隧道式经股静脉PICC置入术在困难静脉通路婴幼儿中的应用研究

doi:10.3761/j.issn.0254-1769.2026.09.002

中华护理杂志 ›› 2026, Vol. 61 ›› Issue (9): 1163-1170.DOI: 10.3761/j.issn.0254-1769.2026.09.002

• 静脉通路装置留置及维护专题 • 上一篇下一篇

隧道式经股静脉PICC置入术在困难静脉通路婴幼儿中的应用研究

周霞¹(), 马艳艳², 师正坤¹, 于海霞², 周艳³, 胡红玲³, 李莜³, 陈思思³, 张京慧¹^,^*()

¹ 中南大学湘雅医院临床护理学教研室长沙市 410008
² 中南大学湘雅护理学院长沙市 410013
³ 中南大学湘雅医院儿童医学中心长沙市 410008

收稿日期:2025-12-03 出版日期:2026-05-10 发布日期:2026-04-30
*通讯作者: 张京慧，E-mail：401212@csu.edu.cn
作者简介:周霞：女，硕士，副主任护师，护士长，E-mail：498342267@qq.com
第一联系人：作者贡献声明
周霞：研究实施、论文撰写；马艳艳、于海霞：数据整理、录入、分析；师正坤、胡红玲、李莜、陈思思：结局指标评价、数据收集；周艳：研究实施；张京慧：研究设计、研究指导、经费支持、论文修改
基金资助:
湖南省自然科学基金面上项目(2024JJ5590)

A study on the application of tunneled femoral PICC in pediatric patients with difficult venous access

ZHOU Xia¹(), MA Yanyan², SHI Zhengkun¹, YU Haixia², ZHOU Yan³, HU Hongling³, LI You³, CHEN Sisi³, ZHANG Jinghui¹^,^*()

¹ Teaching and Research Section of Clinical Nursing， Xiangya Hospital，Central South University， Changsha 410008， China
² Xiangya School of Nursing， Central South University， Changsha 410013， China
³ Pediatric Medical Center， Xiangya Hospital，Central South University， Changsha 410008， China

Received:2025-12-03 Online:2026-05-10 Published:2026-04-30
* Corresponding author: ZHANG Jinghui，E-mail：401212@csu.edu.cn
Funding program:
Hunan Provincial Natural Science Foundation General Project(2024JJ5590)

摘要/Abstract

摘要：

目的探讨隧道式经股静脉PICC置入术在困难静脉通路婴幼儿中的应用效果，为置管方式的选择提供参考。方法采用便利抽样法，选取2025年4—10月在长沙市某三级甲等综合医院儿童医学中心住院的254例困难静脉通路婴幼儿作为研究对象。采用简单随机分组法将其分为两组，试验组采用隧道式经股静脉PICC置入术置管，对照组采用非隧道式经股静脉PICC置入术置管。比较两组导管相关并发症发生率、一次性置管成功率、置管时长、术中出血量、术中疼痛评分、导管留置时长、非计划性拔管率。结果 253例婴幼儿完成研究，其中试验组127例、对照组126例。试验组和对照组的导管相关并发症总发生率分别为4.72%、31.75%，差异具有统计学意义（P<0.001），其中试验组导管脱出、导管相关性感染、导管相关性皮肤损伤发生率均低于对照组，差异具有统计学意义（P<0.05）。试验组非计划性拔管率为0，对照组为8.73%，差异具有统计学意义（P=0.001）。两组其他指标比较，差异均无统计学意义（P>0.05）。结论采用隧道式经股静脉PICC置入术可减少困难静脉通路婴幼儿导管脱出、导管相关性感染及导管相关性皮肤损伤的发生风险，降低非计划性拔管率，且未影响一次性置管成功率、术中出血量及疼痛程度等。

关键词: 皮下隧道技术, 股静脉, 经外周静脉置入中心静脉导管, 困难静脉通路, 儿科护理学

Abstract:

Objective To investigate the application effect of tunneled femoral vein PICC insertion in infants and young children with difficult venous access，and to provide a reference for the selection of catheterization methods. Methods A total of 254 infants and young children with difficult venous access who were hospitalized in the Children’s Medical Center of a tertiary A general hospital in Changsha from April to October 2025 were selected by a convenience sampling method. They were divided into 2 groups by a simple random grouping method. The experimental group underwent tunneled femoral vein PICC insertion，while the control group underwent non-tunneled femoral vein PICC insertion. The incidence of catheter-related complications，success rate of one-time catheterization，catheterization duration，intraoperative blood loss，intraoperative pain score，catheter indwelling duration，and unplanned extubation rate were compared between the 2 groups. Results A total of 253 infants and young children completed the study，including 127 in the experimental group and 126 in the control group. The total incidence of catheter-related complications in the experimental group and the control group was 4.72% and 31.75%，respectively，with a statistically significant difference（P<0.001）. The incidence of catheter dislodgement，catheter-related infection，and catheter-related skin injury in the experimental group were lower than those in the control group，with statistically significant differences（P<0.05）. The unplanned extubation rate in the experimental group was 0，while that in the control group was 8.73%，with a statistically significant difference（P=0.001）. There were no statistically significant differences in other indicators between the 2 groups（P>0.05）. Conclusion Tunneled femoral vein PICC insertion can reduce the risk of catheter dislodgement，catheter-related infection，and catheter-related skin injury in infants and young children with difficult venous access，and decrease the unplanned extubation rate，without affecting the success rate of one-time catheterization，intraoperative blood loss，or pain degree.

