SiteRite5血管超声引导结合微插管鞘技术行上臂中心静脉置管的效果

目的观察SiteRite5血管超声引导系统结合微插管鞘技术对血管条件差的患者行上臂中心静脉置管（peripherally inserted central catheters,PICC）的效果。方法选择某院2009年1-11月需行PICC置管的血管条件差的139例患者,按其入院时间的先后分为对照组（N=67）与观察组（N=72）。观察组患者采用美国巴德SiteRite5血管超声引导系统评估血管,利用微插管鞘技术行上臂PICC穿刺;对照组患者在普通超声下穿刺血管行PICC。比较两组患者一次穿刺成功率、总穿刺成功率、穿刺并发症的发生率和患者的舒适情况。结果观察组患者一次穿刺成功率为97.2%,总穿刺成功率为100%,术后机械性静脉炎、深静脉血栓、局部感染等并发症的发生率为0,与对照组相比,差异均有统计学意义（均P〈0.01）。观察组患者穿刺时置管处疼痛情况与对照组患者相比,差异有统计学意义（P〈0.01）。结论采用SiteRite5血管超声引导系统和微插管鞘技术行上臂PICC穿刺,操作更加安全,提高了一次穿刺成功率,有效降低了置管并发症发生率,减少了患者疼痛,有较好的临床价值。

Effects of Upper Arm Placement of Peripherally Inserted Central Catheters with SiteRite5 Vascular Ultrasound Guidance System and Microintroducer Technique

Objective To observe the effects of peripherally inserted central catheters（PICC） puncture by using SiteRite5 vascular ultrasound guidance system and microintroducer technique.Methods A total of 139 PICC patients from January to November,2009 were divided into the observational group（N=72） and control group（N=67） based on admission sequence.The status of target vessels of the observational group were evaluated with Bard SiteRite5 vascular ultrasound guidance system and then microintroducer technique was used in PICC puncture of the upper arm.The patients of the control group were treated with PICC puncture using normal vascular ultrasound machine.The differences in the one-time success rate and the overall success rate of the puncture,the potential complication and the comfort status were compared between the two groups.Results The one-time success rate and the total success rate reached 97.2% and 100% respectively.After the operation,none of the cases was found with mechanical phlebitis,deep vein thrombosis or local infection.The difference had statistical significance between two groups after therapy（P〈0.01）.Significant difference in PICC puncture pain was observed in the patients of the two groups（P〈0.01）.Conclusion The PICC puncture using SiteRite5 vascular ultrasound guidance system and microintroducer techniques can provide a safe minimal invasive surgery with higher one-time success puncturing rate,lower rate of complications and fewer pains,which has wider clinical applications.