生理盐水导引腔内心电图辅助PICC尖端定位  

Normal saline assisted intracavitary electrocardiography method for positioning the tip of PICCs

作　　者：鲍爱琴[1] 闻曲[1] 成芳[1] 徐文洁[1] 陈莎[1] 刘为红[1] 桂琳君[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院肿瘤医院PICC专科,湖北武汉430022

出　　处：《护理学杂志》2016年第11期42-45,共4页Journal of Nursing Science

基　　金：华中科技大学2015年自主创新研究基金项目(0118530265)

摘　　要：目的探讨利用生理盐水作为介质导引腔内心电图辅助PICC尖端定位的可靠性和安全性。方法对PICC置管的501例患者行生理盐水导引腔内心电图定位技术,导管尖端位置的确定依据心电图Ⅱ导联P波的变化,导管固定后行X线检查(胸部正位片)确定导管尖端最佳位置,记录生理盐水导引腔内心电图显示的导管最终尖端位置、是否调管及调整长度等。结果 501例患者通过生理盐水介导,均能获得腔内心电图,到位率为100%,稳定率为97.4%,准确率为98.6%;心电图定位导管放置长度与体表测量长度一致者49.3%,导管放置长度与体表测量长度不一致50.7%,波动在±3.0cm。导管置入欠佳者均调管至最佳位置。结论生理盐水导引腔内心电图辅助PICC尖端定位,能有效提高腔内心电图定位效率及准确性,杜绝导管异位发生,保障患者PICC置管的安全。Objective To investigate the reliability and safety of normal saline assisted intracavitary electrocardiography（ECG）method for positioning the tip of PICCs.Methods Normal saline assisted intracavitary ECG was performed in 501 patients for placement of PICC catheters,and the tip of the catheter was identified according to the variations of the shape of the P wave.After securing the catheter,a chest X-ray was conducted to verify the catheter tip position.The final catheter tip location,adjustment of the tip position,and length of catheter adjusted were recorded.Results Clear ECG waveform was obtained in all of the patients during catheterization.All of the catheters were introduced at superior vena cava（SVC）,with the rate of tip located at planned optimal position accounting for 98.6%.After tip positioning,97.4% of the patients still had clear and stable ECG waveform.The length of catheter was correctly placed,as estimated using anatomic landmarks,in 49.3% of the cases,whereas the rest（50.7%）needed to be adjusted about±3.0cm.The unacceptably placed catheters were adjusted to the planned optimal position.Conclusion Normal saline assisted intracavitary ECG for PICC insertion can effectively improve the efficiency and accuracy of tip positioning and avoid malposition,thus to guarantee safety of PICC placement.

关 键 词：经外周静脉置入中心静脉导管 尖端定位 生理盐水 腔内心电图 

分 类 号：R472[医药卫生—护理学] R473.5[医药卫生—临床医学]