PICC置管史对穿刺过程和导管留置效果的影响

doi:10.3761/j.issn.0254-1769.2020.12.015

摘要/Abstract

摘要：

目的探讨PICC置管史对再次置管过程及留置效果的影响。方法回顾2019年1月—12月杭州市某三级甲等综合医院PICC置管患者的操作及留置效果的资料,进行整理分析。共收集2 877例有效病例,根据PICC置管史分为有置管史组和无置管史组,将有置管史组又分为1次置管史组和多次置管史组;根据置管史不同情况分为同侧置管史组和非同侧置管史组,同一血管置管史组和非同一血管置管史组。比较组间穿刺及送管情况、留置过程中的并发症发生情况及留置时间。结果有置管史组与无置管史组的置管总成功率、置管血管、置管手臂选择、置管中的调整比率、原发异位发生率比较,差异有统计学意义;有置管史组与无置管史组的并发症总发生率差异有统计学意义。1次置管史和多次置管史组,同侧置管史和非同侧置管史组,同一血管置管史和非同一血管置管史组组间置管总成功率、原发异位发生率差异无统计学意义,置管血管、置管手臂选择上差异无统计学意义。同侧置管史和非同侧置管史组并发症总发生率差异有统计学意义;导管相关性血栓发生率两组差异有统计学意义。结论有PICC置管史患者置管难度增加,可供穿刺的静脉受限,多选择肱静脉进行穿刺,难度大,置管中导管原发异位发生率高,留置期间并发症发生率高,尤其是同侧置管史患者的导管相关性血栓的发生率高,影响PICC的安全使用及长期保留。

关键词: 经外周静脉穿刺的中心静脉导管, 并发症, 护理

Abstract:

Objective To explore the influence of PICC catheterization history on the reinsertion process and the indwelling effect. Methods The data of the operation and indwelling process of PICC patients in a tertiary hospital in Hangzhou from January to December 2019 were reviewed and analyzed. A total of 2 877 effective cases were collected to compare the puncture and delivery process,the occurrence of complications and the indwelling time between patients with different catheterization history. Results There were statistical differences in the total success rate of catheterization,vein selection,arm selection,adjustment ratio during catheterization,and the incidence of primary malposition between 2 groups without catheterization history and those with catheterization history. There was a statistically significant difference in the total incidence of complications between 2 groups without a history of catheterization and that with a history of catheterization. There was a statistically significant difference in the total incidence of complications and the incidence of catheter-related thrombosis between the ipsilateral catheterization history and the non-ipsilateral catheterization history. Conclusion Patients with a history of PICC catheterization are limited in the veins available for puncture,while brachial veins are often used for puncture. The difficulty of catheterization was increased. The incidence of primary malposition is higher,and the incidence of complications during indwelling is higher. Particularly,for patients with a history of ipsilateral catheterization,the incidence of catheter-related thrombosis is higher,which affects the safe use and long-term indwelling of PICC.

Key words: Peripherally Inserted Central Catheter, Complication, Nursing Care

曹秀珠,赵林芳,曾旭芬,王雅萍,金向红,陈香花. PICC置管史对穿刺过程和导管留置效果的影响[J]. 中华护理杂志, 2020, 55(12): 1844-1849.

CAO Xiuzhu,ZHAO Linfang,ZENG Xufen,WANG Yaping,JIN Xianghong,CHEN Xianghua. The influence of PICC catheterization history on PICC insertion process and catheter indwelling effect[J]. Chinese Journal of Nursing, 2020, 55(12): 1844-1849.

图/表 4

表1 无置管史组和有置管史组的置管操作情况比较[例(百分比,%)]

Table 1 The results of Non-PICC catheterization history and PICC catheterization history on PICC insertion process [cases(percentage,%)]

表2 有置管史各组置管操作情况比较[例（百分比,%）]

Table 2 The results of PICC catheterization history on PICC insertion process[cases（percentage,%）]

表3 无置管史组和有置管史组的导管留置期间情况比较

Table 3 The results of Non-PICC catheterization history and PICC catheterization history during catheter indwelling

表4 有置管史各组导管留置期间情况比较

Table 4 The results of PICC catheterization history during catheter indwelling

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