外周静脉穿刺置入中心静脉导管的护理

2000～2002年，我们对16例患者实施外周静脉穿刺中心静脉导管置入术(PICC)，取得了良好效果。现将护理体会报告如下。     

经外周置入中心静脉导管在急诊重症监护室中的应用

目的 探讨经外周置入中心静脉导管（PICC）在急诊重症监护室的应用及护理体会.方法 使用改良贝朗方法对87例急诊重症监护室患者进行PICC留置术,置管前、置管中、置管后进行观察,总结护理注意事项及并发症.结果 置管成功率为 90.80%（79/87）,并发症较少.结论 PICC在危重病人中的应用已基本取代了传统的静脉切开,成为危重病人抢救治疗的重要措施之一,为抢救危重病人开辟了一条绿色通道,为快速诊断和治疗疾病提供了可靠的手段.在医生进行其他抢救措施时,由护士单独执行操作,为病情重笃的急诊重症监护室（EICU）病人抢救赢得了时间.对常见并发症及其护理的掌握和及时处理,能最大限度减少并发症给患者带来的不良后果.     

外周静脉置入中心静脉导管并发症的观察与护理

外周静脉置入中心静脉导管（PICC）是一种能够满足各种静脉给药的深静脉导管，在国外早已广泛应用，它以其独特的优点在临床应用。近年来，我们已在ICU病人中广泛应用。现就我们2003—12／2004—12应用PICC置管15例病人护理体会，介绍如下。     

经外周静脉置入中心静脉导管常见并发症防治与护理

经外周中静脉置入中心静脉导管（PICC）已发展为一种安全有效的置管技术,其操作方法简单,可床旁操作,穿刺成功率高、留置时间长,并发症较少。具有减轻患者反复穿刺的痛苦,提高患者生活质量,也为患者赢得抢救时机。临床中广泛应用于长期静脉输液、静脉化疗、胃肠外营养等患者,为患者提供一条安全、可靠的深静脉通道。我院2008年1月—2011年5月开展PICC置管术228例,现将置管患者常见并发症防治与护理体会总结如下。     

健康教育在神经内科经外周静脉置入的中心静脉导管术置管患者中的应用

目的探讨对60例神经内科经外周静脉置入的中心静脉导管术（PICC）置管患者实施全程分期式健康教育方法。方法在患者入院时、置管前、中、后,出院前5个阶段对患者实施有针对性、连续、系统的健康教育。结果 60例置管患者对PICC概念的了解由入院时的5%上升至置管后的100%,置管成功率100%,最长置管时间286d,并发症发生率13.3%。结论对神经内科PICC置管患者实施全程分期式健康教育可以提高患者置管依从性、提高患者满意度、提高置管成功率、减少并发症、延长导管安全留置时间。     

品管圈活动对经外周静脉置入中心静脉导管带管出院患者导管维护依从性的影响

目的分析品管圈活动对经外周静脉置入中心静脉导管(PICC)带管出院患者导管维护依从性的影响。方法选取2015年2月—2017年7月哈尔滨医科大学附属第四医院PICC带管出院患者50例,按照随机抽签法分为对照组和观察组,每组25例。对照组患者行常规护理,观察组患者采用品管圈活动进行护理。比较两组患者护理前后导管维护健康知识掌握评分、PICC知识掌握评分、抑郁自评量表(SDS)、焦虑自评量表(SAS)评分及护理后导管维护依从率、总满意度。结果护理前两组患者维护健康知识掌握评分、PICC知识掌握评分、SDS评分及SAS评分比较,差异无统计学意义(P>0.05);护理后观察组患者导管维护健康知识掌握评分、PICC知识掌握评分高于对照组,SDS评分和SAS评分低于对照组(P<0.05)。护理后观察组患者导管维护依从率和总满意度高于对照组(P<0.05)。结论品管圈活动能有效提高PICC带管出院患者导管维护依从性及护理满意度,改善患者抑郁、焦虑情绪,值得在临床护理中推广。     

