床旁超声心动图导管尖端定位在减少新生儿PICC置管异位中的应用  

Application of catheter tip positioning by bedside echocardiography in reducing neonatal ectopic PICC catheterization

作　　者：陈晓春[1] 陈赢赢[1] 童燕芬 朱聪[1] CHEN Xiaochun;CHEN Yingying;TONG Yanfen;ZHU Cong(Neonatal Department,Second Affiliated Hospital of Wenzhou Medical University,Wenzhou325000,China)

机构地区：[1]温州医科大学附属第二医院新生儿科,浙江温州325000

出　　处：《中国现代医生》2021年第7期123-127,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2018KY529);浙江省温州市科协服务科技创新项目(2019KXCX-KT21)。

摘　　要：目的探讨床旁超声心动图导管尖端定位在减少新生儿PICC置管异位中的应用。方法选取2018年5月至2019年5月我院140例PICC置管的新生儿,随机分为观察组与对照组,每组各70例,观察组送管成功后先行床旁超声心动图定位,置管结束后再床旁X线胸腹摄片定位;对照组只在置管结束后行床旁X线胸腹摄片定位。比较两组置管一次性到位率、原发性导管异位率、成功置管率、X线暴露次数、非计划性拔管率和并发症发生情况。结果观察组置管一次性到位率、成功置管率明显高于对照组(P<0.01),原发性导管异位率、非计划性拔管率和并发症总发生率均明显低于对照组(P<0.01与P<0.05),观察组X线暴露次数也明显少于对照组(P<0.05)。结论超声心动图导管尖端定位可及时发现导管异位并及时纠正,降低导管异位率及相关并发症发生率,而且操作简便、动态显示、随时定位,可减少X线暴露。床边超声心动图尖端定位不仅可使用于置管过程中,而且在导管使用过程中也可随时床边跟踪定位,获取尖端位置的实时信息,以便及早发现异位并及时做出应对措施。Objective To explore the application of bedside echocardiography catheter tip positioning in reducing neonatal PICC catheter ectopic.Methods A total of 140 neonates with PICC in our hospital from May 2018 to May 2019 were randomly divided into an observation group and a control group,with 70 cases in each group.The bedside echocardiography after successful tube delivery was first performed in the observation group.After the end of the tube placement,the bedside X-ray chest and abdomen radiographs were performed for positioning.In the control group only X-ray chest and abdominal radiographs were performed for positioning after tube placement.The differences between the two groups were compared in terms of the rate of one-time catheter placement,primary catheter ectopic rate,successful catheter placement rate,number of X-ray exposures,unplanned extubation rate,and complications.Results The one-time placement rate and successful tube placement rate of the observation group were significantly higher than those of the control group(P<0.01),the occurrence of primary catheter ectopic rate,unplanned extubation rate and total incidence of complications was significantly lower than that of the control group(P<0.01 and P<0.05),and the number of X-ray exposure in the observation group was also significantly less than that of the control group(P<0.05).Conclusion Echocardiographic catheter tip positioning can promptly find and correct ectopic catheter,reduce the ectopic rate of catheter and related complications.It is easy to operate,with dynamic display,localization at any time,and can reduce X-ray exposure.Bedside echocardiographic tip positioning can be used not only during tube placement,but also at bedside tracking and positioning at any time during catheter use,to obtain real-time information on the position of the tip,in order to detect ectopics early and make timely response measures.

关 键 词：导管插入术 外周 超声 定位 新生儿 

分 类 号：R473.72[医药卫生—护理学]