大隐静脉PICC置管在上腔静脉压迫征患者中的应用

目的 探讨大隐静脉PICC置管在上腔静脉压迫征患者中的应用效果,为临床对上腔静脉压迫征患者合理的静脉通路选择提供依据。 方法 对2015年1月-2016年8月入住浙江省中医院的12例因有上腔静脉压迫征无法将PICC管置入上腔静脉的预行中心静脉置管化疗的肿瘤患者给予正确、全面评估,并与医生讨论后制定开通静脉通路的方案,向患者及家属详细说明目的与方法,征得患者及家属的同意,按医院PICC置管操作规范流程,对双下肢大隐静脉进行全面细致的评估,在大腿中上段确定穿刺点并做好标记,测量从预穿刺点至剑突的距离为置管长度,以穿刺点为中心用75%酒精和2%的葡萄糖酸氯己定顺时针、逆时针各3遍严格消毒皮肤,直径≥ 20 cm,依次铺大单洞巾、套探头套,做好最大的无菌屏障后行大隐静脉置入PICC导管,置管成功后予IV3000敷贴妥善固定,并对所有患者临床资料进行总结分析。 结果 12例患者均一次置管成功,导管头端定位于下腔静脉内,置管成功率100%;12例患者中11例在完成所有化疗疗程后拔管,1例因无法忍受化疗副作用主动放弃化疗而拔管;所有患者在导管留置期间内无并发症发生。 结论 因有上腔静脉压迫征无法将PICC导管置入上腔静脉的肿瘤患者经大隐静脉PICC置管是开通静脉通路安全而有效的方法,该方法解决了上腔静脉压迫综合征不能在上肢输液的问题,具有一定的临床优势,值得临床推广应用。 

PICC placement via the greater saphenous vein in patients with superior vena cava syndrome

Objective To investigate the efficacy of PICC placement via the greater saphenous vein and explore best approach for clinical catheterization in patients with superior vena cava syndrome (SVCS). Methods A total of 12 tumor patients with SVCS who were unable to place PICC into the superior vena cava for chemotherapy via central venous catheter (CVC) in our hospital between January, 2015 and August, 2016 were enrolled into this study. On the basis of evolution and consultation with patients, family members and doctors, PICC placement via the greater saphenous vein was performed according to PICC catheterization standard operation procedure (including marker, measurement, disinfect, puncture, catheter placement and fixation with IV3000). The clinical data of all patients were summarized and analyzed. Results The catheterization via saphenous vein was performed in all 12 patients with an success rate of 100%. The extubation was carried out in 11 cases when all courses of chemotherapy were completed, and 1 case gave up chemotherapy due to intolerable side effects of chemotherapy. There was no complication in all patients during the catheter indwelling period. Conclusion PICC placement via the greater saphenous vein is a safe and effective method for patients with SVCS who were unable to place PICC into the superior vena cava for chemotherapy. With certain clinical advantages, it solves the problems in intravenous infusions in the upper extremities and is worthy of clinical application.