经外周静脉中心静脉置管和植入式中心静脉输液港对老年结直肠癌化疗患者生命质量影响的纵向对比研究

【目的】研究经外周静脉中心静脉置管(Peripherally Inserted Central Catheter, PICC)和植入式中心静脉输液港(Totally Implantable Venous Access Ports, TIVAP)对老年结直肠癌化疗患者不同时间阶段生命质量的影响。【方法】选取2019年7月-2020年7月我院老年结直肠癌化疗患者170例,PICC组和TIVAP组各85例,比较两组患者分别在置管前、置管后3个月、6个月、9个月不同时间段癌症康复评价系统简表(CARES-SF)、日常生活能力量表(ADL)、导管维护依从性问卷的测量结果。【结果】比较两组患者癌症康复评价系统简表得分,在置管前、置管后6个月时间段,TIVAP组得分略高于PICC组,差异无统计学意义(均R>0.05),置管后3个月时间段TIVAP组得分略高于PICC组,差异有统计学意义(R<0.05),置管后9个月时间段PICC组得分略高于TIVAP组,差异有统计学意义(R<0.05)。比较两组患者日常生活能力量表,在置管前PICC组得分略高于TIVAP组,差异无统计学意义(均R>0.05),置管后3个月、6个月时间段PICC组得分明显高于TIVAP组,差异有统计学意义(均R<0.05),置管后9个月时间段TIVAP组得分略高于PICC组,差异有统计学意义(R<0.05)。比较两组患者导管维护依从性问卷总分,在置管后3个月、6个月时间段,TIVAP组得分略高于PICC组,差异无统计学意义(均R>0.05),置管后9个月时间段PICC组得分高于TIVAP组,差异有统计学意义(R<0.05)。【结论】PICC和TIVAP对老年结直肠癌化疗患者的健康相关生命质量影响差异不大,仅在生理纬度具有差异；但PICC对患者的日常生活影响明显大于TIVAP,从而可能影响患者导管维护依从性。     

两种置管方式对肿瘤静脉化疗患者满意度和服务体验的影响

目的:探讨置入式静脉输液港(VPA)与外周置入中心静脉导管(PICC)对肿瘤静脉化疗患者满意度和服务体验的影响。方法:将120例肿瘤静脉化疗患者按导管置入方式随机分为研究组和对照组各60例,研究组采用VPA置管方式,对照组采用PICC置管方式。采用调查问卷法调查两组患者满意度、服务体验和置入导管总体服务评分情况。结果:研究组满意度、服务体验和置入导管总体服务评分与对照组比较差异有统计学意义(P<0.05)。结论:对肿瘤静脉化疗患者选用VPA置管方式,可提高患者满意度、服务体验。     

化疗间歇期病人PICC导管自我管理体验的质性研究

[目的]探讨化疗间歇期病人经外周静脉置入中心静脉导管(PICC)自我管理的真实体验与心理感受。[方法]采用现象学研究方法,对18例留置PICC导管病人进行半结构访谈,应用Colaizzi现象学7步分析法分析资料。[结果]通过访谈归纳出3个主题,即病人携带PICC导管期间遇到的问题与困扰、病人自我管理过程中闪光之处、病人对护理人员的认可与期待。[结论]病人应积极主动地参与导管的自我管理过程,医护人员也应充分了解病人PICC导管自我管理期间的问题及困扰,并结合其自身特质采取有效措施规范并促进病人的自我管理。     

全身麻醉下行PICC置管的急性白血病患儿父母真实体验的质性研究

目的:探讨全身麻醉下行经外周静脉置入中心静脉导管(PICC)的急性白血病患儿父母的真实体验,为其他患儿父母选择置管麻醉方式提供依据.方法:采用半结构式访谈对18例急性白血病患儿父母进行访谈,应用Colaizzi现象学分析步骤进行阅读、分析、分类和提炼.结果:归纳出全身麻醉下行PICC置管的急性白血病患儿父母真实体验的3个主题:负性置管体验;正性置管体验;社会支持系统强弱.结论:全身麻醉下行PICC置管的急性白血病患儿父母普遍具有复杂的体验,主要表现为恐惧、焦虑、担心和无奈以及置管成功后的放松与欣慰,护士应根据具体情况给予个性化的心理护理和专业性的护理指导,呼吁社会支持系统,更好满足父母的真实需求,以便更好地配合后续治疗.     

