改良经外周中心静脉置管留置长度的体表测量方法研究  

Body surface measurement method for indwelling length of modified peripherally inserted central catheter

作　　者：张玲芳[1] 陶志芳[1] 陆婷[1] 王富芳[1] 樊爱东[1] ZHANG Lingfang;TAO Zhifang;LU Ting;WANG Fufang;FAN Aidong(Department of Oncology,Subei People′s Hospital,Yangzhou,Jiangsu,225001)

机构地区：[1]江苏省苏北人民医院肿瘤科

出　　处：《实用临床医药杂志》2019年第24期11-13,17,共4页Journal of Clinical Medicine in Practice

摘　　要：目的探讨改良的通过上肢静脉经外周中心静脉置管(PICC)置入导管长度测量的方法对提高导管尖端位于上腔静脉下段与卡沃-心房交接处(CAJ)以上位置的准确率的效果.方法将接受PICC的160例患者随机分为对照组80例与改良组80例.对照组测量方法为从上肢预穿刺点沿静脉走向到右胸锁关节外侧缘至第三肋间;改良组测量方法为从上肢预穿刺点沿静脉走向到右胸锁关节外侧缘至胸骨角末端终点(胸骨角向下2.00 cm).置管成功后,根据患者的X胸片确定导管尖端位置,比较2组测量方法使导管尖端位于上腔静脉下段与CAJ以上的准确率.结果改良组PICC导管置入患者的上腔静脉下段与CAJ以上的位置准确率是95.00%,高于对照组68.75%,差异有统计学意义(P<0.05).结论改良组的测量方法能够使经上肢PICC的留置长度预测更加准确,有效提高导管尖端到指定位置的成功率.Objective To explore the efficacy of measurement method for indwelling length of modified peripherally inserted central catheter(PICC)through the vein of the upper extremity in increasing accuracy of catheterization between the lower part of the superior vena cava and the Cavo-atrial junction(CAJ).Methods A total of 160 patients with PICC were randomly divided into control group and treatment group,with 80 cases in each group.The measurement for the control group was from the pre-puncture point in upper limb along the vein down to the third intercostal space beside the right sternal joint,the measurement for the treatment group was from the pre-puncture point in upper limb along the vein down to the sternal angle end point(2.00 cm below the sternum angle)beside the lateral edge of the righ tsternosacral joint.After successful catheterization,the position of the catheter tip was determined according to the patient′s X chest radiograph.The accuracy of the two measurement methods was compared in the position of the tip of the catheter between the lower part of the superior vena cava and the CAJ.Results The accuracy of placement of PICC tube in the position between the lower part of the superior vena cava and the CAJ was 95.00%in the treatment group,which was significantly higher than 68.75%in the control group(P<0.05).Conclusion The measurement method in the treatment group is more accurate to predict the length of PICC through peripheral vein of upper extremity and reduce the risk of complications.

关 键 词：上腔静脉下段 卡沃-心房交接处 胸椎上缘处 经外周中心静脉置管 留置长度 测量方法 

分 类 号：R730.5[医药卫生—肿瘤]