皮下隧道法在肿瘤患者上臂高位置入PICC中的应用效果观察  

Observation on the effect of PICC placement by subcutaneous tunnel method in the upper arm of patients with tumor

作　　者：郭亚茹 李海云[1] 彭会珍[1] 丁楠楠 高永 赵文利[1] GUO Yaru;LI Haiyun;PENG Huizhen;DING Nannan;GAO Yong;ZHAO Wenli(Henan Provincial People’s Hospital,Zhengzhou Henan 450003)

机构地区：[1]河南省人民医院,河南郑州450003

出　　处：《天津护理》2023年第2期176-180,共5页Tianjin Journal of Nursing

基　　金：2021年河南省科技攻关项目(212102310683)。

摘　　要：目的:探讨肿瘤患者心腔内电图定位联合超声引导下经上臂高位置入隧道式PICC的临床应用效果。方法:选择2019年3月至2021年6月在河南省某三级甲等综合性医院行PICC置管的311例恶性肿瘤患者为研究对象,随机分为对照组156例和试验组155例。对照组采用心腔内电图定位联合超声引导下PICC置管。试验组在对照组的基础上增加皮下隧道法置入PICC。比较两组操作过程质量和带管期间PICC相关并发症发生情况。结果:两组操作用时、疼痛评分、术中出血量、静脉血栓形成发生率、导管堵塞率比较,差异无统计学意义(P>0.05);但试验组的一次性穿刺成功率、一次送管成功率均优于对照组,且静脉炎、导管滑脱、导管脱出、穿刺点感染、穿刺点渗血程度等并发症发生率及非计划拔管率均低于对照组,差异有统计学意义(P<0.05)。结论:与传统PICC置管相比,采用皮下隧道法经上臂上1/3段区域静脉留置PICC操作成功率高,未加重患者术中出血量及疼痛程度,同时能明显降低带管期间穿刺点感染、渗血、静脉炎、导管移位及非计划拔管的发生率。Objective:To explore the effect of PICC placement by subcutaneous tunnel method in the upper arm of patients with tumor.Methods:A total of 311 patients with malignant tumor who underwent PICC implantation in a Class A tertiary hospital in Henan Province from March 2019 to June 2021 were included,and were divided into the control group(156 cases)and the experimental group(155 cases)according to the random number table method.The experimental group adopted the subcutaneous tunneling technique to place PICC based on the routine method,and the control group adopted the routine method.The quality of operation process and the incidence of PICC related complications were compared between the two groups.Results:The rate of successful one-time puncture and one-time catheter delivery in the experimental group were significantly higher than those in the control group,and the degree of bleeding at puncture point,infection rate at puncture point,catheter displacement rate,mechanical phlebitis,incidence of total complications with catheter,unplanned extubation rate in the experimental group were significantly lower than those in the control group(P<0.05).There was no significant difference in operation time,pain score,intraoperative blood loss,venous thrombosis rate and catheter blockage rate between two groups(P>0.05).Conclusion:Compared with traditional PICC catheterization,PICC placement by subcutaneous tunnel in the upper arm has a higher success rate.It can significantly reduce the incidence of puncture point infection,bleeding,phlebitis,catheter displacement and unplanned extubation without aggravating the amount of bleeding and the degree of pain.

关 键 词：皮下隧道 心腔内电图 PICC 并发症 护理 

分 类 号：R472[医药卫生—护理学]