中心静脉压波形在耐高压注射型经外周置入中心静脉导管位置判断中的应用  

Effect of central venous pressure waveforms on location of power PICC tip localization

作　　者：白利平[1] 王若婧[1] 丁彤红 吴林珠[1] 陈利芬[1] 

机构地区：[1]中山大学附属第一医院,广东广州510080

出　　处：《现代临床护理》2017年第8期42-45,共4页Modern Clinical Nursing

摘　　要：目的探讨中心静脉压(central venous pressure,CVP)波形在耐高压注射型经外周置入中心静脉导管(power peripherally inserted central catheter,Power PICC)位置判断中的应用。方法 2015年1月至12月对本科室47例危重症行Power PICC双腔导管穿刺术患者,采用4步法进行穿刺定位,依据CVP的波形判断有无异位胸腔内其他静脉,并将其与胸部X片结果进行对比。结果 45例(95.75%)患者静脉穿刺后监护仪显示CVP的波形为典型波形,患者胸部X光检查Power PICC导管尖端位于上腔静脉中下段(胸5至胸8),1例(2.13%)患者显示CVP的波形不典型,患者胸部X光检查结果显示Power PICC导管尖端在腋静脉返折,1例(2.13%)患者显示CVP的波形无法判断,患者胸部X光检查结果显示Power PICC导管尖端位于左颈内静脉,依据CVP的波形判断Power PICC导管尖端位置与胸部X光检查结果判断符合率达100.00%。结论依据CVP的波形可初步判断Power PICC导管尖端是否位于上腔静脉下1/3段至上腔静脉与右心房的连接处,其可作为置入Power PICC后判断导管尖端位置的参考方法之一,但其尚不能代替置管后的胸部X光检查判断导管尖端位置。Objective To explore the effect of central venous pressure waveforms on the location of power PICC tip. Methods From January 2015 to December 2015, we placed power PICC for 47 patients in our intensive care unit. The CVP waveforms were applied to detect any displacement into small thoracic veins after a four-step localization method. The position of the catheter tip was finally confirmed by X-ray inspection. Results Among the 47 cases undergoing PICC implantation, 45（95.75%） displayed a typical CVP waveform, with the catheter tip positions were located in the superior vena cava inferior segment, 1（2.13%） displayed a typical CVP waveform, with the catheter tip was misplaced into axillary vein and retraced and 1（2.13%） did not display typical CVP waveforms and CVP value was negative, with the catheter tip was in left internal jugular vein. To locate the catheter tip position with CVP waveform and chest X-rang were 100.00% the same. Conclusions The central venous pressure waveform can be used to determine whether the catheter tip is located in the inferior segment of the superior vena cava or not immediately after the placement of a power PICC. However,chest X-ray inspection conformation is still needed.

关 键 词：耐高压注射型经外周置入中心静脉导管 中心静脉压 导管 异位 

分 类 号：R472[医药卫生—护理学]