SiteRite5血管超声引导结合微插管鞘技术行上臂双腔PowerPICC置管的效果

目的观察SiteRite5血管超声引导结合微插管鞘技术行上臂双腔PowerPICC穿刺置管的穿刺成功率、并发症、液体流速、高压注射应用情况。方法选择需行PICC置管的106例患者，按其入院先后分为对照组（n=54）和观察组（n=52），两组均采用美国巴德SiteRite5血管超声导引系统评估血管、利用微插管鞘技术行上臂PICC穿刺，其中对照组采用巴德三项瓣膜式双腔PICC导管，观察组采用双腔PowerPICC导管。比较两组穿刺成功率、并发症的发生率及两组患者接受增强CT时高压注射的途径及效果。结果两组穿刺成功率均为100％，术后并发症的发生率对照组为7．41％，观察组为0．00％，两组比较差异有统计学意义（X2=5．76，P〈0．05）；观察组在接受增强CT检查时可直接连接高压注射器进行增强扫描，而对照组患者100％需再次进行外周大静脉穿刺；对照组药液外渗、局部肿胀及局部疼痛、不适的发生率分别为17．02％，25．53％，观察组发生率均为0．00％，差异均有统计学意义（x2=18．60，29．27；P〈0．01）。结论SiteRite5血管超声引导结合微插管鞘技术行上臂双腔PowerPICC置管操作安全、微创，穿刺成功率高，置管并发症低，输液速度、流量达到临床要求，并能应用于CT增强扫描等辅助检查，弥补现有PICC置管不能用于高压注射的缺憾，无药物外渗的危险，提高导管利用率、有效减少护士工作量及提高患者的满意度，有较好的临床应用价值。

Effect of SiteRite5 vascular ultrasound and micro intubation scabbard technology on indwelling double channel power peripherally inserted central catheters ( Power PICC) in upper arm

Objective To observe the successful puncture rate,complications,the liquid flow rate and the high-pressure-injection status of upper arm indwelling double-channel Power PICC with SiteRite5 vascular ultrasound and micro inmbation scabbard technology.Methods Totals of 106 patients received PICC randomly divided into control group(53 cases) and observation group(53 cases),and two groups were assessed vessel by SiteRite5 vascular ultrasound of American Bard and used micro intubation scabbard technology in indwelling double-channel Power PICC.Control group used there valve type double-channel PICC catheter of Bard,while observation group used double-channel Power PICC catheter.Then successful puncture rate,complications ratio,the way and effects of high-pressure-injection when received enhanced CT examination in two groups were compared.Results The successful puncture rate of two groups was 100％,respectively.Complications ratio of control group was 7.41％ and observation group was 0.00％,the difference was statistical significant( x2 =5.76,P＜0.05).Observation group received enhanced-CT examination that can directly connected with highpressure-injection,while 100％ patients of control group needed peripheral large veins puncture again; liquor exosmosis and local swelling ratio and local pain,unwell ratio of control group was 17.02％ and 25.53％,and that of observation group was 0.00％,and the difference was statistical significant ( x2 =18.60,29.27 ; P ＜0.01 ).Conclusions Upper arm indwelling double-channel Power PICC with SiteRite5 vascular ultrasound and micro intubation scabbard technology has a safety operation,wiresoft,high successful puncture ratio,low complication ratio,liquor velocity and flow reach clinical requirement,and can use enhanced-CT to make up the deficiency of existing PICC puncture,no risk for liquor exosmosis,and can increase Catheter utilization ratio,effectively decrease the workload of nurses,and improve the satisfaction of patients,which has a better clinical utilization value.