PICC穿刺部位顽固性渗液1例临床护理

经外周静脉穿刺置入中心静脉导管(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,适用于长期静脉输液、肿瘤化疗、肠外营养、老年患者输液,还可用于NICU的患者治疗。PICC有许多优点,但亦存在一些并发症危险。2011年2月,我院收治1例胶质瘤复发患者,结合其病情及静脉穿刺情况为其行PICC,置管1周后,置管处顽固性渗     

肿瘤患者经外周静脉中心静脉导管留置期间真实体验的质性研究

目的探讨肿瘤患者经外周静脉中心静脉导管(peripherally inserted central catheter,PICC)留置期间的真实体验。方法目的性抽样选择山东大学齐鲁医院11例留置PICC的肿瘤患者,对其进行半结构式访谈,采用Nancy现象学7步分析法对资料进行分析。结果通过访谈归纳出4个主题:感受身体的变化;置管后维护的感受;对日常生活的影响;体会到的受益感。结论大部分患者能感知到PICC为自己带来的益处,留置PICC对肿瘤患者日常生活影响不大,但置管后维护成本及对置管医院的依赖影响患者的日常导管维护行为,应针对留置导管患者的维护问题采取相应的措施。     

白血病患儿PICC置管后发生静脉炎1例的护理体会

<正>经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)是经外周静脉(贵要静脉、肘正中静脉、头静脉)穿刺置管,头端位于上腔静脉的导管。PICC置管可减少反复静脉穿刺所致的静脉损伤,减少化疗药物及其他刺激性药物对外周血管的刺激或因药物渗漏导致的局部组织坏死,适用于长期静脉输液、肿瘤化疗、肠外营养、老年患者输液及早产儿营养通路[1]。但     

改良衣袖在经外周静脉置入中心静脉导管置管患者中的应用

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,也可用于大面积烧伤、大手术、危重患者的抢救治疗。     

PICC与PVC在结直肠癌患者FOLFOX4化疗中的应用比较

【目的】探寻结直肠癌患者FOLFOX4化疗的最优输液方法。【方法】收集2014年全年结直肠癌术后采用FOLFOX4方案化疗患者318例,根据化疗药物输液方法分为经外周静脉置入中心静脉导管（PICC）组和外周静脉导管（PVC）组,比较两组之间药物渗漏、针眼局部感染、静脉炎和脱管的发生率。【结果]PICC组药物渗漏、针眼局部感染、静脉炎和脱管的发生率低于PVC组,差异均具有统计学意义（P〈0．05）。【结论】在结直肠癌患者FOLFOX4化疗过程中,PICC置管明显优于PVC输液,值得在临床推广。     

乳腺癌化疗病人留置PICC真实体验的质性研究

[目的]探讨乳腺癌化疗病人经外周静脉置入中心静脉导管(PICC)的真实感受和心理体验。[方法]采用现象学研究方法对10例留置PICC的病人进行深度访谈,收集资料,应用Colaizzi分析法进行分析、归纳、整理。[结果]通过访谈归纳出PICC的选择与决策、病人的担心和顾虑、PICC对日常生活的影响、后期维护的考量和感受4个主题。[结论]护理人员应结合病人的个体情况多方位考虑,为病人选择最佳的化疗途径,做好病人管路的延伸护理,保证治疗的顺利进行。同时要关注乳腺癌化疗病人的心理,提高病人的生存质量。     

经PICC与经CVC测量中心静脉压值的一致性分析

目的探讨经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)与经中心静脉插管(central venous catheterization,CVC)测量中心静脉压值的一致性.方法收集广州市某三级甲等医院血液科实施PICC及CVC的住院患者62例,分别经PICC与经CVC测量患者的中心静脉压.应用Bland-Altman分析评价2种途径测得中心静脉压数值的一致性.结果 Bland-Altman分析表明:经PICC测得的中心静脉压值高于经 CVC测得的中心静脉压值,2种途径测得中心静脉压值一致性界限为(2.024,-1.214)cmH2O(1 cmH2O=0.098 kPa);3%(2/62)的点在95%的一致性界限以外,在一致性界限范围内,2种途径测量中心静脉压差值的最大值为1.80 cmH2O,最小值为-1.0 cmH2O.结论经PICC与经CVC测得的中心静脉压值一致性好,经 PICC测量是中心静脉压测量的有效方法.     

双腔耐高压注射型经外周置入中心静脉导管在ICU中的应用效果

目的探讨重症监护病房(ICU)应用双腔耐高压注射型经外周置入中心静脉导管(PICC)的临床效果。方法回顾分析本院ICU行静脉置管术的557例患者的临床资料,观察组283例采用双腔耐高压注射型PICC置管术,对照组274例采用双腔中心静脉导管(CVC)置管术,对比分析2组患者的疗效及安全性指标。结果观察组单根导管治疗完成率显著高于对照组,静脉导管留置时间显著长于对照组(P0.05),2组患者一次置管成功率差异则无统计学意义(P0.05)。在置管操作过程中,2组患者气胸、血胸、心律失常、置管误入动脉、穿刺点渗血的并发症发生率差异无统计学意义(P0.05),观察组原发异位率显著高于对照组(P0.05)。静脉导管留置期间,观察组导管相关血流感染、非计划拔管的发生率显著低于对照组,静脉炎发生率显著高于对照组(P0.05),2组患者血栓形成、静脉导管移位、脱出、堵管的并发症发生率差异无统计学意义(P0.05)。结论与双腔CVC置管术相比,ICU应用双腔耐高压注射型PICC置管术具有留置期间安全性、有效性更佳等优点。     

