超声定位在早产儿PICC置管术中的应用价值

目的探讨超声在早产儿经外周静脉置入中心静脉导管(PICC)定位中的应用价值。方法回顾性分析2017年8月至2019年6月大坪医院儿科收治的216例PICC置管超声定位早产儿的临床资料。所有PICC放置后的早产儿即行超声定位,如果PICC尖端位置位于下/上窦房结,则确认PICC放置成功。其中43例早产儿超声定位检查后立即行胸部X线定位,比较超声定位的准确性。结果216例患儿中,首次成功置入PICC者200例(92.6%),16例(7.6%)导管头端放置位置超出理想位置:导管头端过深(右心房)6例,导管头端过浅6例,导管头端定位不正确4例。超声诊断PICC尖部定位的敏感性和特异性均为100.0%。并发症发生率为6.5%。结论超声定位PICC导管头端位置是一种及时、准确、可靠的方法,能较准确地识别导管头端,值得推广应用于新生儿病房。

A randomized controlled study of ultrasound localization in PICC catheterization of newborn infants

Objective To study the efficiency of ultrasound for positioning the catheter tip in the placement of peripherally inserted central catheter(PICC)in neonates.Methods The clinical data of 216 cases of premature infants with PICC catheterization were retrospectively analyzed from August 2017 to June 2019 in Pediatrics department of Daping Hospital.Ultrasonic localization was performed immediately after PICC placement in all neonatal patients.Successful PICC placement was confirmed if the PICC tip position was located at the inferior/superior cavoatrial junction.Chest X-ray localization was performed on 43 infants immediately after ultrasound examination to compare the accuracy of ultrasound localization.Results Of the 216 patients,200(92.6%)cases had successful PICC placement on the first attempt.16 cases(7.6%)were placed beyond the ideal position:6 cases were too deep(right atrium),6 cases were too shallow,and 4 cases were incorrect.Both the sensitivity and the specificity of ultrasound for identifying PICC tip localization were 100%.The incidence of complications was 6.5%.Conclusion Ultrasonic localization of the PICC tip position is a timely,accurate,and reliable method and can identify the catheter tip with high accuracy.This method could be widely applied in neonatal wards.