介入法在难置型外周中心静脉置管中的应用分析  

Application of Interventional Venous Access in the Difficult Cases of Peripherally Inserted Central Venous Catheters

作　　者：赵建新[1] 朱晓黎[1] 孙鸽[1] 

机构地区：[1]苏州大学附属第一医院介入科,215000

出　　处：《临床放射学杂志》2011年第9期1373-1377,共5页Journal of Clinical Radiology

摘　　要：目的回顾分析介入法在难置型外周中心静脉置管(PICC)中的应用价值及安全性。资料与方法 2008年1月至2010年11月经PICC专科护士会诊或操作后在床边直视下直接穿刺置入PICC管困难或失败的52例患者,在DSA下运用改良塞丁格技术置入三向瓣膜PICC管。对静脉显影不佳者采用顺行浅静脉造影穿刺靶静脉,对静脉迂曲或变异者采用微导丝导引法置管。结果 52例患者中50例成功置入PICC管,置管成功率96.1%。其中46例一次成功置管,4例第一次置入失败,第二次置入成功;全部病例均采用改良塞丁格穿刺技术,21例采用顺行浅静脉造影穿刺法,4例因头静脉注入深静脉角度过锐或腋静脉-锁骨下静脉段狭窄,走行迂曲而使用微导丝导引克服血管迂曲后置管成功,2例因双侧肘正中静脉缺如,头静脉及贵要静脉狭窄、闭塞置管失败。50例置管患者中,平均留管时间73天,2例(4.0%)发生深静脉血栓,其中1例(2.0%)发生致命性肺栓塞;1例(2.0%)发生无菌性静脉炎。结论 DSA导引下运用介入方法提高了PICC的置管成功率,减少了床边置管的盲目性。Objective To retrospectively analyze the safety and success rate of intervention venous access in patients with difficult insertion of peripherally inserted central venous catheters（PICC）.Materials and Methods From January 2008 to November 2010,fifty two patients were inserted PICC line using the antegrade venography and punctured target vein under the fluoroscopy.All of them were evaluated as difficult insertion of PICC line under direct vision by the clinical PICC nurse specialists ＇s consultation or failed of insertion at the blind bedside insertions.Microguide wire were used in patients with venous tortuosity or mutant.Results 50 in 52 patients were successfully placed PICC lines with a 96.1% success rate.The average period of PICC were 73 days in 50 patients.Among them,46 patients were successfully inserted at the first procedure and 4 was succeed at the second trial.Improved seldinger＇s puncture sets were used in all procedures while 21 were combined with antegrade venography.Four patients used the microguide wire during the procedure.Complications in this study included 2 cases of deep vein thrombosis（4.0%）,1 case of fatal pulmonary embolism（2.0%） and 1 case of aseptic phlebitis（2.0%）.Conclusion Application of interventional venous access is safty and can obviously improve the success rate of PICC line insertion,it can also decrease the blindness of bedside catheterization.

关 键 词：外周中心静脉置管 介入 

分 类 号：R472[医药卫生—护理学]