上臂输液港置入患者行心腔内电图定位失败的处理和原因分析  

Management and cause analysis of intracavitary ECG-guided implantation failure of upper arm infusion ports

作　　者：梁晓红[1] 蔡燕[1] 杨静[1] 石艳[1] Liang Xiaohong;Cai Yan;Yang Jing;Shi Yan(Department of Gynaecology,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院妇科,重庆400010

出　　处：《护理学杂志》2024年第8期74-76,共3页Journal of Nursing Science

基　　金：2021年度重庆医科大学附属第二医院护理骨干科研资助计划项目(2021-04)。

摘　　要：目的总结4例上臂输液港置入患者行心腔内电图定位失败的处理及原因,提出防范对策。方法4例妇科肿瘤患者在输液港置入术中行心腔内电图定位,2例术中见特征性高尖P波,1例术中P波振幅增高,未出现双向P波,1例术中P波振幅不变,术后胸部X线片均示导管尖端异位。分别根据胸部X线片或心腔内电图P波外撤导管,采用生理盐水推注、颈内静脉阻断、前端导丝回撤、呼吸配合等送管方法。结果4例均复位成功。结论外撤导管后重新送管不当、未有效识别异常心腔内电图P波变化特点是IC-ECG定位失败的主要原因。上臂输液港置入术中心腔内电图定位导管尖端位置,应密切观察P波振幅和形态,警惕导管打折或异位。Objective To summarize the management and analyze the causes for intracavitary ECG-guided implantation failure of upper arm infusion ports,and to propose proactive nursing strategies.Methods In 4 cases of gynecological tumor patients undergoing infusion port implantation,intracavitary ECG was used for tip positioning.Two cases showed characteristic high and sharp P waves during the procedure,one case showed an increase in P wave amplitude,and one case showed unchanged P wave amplitude.Post-insertion chest X-ray imaging revealed misplaced catheter tips in all cases.The catheters were pulled back based on chest X-ray results or the characteristics of intracavitary ECG P waves.A slew of methods,including saline flushing,internal jugular vein blockade,pulled back of the guide wire,and coordinated breathing,were used for catheter repositioning.Results Successful catheter repositioning was achieved in the 4 cases.Conclusion Improper catheter reinsertion after guide wire pulled back,failure to effectively identify abnormal changes in intracavitary ECG P waves were the main reasons for IC-ECG guided implantation failure.During intracavitary ECG-guided tip positioning,medical staff should keep a close eye on P-wave amplitude and morphology to guard against catheter bending or misplacement.

关 键 词：输液港 中心静脉装置 静脉置管 静脉治疗 心腔内电图 导管异位 定位失败 导管调整 

分 类 号：R473.5[医药卫生—护理学]