32例肿瘤幼儿经肘下行PICC置管的方法改进

目的 探讨32例肿瘤幼儿肘上贵要静脉穿刺困难或失败后经肘下贵要静脉行改进PICC置管方法的护理体会.方法 根据幼儿的静脉特点,在超声引导下使用24 G留置针行肘下贵要静脉PICC置管,并结合"拔河式"穿刺、纵向扩皮等改进方法.结果 32例肿瘤幼儿均经肘下贵要静脉置管成功,其中27例一次穿刺成功,3例在同侧穿刺两次后成功,2例在同侧穿刺失败后转为对侧穿刺成功.32例肿瘤幼儿穿刺成功后均顺利送入PICC导管,其中2例异位于同侧颈内静脉,即刻重新调管后使导管尖端位于正常位置,总异位率为6.25%.结论 肘下贵要静脉行进改PICC置方法显著提高了肿瘤幼儿PICC置管成功率,为其提供了一条安全可靠的静脉通道.

Improved PICC catheter placing method under the elbow for 32 cases of tumor chil-dren

Objective To discuss the nursing experience of conducting improved PICC indwelling method through the basilic vein below the elbow on 32 cases of children with tumors in the case of difficulty or failure in basilic vein puncture above the elbow. Methods According to children's vein characters, use the 24G detaining needle to place the PICC catheter in the basilic vein under the elbow guided by the ultrasound, combined with the improved meth-ods such as "tug of war" puncture and longitudinal skin expansion. Results A total of 32 cases of tumor children had the catheters successfully placed in the basilic vein under the elbow. Wherein, 27 cases had the successful puncture for one time, 3 cases had the successful puncture on the same side for two times, 2 cases had the successful contralateral puncture after the failure of the lateral puncture. After the successful puncture, 32 cases tumor children had the PICC catheters smoothly placed. Wherein, 2 cases had the malposition in the ipsilateral internal jugular vein. After immediate reset of the catheters, the catheter tips were in the normal position. The total rate of malposition was 6. 25%. Conclu-sions The improved PICC catheter placing method in the basilic vein significantly improves the successful PICC cathe-ter placing rate for the tumor children, which provides a safe and reliable venous channel.