耐高压注射型经外周静脉置入中心静脉导管与中心静脉导管在肝细胞癌肝切除术患者中的应用

目的 比较耐高压注射型经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)与中心静脉导管(central venous catheters,CVC)在肝细胞癌患者行肝切除术后的应用效果。方法 回顾性分析2019年1月至2020年10月在首都医科大学附属北京地坛医院行肝切除术的70例肝细胞癌患者的临床资料。根据放置静脉导管的方式将其分为耐高压注射型PICC组(36例)和CVC组(34例)。分析两组患者静脉穿刺次数、插管成功率、导管留置时间以及导管相关并发症发生情况。采用Logistic回归分析耐高压注射型PICC相关性感染的危险因素。结果 耐高压注射型PICC组导管留置时间显著长于CVC组(中位数：14 d vs 7 d;z=-4.983,P <0.001),两组导管相关并发症发生率无显著差异[31%(11/36) vs 41%(14/34);χ²=0.859,P=0.354]。耐高压注射型PICC组最常见的并发症为静脉炎(5例),而在B组中未观察到静脉炎的发生(χ²=3.2...     

经外周静脉置入中心静脉导管置管术相关并发症的维护对策

经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)是经外周静脉穿刺置管,使导管尖端位于上腔静脉或锁骨下静脉的方法。PICC置管术具有操作方便、安全可靠、一次置管成功率高的优势,目前在临床上已得到广泛应用\[1-6\]。但作为一种有创操作,PICC置管过程中可能引起多种并发症,因此如何提高护理质量,减少并发症的发生,一直是该领域的研究热点\[7\]。本研究通过分析     

严重肝病患者经外周静脉置入中心静脉导管术后护理

严重肝病患者常伴凝血机制障碍,病程长,病情重,长期静脉输液,外周表浅静脉质量差且破坏严重,穿刺后易形成局部紫斑和渗漏、导致皮肤坏死等严重并发症。选择外周静脉置人中心静脉导管(PICC)后,解决了外周静脉质量差,长期输液困难的问题,提高了治疗效果,现将应用体会介绍如下。     

Upper body peripherally inserted central catheter in pediatric single ventricle patients

BACKGROUND There is risk of stenosis and thrombosis of the superior vena cava after upper extremity central catheter replacement. This complication is more serious among patients with single ventricle physiology, as it might preclude them from undergoing further life-sustaining palliative surgery.AIM To describe complications associated with the use of upper extremity percutaneous intravenous central catheters(PICCs) in children with single ventricle physiology.METHODS A single institution retrospective review of univentricular patients who underwent superior cavopulmonary anastomoses as their stage 2 palliation procedure from January 2014 until December 2018 and had upper body PICCs placed at any point prior to this procedure. Clinical data including ultrasonography, cardiac catheterization, echocardiogram reports and patient notes were used to determine the presence of thrombus or stenosis of the upper extremity and cervical vessels. Data regarding the presence and duration of upper extremity PICCs and upper extremity central venous catheter(CVC), and use of anticoagulation were recorded.RESULTS Seventy-six patients underwent superior cavopulmonary anastomoses, of which 56(73%) had an upper extremity PICC at some point prior to this procedure. Median duration of PICC usage was 24 d(25%, 75%: 12, 39). Seventeen patients(30%) with PICCs also had internal jugular or subclavian central venous catheters(CVCs) in place at some point prior to their superior cavopulmonary anastomoses, median duration 10 d(25%, 75%: 8, 14). Thrombus was detected in association with 2 of the 56 PICCs(4%) and 3 of the 17 CVCs(18%). All five patients were placed on therapeutic dose of low molecular weight heparin at the time of thrombus detection and subsequent cardiac catheterization demonstrated resolution in three of the five patients. No patients developed clinically significant venous stenosis.CONCLUSION Use of upper extremity PICCs in patients with single ventricle physiology prior to super cavopulmonary anastomosis is associated with a low rate of catheterassociated thrombosis.     

