1例儿童PICC院外断管人心脏的急救及防范  

Rescue and prevention of breaking of PICC and getting into heart outside hospital in one child

作　　者：刘嫣媚[1] 邵霞[1] 梁熙德[1] 

机构地区：[1]广州医科大学附属第一医院儿科,510120

出　　处：《国际医药卫生导报》2017年第11期1772-1774,共3页International Medicine and Health Guidance News

摘　　要：目的总结1例PICC带管儿童院外断裂残端进入心脏的抢救处理及护理防范。方法运用snaresystem抓捕系统在局麻下行介入手术，于儿童右侧股静脉穿刺RFV并置入7F血管鞘，注入肝素1200U，送入snaresystem抓捕系统于右心房内抓捕PICC残留软管。结果顺利将残留在儿童体内一端位于左侧锁骨下静脉，体部绕过上腔静脉、右心房、右心室、肺动脉，另一端位于右下肺动脉分支的PICC残留端取出，测量导管的残端长度为35．2cm，与脱落的导管管口吻合，无缺失，距断裂口约0．8cm处又见一裂口，经医护及家属三方同时检查导管完整，各断裂口相吻合。结论加强基层医院和社区卫生院的护士对PICC维护操作知识的培训；建立儿科家长护理交流微信群；加强带管出院患儿及家属的保管安全意识教育；依托专科护士及静脉治疗学习班学员建立维护点，将带管出院的患儿转介到维护点进行院外维护。Objective To summarize the rescue treatment and nursing care of breaking of PICC and getting into heart outside hospital in one child. Methods Under local anesthesia and with the snare system capture system, the child was punctured RFV in the right femoral vein and placed in 7F vascular sheath, then injected 1 200 U of heparin, and put the snare system capture system into the right atrium capturing PICC tube and anterograde and took them out in vitro. Results The PICC residual end was removed successfully. The broken end of PICC tube in the child located in the left subclavian vein; and the body bypassed the superior vena cava, right atrium ,right ventricle, and pulmonary artery; and the other end located in the lower right pulmonary artery branch. Conclusions The training of nurses in PICC maintenance and operation knowledge in the primary hospitals and community hospitals should be strengthened. The education on safety awareness of children with tube discharge and their families should be strengthened. A pediatric parents-nursing communication WeChat group should be established. With the help of specialized nurses and the students of intravenous therapy class, we can establish a maintenance place; and the children with tube discharge can be transferred to the maintenance place for maintenance.

关 键 词：儿童PICC 院外断裂 心房 处理 防范 

分 类 号：R473.72[医药卫生—护理学]