穿刺侧上肢不同外展角度对PICC颈内静脉异位的影响  

Study of the correlation between different upper limb abduction angles and the occurrence of malposition of PICC into internal jugular vein

作　　者：董建丽[1] 吕小芹[2] 张晓梅[1] 徐洪秋[1] 周希环[2] DONG Jian-li LU Xiao-qin ZHANG Xiao-mei XU Hong-qiu ZHOU Xi-huan

机构地区：[1]滨州医学院附属医院甲状腺乳腺外科二病区,滨州市256600 [2]滨州医学院附属医院肝胆外科,滨州市256600

出　　处：《中华护理杂志》2017年第5期624-626,共3页Chinese Journal of Nursing

基　　金：基金项目:量化PICC置管侧上肢锻炼模式对血流动力学的影响(2014WS0481)

摘　　要：目的探讨穿刺侧上肢不同外展角度对PICC颈内静脉异位的影响。方法选取我院2015年8月—2017年1月行PICC置管单侧乳腺癌患者210例作为研究对象,随机分为3组,每组70例,3组穿刺侧上肢外展角度分别设为45°、90°、160°,置管静脉均选择健侧贵要静脉,采用超声引导下改良塞丁格技术肘上置管,导管送入预定长度后,进行B超检查,如果在颈内静脉发现导管末端显影,即判定为颈内静脉异位。结果 45°组发生颈内静脉异位率为7.14%(5例),90°组为8.57%(6例),160°组未发生异位;3组比较,差异无统计学意义(χ2=5.95,P>0.05,);两两比较,160°组与45°组、160°组和90°组,差异有统计学意义(P<0.05);45°组和90°组,差异无统计学意义(P>0.05)。结论 45°、90°和160°均可作为PICC的置管角度,可以不仅仅局限于90°,可根据患者具体情况选择置管角度,制订个性化的置管方案。Objective To investigate the effects of different upper limb abduction angles on the occurrence of malposition of PICC into internal jugular vein. Methods Totally 210 cases of patients treated with PICCs for unilateral breast cancer of our hospital from August,2015 to January,2017 were randomly assigned to three groups with 70 cases in each group. The abduction angle of the upper limb for placement was set at 45°,90° and 160°, respectively. We chose the basilic vein of the uninfected arm using modified Seldinger technique under the guidance of ultrasound for PICC,and malposition was confirmed by detecting the tip of PICC in internal jugular vein. Results The incidence rate of internal jugular venous dislocation in 45° group was 7.14%（5 cases） and 8.57% in 90° group （6 cases）,and no internal jugular venous dislocation in 160° group. There was no statistically significant difference among 45°,90° and 160° groups（χ^2=5.95 ,P〉0.05）. Significant differences of group comparisons for 45° v.s. 160° and 160° v.s. 90° were found （P〈0.05）. There was no statistically significant difference between 45° and 90° groups （P〉0.05）. Conclusion Abduction angles of 45° ,90° and 160° can all be used for PICC placement. The abduction angle can be selected according to specific situation of patients instead of being limited to the standard abduction angle of 90°.

关 键 词：导管插入术 外周 上肢 外展角度 颈内静脉异位 

分 类 号：R472[医药卫生—护理学]