Key words: Subcutaneous Tunneling Technique, Femoral Venous, Peripherally Inserted Central Catheter, Difficult Venous Access, Pediatric Nursing

周霞, 马艳艳, 师正坤, 于海霞, 周艳, 胡红玲, 李莜, 陈思思, 张京慧. 隧道式经股静脉PICC置入术在困难静脉通路婴幼儿中的应用研究[J]. 中华护理杂志, 2026, 61(9): 1163-1170.

ZHOU Xia, MA Yanyan, SHI Zhengkun, YU Haixia, ZHOU Yan, HU Hongling, LI You, CHEN Sisi, ZHANG Jinghui. A study on the application of tunneled femoral PICC in pediatric patients with difficult venous access[J]. Chinese Journal of Nursing, 2026, 61(9): 1163-1170.

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参考文献 24

[1]	Nickel B, Gorski L, Kleidon T, et al. Infusion therapy standards of practice,9th edition[J]. J Infus Nurs, 2024, 47(Suppl 1):S1-S285.
[2]	Bahl A, Johnson S, Alsbrooks K, et al. Defining difficult intravenous access(DIVA):a systematic review[J]. J Vasc Access, 2021, 24(5):904-910.
[3]	胡红玲, 周霞, 贺莲香, 等. 危重婴幼儿股静脉留置耐高压双腔PICC的应用研究[J]. 解放军护理杂志, 2017, 34(17):53-55,58.
	Hu HL, Zhou X, He LX, et al. Investigation of the application of the high pressure resistant double lumens PICC catheter in femoral vein of infants with serious illness[J]. Nurs J Chin PLA, 2017, 34(17):53-55,58.
[4]	Ostroff MD, Moureau N, Pittiruti M. Rapid Assessment of Vascular Exit Site and Tunneling Options(RAVESTO):a new decision tool in the management of the complex vascular access patients[J]. J Vasc Access, 2023, 24(2):311-317.
[5]	胡婷婷, 谷小燕, 杨金芳, 等. 隧道式经股静脉留置PICC在上腔静脉综合征病人中的应用[J]. 护理研究, 2020, 34(17):3148-3152.
	Hu TT, Gu XY, Yang JF, et al. Application of tunnel type indwelling PICC through femoral vein in patients with superior vena cava syndrome[J]. Chin Nurs Res, 2020, 34(17):3148-3152.
[6]	张京慧, 李雪兵, 贺连香, 等. 肺癌合并上腔静脉梗阻患者股静脉留置PICC导管的研究[J]. 中华护理杂志, 2015, 50(6):692-696.
	Zhang JH, Li XB, He LX, et al. The feasibility of ultrasound-guided PICC insertion by the middle-thigh femoral vein in lung cancer patients with superior vena cava obstruction[J]. Chin J Nurs, 2015, 50(6):692-696.
[7]	颜艳, 王彤. 医学统计学[M]. 5版. 北京: 人民卫生出版社, 2020.
	Yan Y, Wang T. Medical statistics[M]. 5th ed. Beijing: People’s Medical Publishing House, 2020.
[8]	张京慧, 吴畏. 血管通路技能培训与管理[M]. 北京: 化学工业出版社, 2024.
	Zhang JH, Wu W. Skills training and management of vascular access[M]. Beijing: Chemical Industry Press, 2024.
[9]	中国研究型医院学会. 婴幼儿隧道式经股静脉穿刺中心静脉导管置入术操作规范:T/CRHA217—2025[S]. 北京: 中国研究型医院学会, 2025.
	Chinese Research Hospital Association. Specificationforoperatingoftunneledfemorallyinsertedcentralcathetersplacementininfantsandyoungchildren:T/CRHA217—2025[S]. Beijing: Chinese Research Hospital Association, 2025.
[10]	Ma MD, Zhang JH, Hou JM, et al. The application of intracavitary electrocardiogram for tip location of femoral vein catheters in chemotherapy patients with superior vena cava obstruction[J]. J Vasc Access, 2021, 22(4):613-622.
[11]	徐柳, 季福婷, 杨宾. 新生儿PICC经下肢置入导管长度测量方法的探讨[J]. 上海护理, 2021, 21(9):42-45.
	Xu L, Ji FT, Yang B. Discussion on measurement of length of PICC inserted via lower limbs in neonates[J]. Shanghai Nurs, 2021, 21(9):42-45.
[12]	中华护理学会静脉输液治疗专业委员会. 临床静脉导管维护操作专家共识[J]. 中华护理杂志, 2019, 54(9):1334-1342.
	Intravenous Infusion Therapy Committee of Chinese Nursing Association. Expert consensus on venous catheter maintenance[J]. Chin J Nurs, 2019, 54(9):1334-1342.
[13]	国家卫生健康委办公厅. 血管导管相关感染预防与控制指南(2021版)[EB/OL]. (2021-03-17)[2025-12-03]. https://www.nhc.gov.cn/yzygj/c100068/202103/feb9ec8a985048f896226e8b59a6f76d.shtml.
