体位改变对经外周置入中心静脉导管尖端位置的影响

目的 评估体位改变对经外周置入中心静脉导管(PICC)尖端位置的影响。方法 便利抽样法选取2015年12月至2016年3月期间在安徽省蚌埠医学院第一附属医院需置入PICC导管的70例病人,在X线透视下置管,置管过程中观察当病人由置管体位即平卧手臂外展90°(体位1)转变成平卧手臂内收于躯体侧(体位2)、由体位1转变成体位3(病人直立手臂内收于躯体侧)时导管尖端移动的方向和距离,并探讨性别、置管静脉、置管手臂等自变量对尖端移动总幅度的影响。结果 体位1到体位2转变时导管尖端平均向右心房方向移动(1.59±0.58)cm,体位1到体位3转变时导管尖端平均向右心房方向移动(3.02±0.87)cm。性别、置管静脉、置管手臂、对导管移动幅度的影响差异无统计学意义(P>0.05)。结论 体位改变是导管尖端位移的重要影响因素。PICC最初尖端位置的确定、置管后X线定位报告、带管病人的健康教育都应将此因素考虑其中。

Influnence of arm movement and postural changes on central tip location of peripherally inserted central catheter

Objective To evaluate the influnence of arm movements and postural changes on central tip location of peripherally inserted central catheter in adult and analyze the factors affecting catheter tip migration. Methods 70 adults acquired for PICCs were selected by the convenience trial from December 2015 to March 2016 in The first affiliated hospital of Bengbu medical college.The catheters were inserted under the X-ray.The direction and the range of the catheters'' tip during the catheters inserted process under three positions were observed.The patient in supine position with the arm abduction named position 1,the patient in supine position with the arm adduction named position 2,the patient upright position with the arm adduction named position 3.We also discussed the influnence of different factors to the range of catheters'' tip.Results The mean distances from position 1 to position 2 was (1.59±0.58) cm toward the heart.The mean distances from position 1 to position 3 was (3.02±0.87) cm also toward the heart.The sex,vein,position of arm do not significantly influence the range of movement (P>0.05). Conclusion The position changes are important factor for the catheter tip migrates.This knowledge should be considered in achieving the desired final catheter position,X-ray report after intubation and health education of patient go home.