腔内心电图辅助定位减少新生儿PICC导管相关并发症的随机对照研究

  目的   探讨腔内心电图（intracavitary electrocardiogram，IC-ECG）辅助定位技术对新生儿经外周静脉置入中心静脉导管（peripherally inserted central catheter， PICC）相关并发症的影响。   方法   选取2017年1月?2019年12月入住四川省人民医院新生儿重症监护室的经上肢PICC置管患儿210例，按随机数字表法分为IC-ECG组和对照组。IC-ECG组按传统体表测量结合IC-ECG辅助定位技术行PICC置管，对照组按传统体表测量定位法行PICC置管，每组患儿105例。比较两组患儿一般资料及导管相关并发症。   结果   两组患儿性别构成、胎龄、置管日龄、导管留置时间、疾病类型及穿刺部位的比较差异无统计学意义（P>0.05）。IC-ECG组导管相关并发症总体发生率为3.8%，低于对照组的21.9%，差异有统计学意义（P<0.05）；其中IC-ECG组的静脉炎和心律失常的发生率较对照组低（P<0.05）。   结论   在新生儿PICC置管过程中，利用IC-ECG辅助定位，可减少导管相关并发症。

RCT of Reduction in Catheter-Related Complications by Using Intracavitary Electrocardiogram-Assisted Guidance in Neonatal PICC Placement

  Objective   To investigate the effect of intracavitary electrocardiogram (IC-ECG) guidance on peripherally inserted central catheter (PICC) related complications in neonatal patients.   Methods   A total of 210 neonatal patients were included in the study. They were admitted to the Neonatal Intensive Care Unit, Sichuan Provincial People's Hosptial between January, 2017 and December, 2019 and had PICC lines were placed in their upper limbs. The patients were randomly assigned to the observation group, which had PICC placement through conventional anatomical landmark guidance combined with IC-ECG guidance (n=105) or to the control group, which had PICC placement through only conventional anatomical landmark guidance (n=105) for PICC catheter tip positioning. Patient baseline data and data on subsequent catheter-related complications of the two groups were collected and compared.   Results   There were no significant difference between the two groups in sex composition, gestational age, postnatal days on the day of PICC placement, duration of PICC placement, disease profile, and the site of puncture (P>0.05). The observation group showed a significantly lower overall incidence of catheter-related complications (3.8%), compared to that of the control group (21.9%) (P<0.05). The observation group showed significantly lower incidence of phlebitis and arrhthmia compared to that of the control group (P<0.05).   Conclusion   A combination of anatomical landmark guidance and IC-ECG guidance to assist the placement of PICC decreases catheter-related complications.