经浅表静脉穿刺中心静脉导管置管在极低出生体重儿中的应用进展

doi:10.3761/j.issn.0254-1769.2025.13.006

摘要/Abstract

摘要：

经浅表静脉穿刺中心静脉导管（epicutaneo-cava catheters，ECC）置管在极低出生体重儿（very low birth weight infant，VLBWI）液体管理、药物治疗及营养支持等方面发挥着重要作用。该研究结合VLBWI的临床需求，对ECC穿刺导管的选择、置管前准备、置管操作流程、导管的定位及追踪等方面进行综述，并提出相关建议，旨在优化VLBWI的临床管理，提升新生儿重症监护室医护人员ECC置管的成功率、降低并发症的发生风险，改善患儿预后，提升其临床护理质量。

关键词: 早产儿, 极低出生体重儿, 新生儿重症监护室, 经浅表静脉穿刺中心静脉导管, 血管通路, 新生儿护理学

Abstract:

Epicutaneo-cava catheters（ECC） placement plays an important role in fluid management，drug therapy and nutritional support in very low birth weight infants（VLBWI）. This study reviews the selection of ECC catheters，preparation for ECC catheterization，catheterization procedures，catheter positioning and tracking，and revelations and recommendations in light of the clinical needs of VLBWI，with the aim of optimizing the clinical management of VLBWI，increasing the success rate of ECC catheterization in NICUs，decreasing the risk of complications，improving the prognosis of the children，and enhancing the quality of their clinical care.

Key words: Preterm Infants, Very Low Birth Weight Infants, Neonatal Intensive Care Unit, Epicutaneo-Cava Catheters, Vascular Access, Neonatal Nursing

肖诗兰, 罗飞翔, 慎斐, 商祯茹, 王琴. 经浅表静脉穿刺中心静脉导管置管在极低出生体重儿中的应用进展[J]. 中华护理杂志, 2025, 60(13): 1567-1572.

XIAO Shilan, LUO Feixiang, SHEN Fei, SHANG Zhenru, WANG Qin. Progress of central venous catheter placement via superficial venous puncture in very low birth weight infants[J]. Chinese Journal of Nursing, 2025, 60(13): 1567-1572.

