送血管鞘的改良技术在儿童PICC置管中的应用及可行性分析  

Application of a Modified Vascular Sheath Delivery Technique in Peripherally Inserted Central Catheter Placement in Children:a Feasibility Study

作　　者：李延芳 张红[1] 张冰[1] 曹英娟[1] 李雪[1] 李玉美[1] LI Yanfang;ZHANG Hong;ZHANG Bing;CAO Yingjuan;LI Xue;LI Yumei(Department of Pediatrics,Qilu Hospital,Shandong University,Ji'nan 250012,China)

机构地区：[1]山东大学齐鲁医院儿科,山东济南250012

出　　处：《中国医药指南》2022年第16期5-8,共4页Guide of China Medicine

基　　金：基于增强现实技术的PICC技能培训实践教学方案的构建及应用(基金号:XYJG2020117)。

摘　　要：目的 探讨送血管鞘的改良技术在PICC置管中的可行性和安全性。方法 选取2017年1月至2020年12月山东大学齐鲁医院就诊的496例儿童血液肿瘤患者为研究对象,对照组选取塞丁格技术送血管鞘的PICC置管儿童患者227例,试验组选取改良技术送血管鞘的PICC置管儿童患者269例,比较两组患者的置入成功率、置入时间、7 d内维护次数以及置入过程中的出血量和疼痛程度。结果 两组在置管位置、导管直径上差异有显著性(P <0.05);而两组在性别、年龄、疾病类型、外周血管位置上差异无显著性(P> 0.05)。改良的送血管鞘技术置入的总成功率为100.00%,单次置管的总成功率为97.77%,平均置管时间为(15.35±0.11)s,7 d内平均维护次数为(1.03±0.01)次,97.77%没有即刻出血,2.23%少量出血,无一例患儿出现中度或重度出血。大多数3岁以上儿童的疼痛较轻。结论 相对于传统PICC置管方法,改良的送血管鞘技术穿刺成功率高,穿刺过程出血量少,疼痛较轻,平均维护次数少,减少了儿童PICC置管过程中不良反应的发生,提高了儿童患者依从性。Objective To introduce a modified peripherally inserted central catheter(PICC) vascular sheath delivery technique using modified intubation sheath components(MISCs) and evaluate its feasibility and safety.Methods From January 2017 to December 2020,496 pediatric patients with hematological tumor in our hospital were selected as the research object.227 pediatric patients with PICC catheterization with T-cell technique were selected as the control group,and 269 pediatrid patients with PICC catheterization with improved vascular sheath were selected as the experimental group.The insertion success rate,insertion time,maintenance times in 7 days,the amount of bleeding and pain during the insertion were compared between the two groups.Results There were significant differences in catheter placement and catheter diameter between the two groups(P<0.05);but there were no significant differences in gender,age,disease type,and peripheral blood vessel location between the two groups(P>0.05).A total of 496 children underwent MISC-modified PICC catheterization.The total success rate of MISC insertion was 100.00%,while that of single-puncture was 97.77%.The mean insertion time was(15.35±0.11) seconds.The mean maintenance time in 7 days was(1.03±0.01).Of the cohort,97.77% did not have immediate bleeding,and only 2.23% had a small bleeding volume.No children had medium or heavy bleeding.The pain in most children over 3 years of age was minor.Conclusion Compared with the traditional PICC catheterization method,the improved vascular sheath technique has a higher puncture success rate,less bleeding during puncture,less pain,and fewer maintenance times.Patient compliance.

关 键 词：儿童 外周静脉置入中心静脉导管 血管鞘 疼痛 出血量 

分 类 号：R446[医药卫生—诊断学]