床旁超声联合关节活动量角器对预防极低出生体重儿PICC继发性异位的效果评价

doi:10.3761/j.issn.0254-1769.2025.17.003

摘要/Abstract

摘要：

目的评价床旁超声联合关节活动量角器在极低出生体重儿关节活动范围精准监测与管理中的应用效果，以减少其PICC继发性异位的发生。方法采用便利抽样法，选取2024年2—9月于河南省郑州市某三级甲等医院新生儿重症监护病房的128例极低出生体重儿为研究对象，其中，2024年6—9月的患儿为试验组，2024年2—5月的患儿为对照组，每组各64例。试验组在对照组的基础上将床旁超声与关节活动量角器联合应用于经上肢置管患儿关节活动范围的精准监测与管理；对照组采用PICC继发性异位常规预防及处理方法。干预后比较两组PICC继发性异位发生率、PICC继发性异位拔管率、PICC继发性异位相关并发症的发生率及患儿平均住院日。结果最终两组各纳入60例。干预后试验组PICC继发性异位发生率为8.33%，低于对照组的23.33%；PICC继发性异位拔管率为3.33%，低于对照组的16.67%；PICC继发性异位相关并发症的发生率为13.33%，低于对照组的51.37%；平均住院日为50（48，55）d，短于对照组的61（55，65） d，两组比较，差异均具有统计学意义（P<0.05）。结论将床旁超声与关节活动量角器联合应用于经上肢置管患儿关节活动范围的精准监测与管理，有效保障了导管尖端位置安全，同时降低了PICC继发性异位相关并发症的发生率，促进了新生儿护理服务质量的提升。

关键词: 床旁超声, 关节活动量角器, 极低出生体重儿, PICC继发性异位, 新生儿护理

Abstract:

Objective The application effect of bedside ultrasound combined with joint movement protractor on the accurate monitoring and management of joint range of motion in extremely low birth weight infants was evaluated to reduce the incidence of secondary ectopic PICC in extremely low birth weight infants. Methods Convenience sampling was used to select 128 extremely low birth weight infants admitted to the neonatal intensive care unit of a tertiary hospital in Zhengzhou，Henan Province from February to September 2024. Among them，infants enrolled between June and September 2024 were assigned to an experimental group，while those enrolled between February and May 2024 were assigned to a control group，with 64 cases in each group. Whereas the experimental group，based on the control group，combined bedside ultrasound with a joint goniometer for precise monitoring and management of limb movement range in children with upper limb catheterization；the control group received routine prevention and management of PICC secondary displacement. After intervention，the incidence of PICC secondary displacement，the rate of PICC secondary displacement removal，the incidence of complications related to PICC secondary displacement，and the average length of stay of the infants were compared between the 2 groups. Results Ultimately，60 cases were included in each of the 2 groups. The incidence of secondary ectopic PICC in the post-intervention experimental group was 8.33%，lower of 23.33% in the control group；the extubation rate of secondary ectopic PICC was 3.33%，lower of 16.67% in the control group；the incidence of complications related to secondary ectopic PICC was 13.33%，lower of 51.67% in the control group；the average hospitalization day was 50（48，55）d，shorter of 61（55，65）d in the control group. The difference between the 2 groups was statistically significant（P<0.05）. Conclusion The combination of bedside ultrasound and joint movement protractor was used to accurately monitor and manage the range of motion of limbs in children with upper limb catheterization，which effectively guaranteed the safe position of the catheter tip and reduced the incidence of secondary ectopic complications related to PICC. It can be further promoted and applied in clinical practice.

Key words: Bedside Ultrasound, Joint Movement Protractor, Very Low Birth Weight Infants, Catheter Ectopic Secondary to PICC, Neonatal Nursing

崔璐璐, 李平平, 苏鑫, 金歌. 床旁超声联合关节活动量角器对预防极低出生体重儿PICC继发性异位的效果评价[J]. 中华护理杂志, 2025, 60(17): 2063-2068.

CUI Lulu, LI Pingping, SU Xin, JIN Ge. Evaluation of the effect of bedside ultrasound combined with joint movement protractor on preventing secondary ectopic PICC in extremely low birth weight infants[J]. Chinese Journal of Nursing, 2025, 60(17): 2063-2068.

