乳腺癌患者经外周静脉置入中心静脉导管异位分析及复位的处理

目的探讨乳腺癌患者经外周静脉置入中心静脉导管（peripherally inserted central catheters PICC）异位的复位处理方法及防范对策。方法对2011年1月-2013年7月共176例乳腺癌PICC置管患者发生导管异位情况进行回顾性分析，比较不同静脉置管异位的发生率及复位处理方法。结果17例中19例发生导管异位，发生率为10．8％。贵要静脉、肘正中静脉、头静脉间比较异位发生率差异有统计学意义（P〈0．05），其中经头静脉置管发生异位的几率最高。根据异位情况采取不同的复位方法，如拔出部分导管、退管后在送管复位等。19例导管异位患者18例正位成功，复位成功率为95％。结论乳腺癌患者PICC置管应选择异位发生率低的粗、直、静脉瓣少的贵要静脉，尽量避免头静脉或走向头静脉的正中静脉置管，必须在头静脉置管且发生异位时需采取科学的复位方法，避免盲目的退管或送管。

ANALYSIS OF MALPOSITION OF PICC AND LTS NORMOTOPIA FOR PATIENTS WITH BREAST CANCER

Objective To discuss processing method of malposition of peripherally inserted central catheter（PICC）and its normotopia for patients with breast cancer. Methods A retrospective analysis was conducted for malposition of PICC for 152 patients with breast cancer from January 2007 to Octo-ber 2009 and incidence of malposition of different venous catheters and their normotopias were com-pared. Results Malposition occurred in 19 patients, accounting for 12.5% and there was of statistical significance of malposition incidence occurred in basilica vein, median cubital vein, cephalic vein（P〈 0.05）. Different normotopias such as removing some catheters could be adopted. Among those malpo-sitions occurring, 18 patients were with normotopia afterwards and only 1 patient indwelled catheter a-gain. Conclusion PICC should be indwelled in veins that malposition is less frequently seen, particu-larly avoiding cephalic vein.