PICC继发性异位的早期识别与处理  

Early identification and management of secondary malposition of peripherally inserted central catheter

作　　者：江南[1] 赵锐祎[1] 张月娇[1] Jiang Nan;Zhao Ruiyi;Zhang Yuejiao(Department of Intravenous Therapy Speciality,the Second Affiliated Hospital of Medical College of Zhejiang University,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院静脉治疗专科,杭州310009

出　　处：《中国实用护理杂志》2020年第8期617-620,共4页Chinese Journal of Practical Nursing

摘　　要：目的 探讨PICC继发性异位的早期识别与处理方法,减少其他并发症的发生。方法 选择2017年1月至2018年12月浙江大学医学院附属第二医院静脉治疗专科患者8509例,患者置入PICC且原始导管尖端位于上腔静脉,留置过程及时评估导管功能及并发症发生情况,异常者拍摄X线胸部正侧位片确认体内导管走行和尖端位置。异位者,病情允许情况下,通过体外手法(拔出部分导管、改变体位、体外叩击、0.9%氯化钠快速冲洗)复位。结果 早期识别31例PICC继发性异位,27例采用体外手法复位,复位成功19例,复位失败8例,复位成功率70.4%,无其他并发症发生。3例因合并血栓,1例因疾病未采取复位措施。结论 X线胸片是识别PICC继发性异位的一种简单、易行的方法,体外手法处理PICC继发性异位复位成功率高,并发症少,值得临床推广应用。Objective To early identify and manage secondary malposition of peripherally inserted central catheter(PICC),and to reduce other PICC related complications.Methods A total of 8509 patients were included form January 2017 to December 2018 in intravenous therapy department in the Second Affiliated Hospital of Medical College of Zhejiang University.PICC was implanted and the original tip location was in the superior vena cava(SVC).The function and complications of the catheter were evaluated during the indwelling process.X-ray was taken for every abnormal patient to confirm the route and tip position of the catheter.Tip malposition were adjusted by external manipulation(pulling out part of the catheter,changing body position,external percussion,rapid flushing with 0.9%sodium chloride)when patients’situation were allowed.Results A total of 31 cases of PICC secondary malposition were early identified,27 of them were treated with external manual reduction.Totally 19 cases succeeded,and 8 cases failed.The success rate was 70.4%.There was no other complication during the process.3 cases were found venous thrombosis,and 1 case was unable to do external manipulation due to his poor situation.Conclusion X-ray is a simple and easy method to identify secondary malposition of PICC.Using external manipulation to adjust the tip position back to SVC is effective,and the complications are few,which is worthy of clinical application.

关 键 词：导管插入术 外周 继发性异位 识别 处理 

分 类 号：R47[医药卫生—护理学]