改良送鞘法降低PICC置管相关渗血渗液发生率的临床研究

目的比较改良送鞘法与手术刀扩皮送鞘法对PICC后渗血渗液发生率的影响。方法将424例PICC置管患者根据随机数字表生成的随机码,按患者所置导管类型(单腔导管、双腔导管)的置管顺序分为观察组和对照组,单腔导管观察组121例、对照组117例,双腔导管观察组92例、对照组94例,观察组采用改良送鞘法,对照组采用手术刀扩皮送鞘法。分别比较一次性送鞘成功率,置管后24 h、48 h、72 h局部渗血与渗液情况。结果单腔导管观察组一次性送鞘成功率95.87%,其余3组一次性送鞘成功率100%;置管后24 h局部渗血换药例数比较,单腔导管和双腔导管中两组间差异均无统计学意义;48 h局部渗血纱布层数比较,单腔导管和双腔导管的观察组少于对照组,比较差异有统计学意义,但48 h纱布压迫止血例数比较差异无统计学意义;单腔导管对照组6例患者发生渗液,双腔导管对照组2例患者发生渗液,而观察组患者均未发生渗液,单腔导管两组间发生率比较差异有统计学意义。结论使用改良送鞘法行PICC可减少置管后局部渗血和渗液。

Clinical research on application of modified insertion method on reducing incidence of PICC catheterization re-lated bleeding

Objective To Compare the effect of modified insertion method and expanded skin insertion method on in-cidence of PICC catheterization related bleeding. Method Divide 424 PICC patients into observation group and control group by random number table for single and dual lumen catheter separately. There are 121 cases in observation group and 117 cases in control group for single lumen catheter type. There are 92 cases in observation group and 94 cases in control group for dual-lumen catheter type. Patients in observation group receiving modified insertion method and patients in control group receive expanded skin insertion method. Compare the one-time success rate and status of bleeding 24 h, 48 h and 72 h after tube insertion. Result One-time success rate is 95.87% for observation group of single lumen catheter. One-time suc-cess rates for other three groups are 100% . There is no significant difference on cases of bleeding and dressing change be-tween observation group and control group in both single and dual-lumen catheter 24 h after tube insertion. Observation group has less layers of gauze for bleeding than control group 48 h after tube insertion for both single and dual-lumen catheter. The difference is significant. But there is no significant difference on cases of gauze compression hemostasis. There are 6 cases of exudate and 2 cases of exudate in control groups of single and dual-lumen catheter. No exudate happens in observation group. There is significant difference on incidence of exudate between observation group and control group for single lumen catheter. Conclusion Modified insertion method for PICC can reduce local oozing of blood and exudate.