中心静脉导管行胸腔闭式引流治疗气胸的临床观察

目的比较中心静脉导管与粗硅胶引流管行胸腔闭式引流治疗气胸的疗效和并发症。方法我科收治的116例气胸患者随机分为研究组（58例）和对照组（58例）,研究组采用中心静脉导管行胸腔闭式引流,对照组采用粗硅胶引流管行胸腔闭式引流,观察两组的治疗效果和并发症。结果研究组和对照组相比,治疗效果接近,差异无统计学意义。但在某些并发症上,研究组较对照组明显减少,差异有统计学意义。结论采用中心静脉导管行胸腔闭式引流治疗气胸创伤小、操作简单、引流效果可靠、并发症少,值得临床推广。     

中心静脉导管在急性恶性胸水置管引流中的临床应用

目的 观察中心静脉导管引流治疗急性恶性胸水的临床疗效.方法 随机将急性恶性胸水患者分成2组,分别进行胸腔穿刺和中心静脉导管引流,并同时于胸腔内注入丝裂霉素.结果 中心静脉导管引流组的效果优于胸腔穿刺组,其临床耐受良好,不良反应小,疗效满意.结论 应用中心静脉导管装置引流治疗急性恶性胸水能最大限度地排净胸水,为胸水的最终...     

PICC导管在长期留置深静脉导管高龄老年患者中的应用效果

目的观察peripherallyinsertedcentralcatheter（PICC）导管在长期留置深静脉导管高龄老年患者中的应用效果及并发症。方法收集80岁及以上需要长期留置深静脉导管的高龄患者132例。按穿刺途径不同分为两组：PICC导管组（n=72）和颈内静脉组（n=60）。结果PICC导管留置时间较颈内静脉组显著延长,分别为（146．84±100．46）d和（36．60±35．61）d,两组相比差异有统计学意义（P〈0．01）。PICC导管组导管相关性感染和滑脱分别为2例和1例,均较颈内静脉组（10例和9例）显著减少（均P〈0．05）。结论高龄老人可应用PICC导管,留置时间长,安全性好,并发症少,值得临床上推广应用。     

心脏术后中心静脉导管相关性感染的病原菌及药物敏感性分析

目的探讨心脏术后中心静脉导管相关性感染（CVC-RI）的致病菌群分布及药敏情况。方法对我院2009年1月至2011年6月间,进行心脏直视手术并行中心静脉置管术的526例患者临床病历进行筛查,对发生CVC-RI患者的临床资料及细菌培养、药物敏感性试验结果进行回顾性分析。结果 38例患者发生了CVC-RI,总发生率为7.22%（38/526）,培养出病原菌48株,其中革兰氏阳性菌有26株（54.16%）、革兰氏阴性菌有18株（37.50%）、真菌4株（8.33%）;常见的致病菌有金黄色葡萄球菌（29.16%）、表皮葡萄球菌（13.67%）、铜绿假单胞菌（12.50%）。药物敏感性分析显示,革兰氏阳性菌对万古霉素敏感性为100%,其次是氯霉素、左旋氧氟沙星和哌拉西林;而革兰氏阴性菌耐药率高,对亚胺培南敏感性较高,其次是左旋氧氟沙星、头孢他啶、哌拉西林/他唑巴坦。结论心脏术后发生CVC-RI病原菌以金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌为多见,抗感染治疗应据细菌药物敏感结果合理选用抗生素。     

High rate of complications associated with peripherally inserted central venous catheters in patients with solid tumours

BACKGROUND: Peripherally inserted central catheters (PICC) have been used extensively as a cost-effective and safe form of medium-term intravascular access. There are only limited data about complications of PICC lines in oncology patients despite theoretical concerns about the higher risks of complications in these patients as a result of cancer itself and cancer therapy. AIMS: To document the frequency and type of PICC complications in patients with solid tumours. METHODS: All patients with solid tumours who were treated at Flinders Medical Centre, Adelaide, South Australia, Australia between January 2000 and March 2001 were included in a retrospective review of PICC complications. RESULTS: Twenty-seven PICC lines were inserted in 17 patients; 40.7% (11/27) of PICC lines developed complications requiring early removal of the PICC. Complications encountered were sepsis (systemic and cellulitis), thrombosis, blockage and leakage. Septic complications were found at a rate of 8/1000 PICC days or 25.7% (7/27) of PICC inserted. The median dwell time was 20 days. The mean time for a complication to occur was 27.5 days. CONCLUSIONS: The present study demonstrates a high rate of complications, which is higher than the complication rates reported in studies of non-oncology patients. PICC lines should be used with caution in patients with solid tumours. Prospective studies of the factors influencing the incidence of complications might be warranted.     