	General Office of the National Health Commission. Guidelines for the prevention and control of vessel catheter associated infection(2021 edition)[EB/OL]. (2021-03-17)[2025-12-03]. https://www.nhc.gov.cn/yzygj/c100068/202103/feb9ec8a985048f896226e8b59a6f76d.shtml.
[14]	刘凯, 谭炯, 易银芝, 等. 激励式身心抚触在改善骨折患儿负性情绪及疼痛程度的效果分析[J]. 国际护理学杂志, 2023, 42(6):1019-1022.
	Liu K, Tan J, Yi YZ, et al. Effect analysis of stimulating physical and mental touch in improving negative emotion and pain degree of children with fracture[J]. Int J Nurs, 2023, 42(6):1019-1022.
[15]	Zhang JH, Ma GY, Peng S, et al. Risk factors and predictive models for peripherally inserted central catheter unplanned extubation in patients with cancer:prospective,machine learning study[J]. J Med Internet Res, 2023, 25:e49016.
[16]	Sheng Y, Yang LH, Wu Y, et al. Implementation of tunneled peripherally inserted central catheters placement in cancer patients:a randomized multicenter study[J]. Clin Nurs Res, 2024, 33(1):19-26.
[17]	卢婷, 韦洁静, 应燕萍, 等. 一针式与两针式皮下隧道法在肿瘤患者PICC置管中应用效果的比较研究[J]. 中华护理杂志, 2025, 60(13):1558-1563.
	Lu T, Wei JJ, Ying YP, et al. Comparison of the application effects of single-needle and double-needle subcutaneous tunneling methods in PICC placement for tumor patients[J]. Chin J Nurs, 2025, 60(13):1558-1563.
[18]	Xiao MF, Xiao CQ, Li J, et al. Subcutaneous tunneling technique to improve outcomes for patients undergoing chemotherapy with peripherally inserted central catheters:a randomized controlled trial[J]. J Int Med Res, 2021, 49(4):03000605211004517.
[19]	McManus C, Mifflin N, Rivera R, et al. Comparison of outcomes from tunnelled femorally inserted central catheters and peripherally inserted central catheters:a propensity score-matched cohort study[J]. BMJ Open, 2024, 14(5):e081749.
[20]	王文超, 沈伟杰, 顾莺, 等. 中心静脉导管敷贴更换频率对敷贴下皮肤细菌定植的影响[J]. 护理学杂志, 2023, 38(5):9-12.
	Wang WC, Shen WJ, Gu Y, et al. Effect of the replacement frequency of central venous catheter dressing on skin bacterial colonization under the dressing[J]. J Nurs Sci, 2023, 38(5):9-12.
[21]	王克慧, 梁亚琴, 高艳红, 等. 下肢静脉隧道式PICC置管技术在肺癌合并上腔静脉综合征患者中的效果[J]. 甘肃医药, 2025, 44(6):547-549,564.
	Wang KH, Liang YQ, Gao YH, et al. The effect of lower limb vein tunnel PICC catheterization technique in patients with lung cancer complicated by superior vena cava syndrome[J]. Gansu Med J, 2025, 44(6):547-549,564.
[22]	李兰, 杨柳, 蔡志云, 等. 恶性肿瘤患者三种隧道式PICC置管效果观察[J]. 护理学杂志, 2023, 38(5):1-4.
	Li L, Yang L, Cai ZY, et al. Effect observation of three tunneled PICC catheterization methods in patients with malignant tumor[J]. J Nurs Sci, 2023, 38(5):1-4.
[23]	李昉, 徐翠荣, 姜琳, 等. 早产儿经下肢置入PICC并发静脉炎风险预测模型的构建与验证[J]. 中华护理杂志, 2026, 61(2):190-197.
	Li F, Xu CR, Jiang L, et al. Construction and verification of a risk prediction model for venous inflammation in preterm neonates with PICC placed in lower limbs[J]. Chin J Nurs, 2026, 61(2):190-197.
[24]	李乾, 赵欣, 张晓维, 等. 国内成人肿瘤患者PICC相关性血栓发生率的Meta分析[J]. 中华护理杂志, 2022, 57(3):348-355.
	Li Q, Zhao X, Zhang XW, et al. Incidence of peripherally inserted central catheter-related thrombosis in Chinese adult cancer patients:a Meta-analysis[J]. Chin J Nurs, 2022, 57(3):348-355.

隧道式经股静脉PICC置入术在困难静脉通路婴幼儿中的应用研究

A study on the application of tunneled femoral PICC in pediatric patients with difficult venous access

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