中心静脉置管护理进展

中心静脉导管(CentralVenousCatheters,CVC)系指末端位于大的中心静脉的任何静脉导管[1]。中心静脉通道是由导管头的位置所定义而不是插入位置来定义。由于CVC置于上腔静脉、下腔静脉或右心房,其管口周围血流量大,液体易输注,刺激性药物对血管壁不会造成损害。同时穿刺的方法不断更新,保留时间延长,减轻了反复静脉穿刺的痛苦,为抢救病人赢得了时间,提高了护士工作效率。临床应用中心静脉置管是危重病人输血、输液、静脉内营养支持、给药和血液动力学监测的重要诊治措施,适用于中心静脉压监测,以及时调节补液量,控制液体平衡,可使多系统…     

护理人员对PICC置管后日常护理相关知识及态度的调查

目的 了解护理人员对PICC置管后日常护理相关知识的掌握情况以及对PICC置管后日常护理的态度,为进一步开展有针对性的PICC专科培训提供依据.方法 以方便取样的方法选取北京市10所三级甲等医院开展PICC的23个科室的129名护理人员进行问卷调查.结果 (1)护理人员PICC置管后日常护理相关知识的平均得分69.15±13.64分,35.66%的护士得分≤60分;在各条目的正确率中最低的三项依次是"无菌贴膜固定的方式"、"常用消毒剂的性质"以及"PICC置管后日常护理中皮肤的消毒范围";(2)护理人员PICC置管后日常护理态度的平均得分84.14±6.63分,96.12%的护士态度得分>70分.经多元线性回归分析,结果显示是否具有PICC专科资质是影响护理人员PICC置管后日常护理态度的主要因素(P<0.05);(3)护理人员PICC置管后日常护理相关的知识得分与态度得分无相关性(r=0.126,P=0.156).结论 加强对护理人员PICC专科培训和再培训,特别是在PICC新知识、新进展方面,应有侧重点并系统地进行.     

经双腔中心静脉导管主侧孔测量中心静脉压的相关性研究

目的比较经双腔中心静脉导管主孔通道和侧孔通道测量中心静脉压(CVP)的相关性。方法对50例危重患者分别经双腔中心静脉导管主孔和侧孔测量其在平卧位、半卧位30°、半卧位45°的CVP,采用非参数配对检验对两组数据进行统计学分析。结果经主孔通道测量CVP和侧孔通道测量CVP数值比较差异无统计学意义(P0.05)。结论经双腔静脉导管主孔通道进行静脉治疗,侧孔通道监测CVP能同时满足监测和治疗的双重需要,值得在临床上推广。     

A prospective,longitudinal study of central venous catheter‐related deep venous thrombosis in boys with hemophilia

Summary. Background: Central venous catheters (CVCs) are often inserted into boys with hemophilia to secure venous access for factor prophylaxis and immune tolerance induction therapy. Complications associated with CVCs include catheter‐related infections, local hemorrhage, and mechanical failure. Less frequently reported is CVC‐related deep venous thrombosis (DVT). We conducted a prospective study to determine the frequency and outcome of this complication. Methods: All boys (n = 16) with congenital hemophilia A or B with a CVC in place who were registered in the pediatric comprehensive care program at the Hospital for Sick Children, Toronto, were included in the study. They were prospectively assessed by imaging studies and clinical examinations for CVC‐related DVT at two time‐points, 2 years apart. Each boy was evaluated for inherited hypercoagulability. Results: Eleven (69%) of the 16 boys had radiological evidence of DVT at the first evaluation and 13/16 (81%) at the second evaluation. In two boys there was improvement in the venogram findings at the second evaluation. None of the CVC‐related DVTs completely resolved. Median age at the time of initial insertion of a CVC was 1.0 years (range 0.02–6.7 years). Median duration of CVC placement was 6.4 years (range 3.3–15.5 years). Only 4/13 boys with DVTs had clinical evidence of upper venous system obstruction. Only one boy, who did not develop a DVT, had a low protein C level. Conclusions: CVC‐related DVTs occur in the majority of boys with hemophilia who have CVCs inserted for a prolonged period of time. Annual screening with imaging is recommended for boys with CVCs in place for ≥ 3 years. Consideration should be given to removing CVCs as soon as peripheral venous access is feasible.     

