12月在中山大学附属第五医院介入血管外科行股动脉穿刺置管术的患者100例,随机分为试验组和对照组,每组均50例。根据股动脉穿刺置管术后观察和护理的特殊需求,针对现有普通病员裤进行重新设计和改良制作成改良式病员裤。试验组穿改良式病员裤,对照组穿传统普通病员裤。比较患者与护士分别对两种病员裤在隐私保护、方便性、管路安全性、舒适性方面的满意度情况,比较护士在术后护理两组时所需的时间。 结果：试验组患者对改良式病员裤在隐私保护、方便性、管路安全性方面的使用满意度明显高于对照组[分别为90% vs. 14%,78% vs. 30%,84% vs. 34%],差异有统计学意义（P<0.001）;试验组护士为观察患者穿刺点和管道所需时间[（12.16±1.68）vs.（18.31±2.15）]和从管道处接尿激酶持续泵入所需时间[（21.61±2.65）vs.（50.44±7.99）]均小于对照组,差异有统计学意义（P<0.001）。 结论：改良式病员裤是一种便捷、实用、安全的病员裤,可以提高股动脉穿刺置管术后患者满意度,缩短护理工作时间。     

恶性胸腔积液引流管堵塞或引流不畅的影响因素

 目的 探讨恶性胸腔积液(malignant pleural effusion,MPE)置管引流堵管或引流不畅的相关因素。方法 选取2015-11至2017-12行MPE置管引流患者161例,统计患者性别、年龄、置管时间、胸腔积液状态、导管情况等信息,分析MPE置管引流堵管或引流不畅相关危险因素。结果 161例共发生32例引流管堵塞或引流不畅,不同性别、年龄、BMI、原发病、合并症、抗凝药物及靶向药物使用情况、胸腔注药患者间置管引流堵管或引流不畅发生率间无统计学差异(P>0.05),置管时间较长、管口上抬高出液面、积液内含纤维素膜及血块、血小板计数异常、胸水蛋白阳性患者,置管引流堵管或引流不畅发生率较高(P<0.05);Logistic回归分析表明,管口上抬高出液面(OR 2.578,95% CI 1.357~4.846)、积液内含纤维素膜及血块(OR 3.218,95% CI 1.651~10.056)、封管方法(OR 1.689,95% CI 1.427~4.297)为MPE置管引流堵管或引流不畅发生的重要危险因素(P<0.05)。结论 MPE置管引流发生引流管堵塞的主要危险因素包括管口上抬高出液面、积液内含纤维素膜及血块、封管方法,临床可参照上述危险因素采取干预措施。