新生儿重症监护室不同出生体重儿PICC的现状分析  

Status Analysis of PICC in Neonates with Different Birth Weights in Neonatal Intensivecare Units

作　　者：朱凌燕 郭舒文 林艺英 张秀虹 林娟斌 ZHU Lingyan;GUO Shuwen;LIN Yiying;ZHANG Xiuhong;LIN Juanbin(Neonatal Intensive Care Unit,Zhangzhou Hospital Affiliated to Fujian Medical University,Zhangzhou,Fujian Province 363000,China)

机构地区：[1]福建医科大学附属漳州市医院龙文新生儿重症监护室,福建漳州363000

出　　处：《吉林医药学院学报》2024年第4期273-277,281,共6页Journal of Jilin Medical University

基　　金：福建省自然科学基金资助项目(2019J01604)。

摘　　要：目的分析新生儿重症监护室(neonatal intensive care unit,NICU)不同出生体重儿经外周置入中心静脉导管(peripherally inserted central catheter,PICC)的现状,为后续护理质量改进提供依据。方法回顾性分析2017年1月1日至2021年12月31日某三级甲等医院NICU 908例PICC病例的临床资料,按出生体重(birth weight,BW)分为4组,比较各组间置管过程、维护过程、并发症和拔管原因。结果82.7%的患儿PICC经右下肢大隐静脉置管,不同出生体重组间穿刺部位存在差异,其中BW<1 kg和BW≥2.5 kg组经股静脉置管比例高于其他两组。总体一次性穿刺成功率84.8%,不同出生体重组间存在差异,BW≥2.5 kg组一次性穿刺成功率最低,为65.9%。总体一次性到位率为61.8%,过深率为31.9%,不同出生体重组导管尖端首次定位分布未见差异。总体并发症发生率为13.3%,非计划性拔管率为1.9%,不同出生体重组间总并发症发生率和非计划性拔管率未见差异。结论PICC并发症发生率和非计划性拔管率控制得较为理想,但在一次性穿刺成功率和一次性到位率方面仍有较大的提升空间,未来护理质量改进方向应以提高一次性置管成功率为主。Objective To analyze the current situation of peripherally inserted central venous catheter(PICC)in infants with different birth weight in neonatal intensive care unit(NICU),and to provide evidence for the improvement of the quality of follow-up care.Meth⁃ods The clinical data of 908 NICU PICC cases from January 1,2017 to December 31,2021 in a Grade A hospital were retrospectively analyzed and divided into 4 groups according to birth weight(BW).The cathedralization process,maintenance process,complications and causes of extubation among the groups were compared.Results In 82.7% of the children,PICC was catheted through the great saphenous vein of the right lower extremity.There were differences in puncture sites among different birth weight groups,and the proportion of femoral vein catheting in BW<1 kg and BW≥2.5 kg groups was higher than that in the other two groups.The overall success rate of onetime puncture was 84.8%,and there was a difference among different birth weight groups.The success rate of one-time puncture in BW≥2.5 kg group was the lowest(65.9%).The overall one-time placement rate was 61.8%,and the over-depth rate was 31.9%.There was no difference in the first placement distribution of catheter tip among different birth weight groups.The overall complication rate was 13.3%,and the rate of unplanned extubation was 1.9%.There was no difference in the total complication rate and unplanned extubation rate among different birth weight groups.Conclusion The complication rate and unplanned extubation rate of PICC are well controlled,but there is still a large room for improvement in the one-time puncture success rate and one-time arrival rate.The future direction of nursing quality improvement should focus on improving the one-time catheterization success rate.

关 键 词：新生儿 PICC 出生体重 一次性穿刺成功 一次性到位 

分 类 号：R473.72[医药卫生—护理学]