外周静脉留置针拔管指征的实验研究

目的 通过动物实验研究静脉条索状改变血管的病理变化转归及其发生的相关因素,探讨合适的静脉留置针拔管指征.方法 将24只大耳健康新西兰白兔的耳缘静脉（48条）随机分为三组,进行静脉留置针输液,分别留置72h、120 h和168 h,拔针前评估静脉有无条索状改变;对所有拔除静脉留置针7d后的静脉血管活体标本做病理切片观察.结果 随着静脉留置针留置时间的延长,其静脉条索状改变发生率增加,三组比较,差异有统计学意义（P＜0.01）.在对拔除静脉留置针7d后的静脉血管活体标本病理切片观察发现,触及条索状改变的静脉血管切片均有较大机化血栓且再通呈网状或环状贴在血管内部,造成血管腔变窄或半堵塞,使留置部位静脉血管功能受损甚至失去功能.结论 不应以静脉出现条索状改变作为静脉留置针拔除指征,而应以时间为参考条件基础上,注重局部表现的评估,在患者留置72 h后应每天在输液前、输液后和患者主诉不适时评估血管,在有静脉炎早期表现时,及时拔出静脉留置针,避免静脉发生条索状改变.

An experimental study on indicators for removal of peripheral intravenous catheter

Objective To identify indicators for removal of peripheral intravenous catheter through an animal experiment which per- mits us to study predictors of IV site develops a palpable cord and the outcomes of pathological changes. Methods Twenty-four healthy New Zealand rabbits were randomized into one of three groups and received vascular access devices through dorsal auricular veins with the indwell time being 72 h, 120 h, and 168 h respectively. Whether there was a palpable venous cord was evaluated be- fore removal of the catheters, and sections were obtained 7 days after removal of catheters to observe pathological changes. Results The incidence of IV site developed a palpable cord should be higher by virtue of the longer catheter indwell time, with significant difference among the 3 groups （P〈0.01）. Pathological changes of these veins included., large organized thrombus were developed and they reticularly or circularly attached to venous intima after recanalization, which would result in partially or completely occluding the blood vessels and causing further impairing function of the vessels. Conclusion Appearance of venous cord should not be considered as an indicator for removal of intravenous catheters. Removal of catheters should consider catheter indwell time, pay attention to assessment of insertion sites, and assess blood vessels before and after infusion if the indwell time was longer than 72 h or at the moment that patients complain discomfort. We should remove the catheter when symptoms and signs of early phlebitis occur to avoid a tender venous cord.