参考文献 41

[1]	Barone G, Pittiruti M. Epicutaneo-caval catheters in neonates:new insights and new suggestions from the recent literature[J]. J Vasc Access, 2020, 21(6):805-809.
[2]	Biasucci DG, Disma NM, Pittiruti M. Vascular access in neonates and children[M]. Cham: Springer International Publishing, 2022.
[3]	裘梦凡, 张艺, 李丽玲, 等. 极低出生体重儿家庭参与式照护方案的构建及应用研究[J]. 中华护理杂志, 2024, 59(24):2957-2965.
	Qiu MF, Zhang Y, Li LL, et al. Construction and application of a family integrated care program for very low birth weight infants in China[J]. Chin J Nurs, 2024, 59(24):2957-2965.
[4]	中国医师协会新生儿科医师分会循证专业委员会. 新生儿经外周置入中心静脉导管操作及管理指南(2021)[J]. 中国当代儿科杂志, 2021, 23(3):201-212.
	Evidence Based Medicine Group,Neonatologist Society,Chinese Medical Doctor Association. Operation and management guidelines for peripherally inserted central catheter in neonates(2021)[J]. Chin J Contemp Pediatr, 2021, 23(3):201-212.
[5]	Pittiruti M, Celentano D, Barone G, et al. A GAVeCeLT bundle for central venous catheterization in neonates and children:a prospective clinical study on 729 cases[J]. J Vasc Access, 2023, 24(6):1477-1488.
[6]	Yu XH, Yue SJ, Wang MJ, et al. Risk factors related to peripherally inserted central venous catheter nonselective removal in neonates[J]. Biomed Res Int, 2018, 2018:3769376.
[7]	O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections[J]. Clin Infect Dis, 2011, 52(9):e162-93.
[8]	Moureau N. Hydrophilic biomaterial intravenous hydrogel catheter for complication reduction in PICC and midline catheters[J]. Expert Rev Med Devices, 2024, 21(3):207-216.
[9]	Nickel B, Gorski L, Kleidon T, et al. Infusion therapy standards of practice,9th ed[J]. J Infus Nurs, 2024, 47(Suppl 1):S1-S285.
[10]	Sharpe EL, Curry S, Wyckoff MM. NANN neonatal peripherally inserted central catheters:guideline for practice,4th ed[J]. Adv Neonatal Care, 2024, 24(4):313-315.
[11]	罗飞翔, 陈朔晖, 程晓英, 等. 极低出生体重儿PICC尖端位置与体重增长的相关性分析[J]. 中华护理杂志, 2017, 52(8):949-953.
	Luo FX, Chen SH, Cheng XY, et al. A correlation analysis of PICC tip position and weight gaining in very low birth weight infants[J]. Chin J Nurs, 2017, 52(8):949-953.
[12]	Yu XY, Wang XJ, Fan L, et al. Iatrogenic pleural effusion due to extravasation of parenteral nutrition via an epicutaneo cava catheter in neonates:a prospective cohort study[J]. Front Pediatr, 2020, 8:570978.
[13]	Ares G, Hunter CJ. Central venous access in children:indications,devices,and risks[J]. Curr Opin Pediatr, 2017, 29(3):340-346.
[14]	郭舒文, 谢丽琴, 许丽萍, 等. 早产儿经右下肢静脉留置PICC导管的可行性[J]. 中华护理杂志, 2012, 47(2):153-156.
	Guo SW, Xie LQ, Xu LP, et al. The feasibility of PICC insertion by the veins of right lower extremity in preterm infants[J]. Chin J Nurs, 2012, 47(2):153-156.
[15]	Ma MY, Garingo A, Jensen AR, et al. Complication risks associated with lower versus upper extremity peripherally inserted central venous catheters in neonates with gastroschisis[J]. J Pediatr Surg, 2015, 50(4):556-558.
[16]	D’Andrea V, Prontera G, Pezza L, et al. Rapid Superficial Vein Assessment(RaSuVA):a pre-procedural systematic evaluation of superficial veins to optimize venous catheterization in neonates[J]. J Vasc Access, 2024, 25(1):303-307.
[17]	袁皓, 杨童玲. 新生儿医源性皮肤损伤处理的专家共识[J]. 中国循证儿科杂志, 2021, 16(4):255-261.
	Yuan H, Yang TL. Expert consensus on treatment of iatrogenic skin injury in newborns[J]. Chin J Evid Based Pediatr, 2021, 16(4):255-261.
[18]	Hynes S, Moore Z, Patton D, et al. Accuracy of transcutaneous bilirubin versus serum bilirubin measurement in preterm infants receiving phototherapy:a systematic review[J]. Adv Neonatal Care, 2020, 20(6):E118-E126.
[19]	Chapman AK, Aucott SW, Milstone AM. Safety of chlorhexidine gluconate used for skin antisepsis in the preterm infant[J]. J Perinatol, 2012, 32(1):4-9.
[20]	Neri I, Ravaioli GM, Faldella G, et al. Chlorhexidine-induced chemical burns in very low birth weight infants[J]. J Pediatr, 2017, 191:262-265.