Central Line Mechanical Complication Rate in Emergency Medicine Patients

Central line (CL) placement in the emergency department (ED) is a common practice. Previously published small-scale studies have quoted mechanical complication rates in emergency medicine patients of 10-15%. OBJECTIVE: To determine the mechanical complication rate of central venous catheterization in a large (65,000 visits/year) academic urban ED. METHODS: This was a retrospective review of all ED-placed CLs over a three-year period from May 1995 to May 1998. Data were collected as part of a monthly quality assurance project and analyzed using Fisher's exact test (significance = p < 0.05). Central lines were defined as subclavian, internal jugular, femoral, and interosseous lines. Mechanical complication was defined as a pneumothorax, hematoma, line misplacement, or hemothorax. RESULTS: There were 22 complications of a total of 643 CLs placed [complication rate 3.4% (95% CI = 1.9% to 4.8%)]. The complication rate for patients with a confirmatory chest x-ray receiving a subclavian or internal jugular CL (excluding all patients who died prior to x-ray evaluation of CL) was 6.2% (22/355) (95% CI = 3.9% to 9.3%). There were 402 (63%) CLs placed during a code with a complication rate of 2.2% (95% CI = 1.0% to 4.2%), 79% (317/402) medical and 21% (85/402) trauma codes. Thirty-seven percent (241) of the CLs were placed on an "elective urgent" basis. Residents placed the majority of CLs (567/643), with a complication rate of 3%. There was no statistically significant difference in complication rates based on level of resident training. CONCLUSIONS: The CL mechanical complication rate in the ED at this institution is 3.4%. This is substantially lower than previously reported mechanical complication rates.     

中心静脉导管相关性败血症病原菌的临床分析及处理

目的:探讨中心静脉导管相关性败血症(catheter-relatedsepsis,CRS)病人病原菌的分布特点及耐药情况。方法:对40例CRS病人的静脉导管尖端进行培养和药敏试验。结果:CRS常见的致病菌依次为革兰阳性球菌(32/45),真菌(8/45),革兰阴性杆菌(5/45)。革兰阳性球菌以表皮葡萄球菌为主,而且多数对苯唑西林耐药,万古霉素敏感率为100%,白色念珠菌为主要的致病真菌(7/8),革兰阴性杆菌常为耐药菌株。结论:CRS病原菌以革兰阳性球菌为主。CRS的有效处理方法是拔除感染的导管。     

外周导入中心静脉置管与中心静脉置管输入化疗药物对照试验的Meta分析

目的评价经外周导入中心静脉置管(PICC)和中心静脉置管(CVC)使用化疗药物的安全性和效果。方法采用Meta分析方法,对国内外有关经外周导入中心静脉置管与中心静脉置管进行化疗的对照试验进行综合定量分析。采用RevMan 4.2软件进行数据处理,计算两组相关研究指标的比值比(OR)及其95%可信区间(CI)。结果共纳入22个研究,总样本量2943例次。PICC组在一次穿刺成功率、穿刺操作时间、血气胸发生率、血肿发生率等共8项指标方面优于CVC组;在脉管炎发生率、血栓发生率方面CVC组则较优;堵管发生率、导管渗漏率、局部动静脉损伤率、导管漂移率4项指标在两组间差异无显著意义。结论输入化疗药物时,PICC较CVC有明显优势。     

Totally implantable venous access devices via subclavian vein: A retrospective study of 368 oncology patients

Totally implantable catheters and totally implantable venous access devices (TIVADs) represent a valid method of administering long-term chemotherapy. TIVADs have several advantages over other methods of venous access: they are easy to implant under local anesthesia, they cause less discomfort for patients, and they can be implanted and managed on an outpatient basis. A total of 368 oncology patients were scheduled for percutaneous venous access devices. The purpose of this study was to examine the early and late complication rates of TIVADs used to deliver long-term chemotherapy. From June 2001 to January 2006, we placed 368 TIVADs, under x-ray guidance, for long-term chemotherapy in general oncology patients under local anesthesia (95% solid, 5% hematologic tumors). Percutaneous venous access devices were inserted into the subclavian vein, and adequate follow-up was provided in all cases (median, 145 d; range, 1–348 d). A total of 112 devices (30%) remained in situ at the end of the study. Early complications of TIVADs included 9 (2.4%) arterial punctures, 2 (0.5%) malpositions, and 1 (0.3%) pneumothorax, which required no thoracic aspiration. Late complications included 3 cases (0.8%) of venous thrombosis, 2 cases (0.5%) of pocket infection, and 1 case (0.3%) of port-related bacteremia. This study describes a series of patients with subcutaneous infusion ports connected to various catheters. This device is a good option for long-term access to the subclavian vein; major complications related to implantation are rare, and ongoing management of these devices supports their increased use in oncology patients.