中心静脉导管联合高渗葡萄糖治疗肝性胸水的疗效观察

目的观察中心静脉导管联合高渗葡萄糖治疗肝性胸水的临床疗效。方法 55例肝性胸水患者随机分成治疗组（27例）和对照组（28例）,治疗组采用中心静脉导管留置胸腔持续引流胸水,胸水经B超或胸部X线片证实完全排净后注入高渗葡萄糖溶液。对照组则采用常规胸腔穿剌抽胸水治疗。两组患者均给予护肝、输白蛋白等支持治疗,观察两组患者的治疗效果和并发症的发生情况。结果 治疗组治疗总有效率为81.5%,对照组治疗总有效率为71.4%,两组比较有明显差异（P〈0.05）;治疗组胸水穿刺次数、胸水消退的天数、穿刺费用和住院天数较对照组均明显缩短（P〈0.05）,并发症少。结论中心静脉导管联合高渗葡萄糖治疗肝性胸水的疗效显著,操作简便,副作用少,值得临床推广。     

Complete heart block—an underappreciated serious complication of central venous catheter placement

Central venous catheter (CVC) placement is a common bedside procedure that is frequently performed in critically ill patients. More than 5 million CVCs are inserted annually across the United States alone. Procedure-related complications may vary from minor bleeding to life-threatening complications such as arterial perforation and pneumothorax. Cardiac arrhythmias can often occur during the guidewire placement, and bundle-branch blocks have also been reported. We herewith report a case of complete heart block during CVC placement, which is a rare but serious complication of this procedure. Because the patient had a preexisting left bundle-branch block, complete heart block likely resulted from a probable trauma to the right bundle branch during the guidewire insertion.     

Iatrogenic cardiac tamponade after central venous catheter

Myocardial perforations with a central venous catheter are rare in adults (67 cases published since 1968). These accidents are fatal in more than two-thirds of the cases owing to confusion caused by misleading symptoms which suggest pulmonary embolism. The perforation is generally localized in the right atrium (29 cases), less frequently in the right ventricle (18 cases). The superior vena cava is rarely affected (3 cases). The site of the perforation was not found in the other published cases. Clinical symptoms are signs of tamponade with disorders of cardiac rhythm. An enlargement of the cardiac shadow and an abnormal position of the catheter, buckled or openly intrapericardial, make the diagnosis radiologically. Echocardiography provides some information, but this is often too late for practical application. The diagnosis is made with right catheterization when it shows an equalization of the diastolic pressures. This allows the patient to be watched closely following the pericardial tap, after which a surgical approach may be indicated and performed. Prevention of these iatrogenic accidents must be systematic and strictly controlled for.     

中心静脉导管腹腔留置治疗肝纤维化顽固性腹水效果

目的 目的 探讨肝纤维化并顽固性腹水的综合治疗方法。 方法 方法 收集54例肝纤维化并顽固性腹水住院患者, 随机 分为实验组和对照组。实验组采用改良中心静脉导管腹腔内留置进行放液、 灌洗、 腔内药物注射, 并结合全身情况综合治 疗。对照组常规腹腔穿刺抽液。结果 结果 实验组总有效率82.1%, 对照组总有效率57.7%, 差异有统计学意义 （χ2 = 3.87, P＜0.05）。实验组住院天数、 腹穿次数、 腹水消退时间均少于对照组, 差异均有统计学意义 （P均＜0.05）。结论 结论 改良中心 静脉导管腹腔留置治疗肝纤维化并顽固性腹水安全、 有效、 方便。