8例血液病患者经B型超声引导下PICC穿刺失败的原因分析及对策  

To explore the causes and management of peripherally inserted central catheters failure by B-ultrasound in 8 cases of hematologic malignancy patients

作　　者：彭美君[1] 胡月云[1] 李芳[1] PENG Mei-jun HU Yue-yun LI Fang(The Third Affiliated Hospital of Sun Yat-sen University, south of the Five Ridges hospital, Guangzhou 510000 China)

机构地区：[1]中山大学附属第三医院岭南医院血液内科,广州510000

出　　处：《当代护士（上旬刊）》2017年第7期146-148,共3页Modern Nurse

摘　　要：目的探讨血液病患者经B超引导下置入经外周插管的中心静脉导管(PICC)穿刺失败原因及处理。方法对2013年1月~2015年7月在我区住院的125例置入PICC的血液病化疗及移植患者进行观察,对8例穿刺困难的原因进行分析及处理。结果穿刺过程中B超探头固定不当1例、进针过快1例、患者精神紧张1例、操作者精神紧张1例、患者上臂皮下松弛1例,患者消瘦、止血带扎住静脉导致导丝送入困难1例,血管畸形1例,血管条件差1例。通过提早松开消瘦者的止血带、缓慢退出过深穿刺针可使穿刺补救成功2例。加强操作者情绪稳定、置管侧上臂垫高、置管者左肘关节固定、左腕关节放松的方法固定B超探头行二次穿刺成功3例,更换血管穿刺成功3例。结论加强病情和静脉条件的评估、缓解置管双方精神紧张、提高穿刺技巧可有效提高血液病化疗及移植患者B超引导下PICC置管穿刺成功率。Objective To explore the causes and management of peripherally inserted central catheters failure by B-ultrasound in hematologic malignancy patients. Methods 125 cases of hospitalized patients with central vein catheter received chemotherapy and hematopoietic stem cell transplantation were analyzed from January 2013 to July 2015,8 cases were fail and the causes and management were analyzed. Result The failure were resulted from the improper B-ultrasound guidance,fast injection,the nerves of patient,the nerves of operator,subcutaneous relaxation of upper arm,the vein was bundle by tourniquet lead to hard insertion,venous malformation,bad condition of blood tube. 2 cases were salvaged by early unbundle the vein and slowly withdrawal the depth insertion. 3 cases were salvaged by stabling the mood of operator,elevating the intertie upper arm and B-ultrasound guidance fixed by left wrist joint of operator. 3 cases were salvaged by changing the vein.Conclusion The improvement succession rate of peripherally inserted central catheters by B-ultrasound in hematologic malignancy patients was by strengthening the evaluation of the disease and the condition of the vein,relieving the nervousness of the patient and the operator and improving the technique of puncture.

关 键 词：经外周插管的中心静脉导管(PICC) B超引导 

分 类 号：R473.73[医药卫生—护理学]