微插管器建立皮下隧道在隧道式PICC中的应用  

Application of microintroducer tunnelling technique in placement of the tunnelled peripherally inserted central catheter

作　　者：王家岸[1] 高元瑾 杨琳 许彩虹 李斌[2] Wang Jiaan;Gao Yuanjin;Yang Lin;Xu Caihong;Li Bin(Specialized Nursing and Diagnostic Center,Hainan General Hospital,Haikou 570102,Hainan Province,China;Department of Nursing Administration,Hainan General Hospital,Haikou 570102,Hainan Province,China.)

机构地区：[1]海南省人民医院专科护理诊疗中心,海南海口570102 [2]海南省人民医院护理部,海南海口570102

出　　处：《现代临床护理》2024年第12期29-34,共6页Modern Clinical Nursing

基　　金：海南省科学技术厅2022年省重点研发项目立项(琼科[2022]61号),项目编号为ZDYF2022SHFZ102。

摘　　要：目的使用微插管器建立皮下隧道的操作方法,并探讨其在留置隧道式经外周静脉置入中心静脉导管(tunnel peripherally inserted central catheter,TPICC)中的应用效果。方法采取回顾性研究方法,选取2021年1月至2023年2月在海南省某三级甲等综合医院住院治疗并留置经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)的521例患者作为研究对象,其中使用微插管器建立皮下隧道的313例TPICC患者设为试验组患者,未建立皮下隧道的208例PICC患者设为对照组。比较两组患者导管移位、伤口渗血、伤口渗液、皮下淤血、血管导管相关性感染、导管堵塞、导管相关性血栓、神经损伤、淋巴漏、非计划性拔管、拔管困难、导管破损的发生率。结果试验组患者的导管移位、伤口渗血、导管相关性感染低于对照组,差异具有统计学意义(均P<0.05);两组患者的伤口渗液、皮下淤血、导管堵塞、导管相关性血栓、神经损伤、淋巴漏、非计划性拔管、拔管困难、导管破损发生率比较,差异无统计学意义(均P>0.05)。结论使用微插管器建立皮下隧道的方法留置TPICC可减少置管后并发症,该穿刺技术安全、有效,值得临床推广应用。Objective To explore the effect of a subcutaneous microintroducer tunnelling technique on placement of tunnelled peripherally inserted central catheter(TPICC).Methods A total of 521 patients undergoing chemotherapy with peripherally inserted central catheters in our hospital from January 2021 to February 2023 were enrolled in this study.A total of 313 patients who received the subcutaneous microintroducer tunnelling were assigned to a tunnelling group and 208 who did not have the subcutaneous tunnelling were assigned to the non-tunnelling group.The two groups were compared in terms of the incidence of catheter displacement,blood leakage,seepage,subcutaneous congestion,catheter associated infection,catheter blockage,catheter-associated thrombosis,nerve injury,lymphorrhagia,unplanned withdraw of catheter,difficulty in catheter withdraw,and catheter damage.Results The subcutaneous microintroducer tunnelling group exhibited a significantly lower incidence of catheter displacement,blood leakage,and catheter associated infections compared to those in the non-tunnelling group(all P<0.05).However,there was no significant difference between the two groups in the incidence of nerve injury,seepage subcutaneous congestion,lymphorrhagia,difficulty in catheter withdraw,catheter damage,incidence of catheter blockage,catheter-associated thrombosis,and unplanned withdraw of catheter(all P>0.05).Conclusion The subcutaneous microintroducer tunnelling is a safe and effective technique.It effectively reduces the rates of post-placement complications in TPICC.

关 键 词：微插管器 皮下隧道 隧道式经外周置入中心静脉导管 穿刺 并发症 

分 类 号：R47[医药卫生—护理学]