[21]	Andersen C, Hart J, Vemgal P, et al. Prospective evaluation of a multi-factorial prevention strategy on the impact of nosocomial infection in very-low-birthweight infants[J]. J Hosp Infect, 2005, 61(2):162-167.
[22]	Sugiyama M, Iguchi A, Terashita Y, et al. Povidone-iodine lowers the incidence of catheter-associated bloodstream infection[J]. Pediatr Int, 2019, 61(3):230-234.
[23]	Kieran EA, O'sullivan A, Miletin J, et al. 2% chlorhexidine-70% isopropyl alcohol versus 10% povidone-iodine for insertion site cleaning before central line insertion in preterm infants:a randomised trial[J]. Arch Dis Child Fetal Neonatal Ed, 2018, 103(2):F101-F106.
[24]	Aitken J, Williams FLR. A systematic review of thyroid dysfunction in preterm neonates exposed to topical iodine[J]. Arch Dis Child Fetal Neonatal Ed, 2014, 99(1):F21-F28.
[25]	李昭颖, 王玥珏, 蒋思远, 等. 新生儿经外周置入中心静脉导管实践指南(第三版)解读(一)[J]. 中华现代护理杂志, 2022, 28(32):4437-4442.
	Li ZY, Wang YJ, Jiang SY, et al. Interpretation of the practice guideline for peripherally inserted central catheter in neonates(third edition)(I)[J]. Chin J Mod Nurs, 2022, 28(32):4437-4442.
[26]	Gandini D, Koh TG. A novel,simple way to insert percutaneous central venous catheters in newborn babies[J]. J Perinatol, 2003, 23(2):162-163.
[27]	Bayley G. Technique for insertion of percutaneous central venous catheters in the newborn period[J]. Arch Dis Child Fetal Neonatal Ed, 2003, 88(3):F256-F257.
[28]	Pettit J. Technological advances for PICC placement and management[J]. Adv Neonatal Care, 2007, 7(3):122-131.
[29]	Uygun I. Peripherally inserted central catheter in neonates:a safe and easy insertion technique[J]. J Pediatr Surg, 2016, 51(1):188-191.
[30]	Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice,8th edition[J]. J Infus Nurs, 2021, 44(Suppl 1):S1-S224.
[31]	Wang Q, Luo FX, Fan XY, et al. Application of epicutaneo-cava catheters with 24G indwelling needles in very low birth weight infants:a safe and simple innovative technique[J]. Front Pediatr, 2023, 11:1172164.
[32]	Mattson D, O’Connor M. Transilluminator assistance in neonatal venipuncture[J]. Neonatal Netw, 1986, 5(1):42-45.
[33]	Perman MJ, Kauls LS. Transilluminator burns in the neonatal intensive care unit:a mimicker of more serious disease[J]. Pediatr Dermatol, 2007, 24(2):168-171.
[34]	Barone G, Pittiruti M, Biasucci DG, et al. Neo-ECHOTIP:a structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in neonates[J]. J Vasc Access, 2022, 23(5):679-688.
[35]	Caglar S, Buyukyilmaz F, Bakoglu I, et al. Efficacy of vein visualization devices for peripheral intravenous catheter placement in preterm infants:a randomized clinical trial[J]. J Peri-nat Neonatal Nurs, 2019, 33(1):61-67.
[36]	Di Puccio F, Giacomarro D, Mattei L, et al. Experimental study on the chemico-physical interaction between a two-component cyanoacrylate glue and the material of PICCs[J]. J Vasc Access, 2018, 19(1):58-62.
[37]	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 Professional Committee of the Chinese Nursing Association. Expert consensus on venous catheter maintenance[J]. Chin J Nurs, 2019, 54(9):1334-1342.
[38]	D’Andrea V, Barone G, Pezza L, et al. Securement of central venous catheters by subcutaneously anchored suturless devices in neonates[J]. J Matern Fetal Neonatal Med, 2022, 35(25):6747-6750.
[39]	D’Andrea V, Prontera G, Cota F, et al. Real-time ultrasound tip location reduces malposition and radiation exposure during epicutaneo-caval catheter placement in neonates[J]. Am J Perinatol, 2024, 41(Suppl 1):e1183-e1189.
[40]	D’Andrea V, Pittiruti M, Prontera G, et al. The SIECC protocol:a novel insertion bundle to minimize the complications related to epicutaneo-cava catheters in neonates[J]. J Vasc Access, 2024:11297298241239699.
[41]	徐丹. 静疗团队管理模式对PICC病人导管维护技能及并发症的影响[J]. 循证护理, 2022, 8(21):2928-2932.
	Xu D. Effect of management model of static therapy team on catheter maintenance skills and complications of PICC patients[J]. Chin Evid Based Nurs, 2022, 8(21):2928-2932.