图/表 3

表1 肩与肘关节活动角度测量方法

Table 3 Measurement methods of shoulder and elbow joint movement protractor

图1 关节活动量角器

Figure 1 Joint movement protractor

表2 两组一般资料的比较[例（百分比，%）]

Table 2 Comparison of general data of 2 groups[case（percentage，%）]

参考文献 23

[1]	胥焕, 杨春燕, 许平. 出生体重<1500g早产儿静脉营养疗效及并发症观察[J]. 中华危重病急救医学, 2019, 31(11):1395-1400.
	Xu H, Yang CY, Xu P. Observation on the efficacy and complications of intravenous nutrition for premature infants with birth weight<1500g[J]. Chin Crit Care Med, 2019, 31(11):1395-1400.
[2]	Bashir RA, Callejas AM, Osiovich HC, et al. Percutaneously inserted central catheter-related pleural effusion in a level Ⅲneonatal intensive care unit:a 5-year review(2008-2012)[J]. JPEN J Parenter Enteral Nutr, 2017, 41(7):1234-1239. DOI PMID
[3]	范歆颀. 新生儿PICC导管继发性异位的临床特点及研究进展[J]. 中华急危重症护理杂志, 2020, 1(5):463-467.
	Fan XQ. Clinical characteristics and research progress of secondary malposition of peripherally inserted central venous catheter in neonates[J]. Chin J Emerg Crit Care Nurs, 2020, 1(5):463-467.
[4]	Sertic AJ, Connolly BL, Temple MJ, et al. Perforations associated with peripherally inserted central catheters in a neonatal population[J]. Pediatr Radiol, 2018, 48(1):109-119. DOI PMID
[5]	Zarkesh MR, Haghjoo M. Neonatal cardiac tamponade,a life-threatening complication secondary to peripherally inserted central catheter:a case report[J]. J Med Case Rep, 2022, 16(1):305.
[6]	陈晓春, 陈琼, 童燕芬, 等. 新生儿PICC尖端异位与自发矫正情况分析[J]. 中华护理杂志, 2019, 54(4):558-561. DOI
	Chen XC, Chen Q, Tong YF, et al. Tip malposition and spontaneous correction of peripherally inserted central catheters among neonates[J]. Chin J Nurs, 2019, 54(4):558-561. DOI
[7]	胡艳玲, 唐孟言, 李小文, 等. 新生儿PICC导管异位影响因素及预防措施的研究进展[J]. 护理学杂志, 2020, 35(22):105-108.
	Hu YL, Tang MY, Li XW, et al. A review of associated factors regarding malposition of neonatal peripherally inserted central venous catheter:nursing interventions[J]. J Nurs Sci, 2020, 35(22):105-108.
[8]	沈婷, 余婷, 聂玲, 等. 新生儿PICC导管尖端继发性异位预防和处理的最佳证据总结[J]. 中华护理杂志, 2023, 58(18):2273-2281. DOI
	Shen T, Yu T, Nie L, et al. Summary of the best evidence for the prevention and management of PICC secondary catheter tip malposition in neonates[J]. Chin J Nurs, 2023, 58(18):2273-2281. DOI
[9]	Sharpe EL. Repositioning techniques for malpositioned neonatal peripherally inserted central catheters[J]. Adv Neonatal Care, 2010, 10(3):129-132. DOI PMID
[10]	左莉莉, 任义梅, 周洁, 等. 超声引导在极低/超低出生体重儿经外周中心静脉置管中的应用[J]. 中华新生儿科杂志(中英文), 2021, 36(5):20-23.
	Zuo LL, Ren YM, Zhou J, et al. Application of ultrasound-guided peripherally inserted central catheter in very/extremely low birth weight infants[J]. Chin J Neonatol, 2021, 36(5):20-23.
[11]	刘燕. 关节量角器示值误差测量不确定度评定[J]. 中国计量, 2024(5):145-147.
	Liu Y. Evaluation of uncertainty in measurement of indication error of joint protractor[J]. China Metrol, 2024(5):145-147.
[12]	冯立春, 冯永利, 王宝中, 等. 面向肩关节康复设备的研究进展[J]. 机械传动, 2024, 48(7):167-176.
	Feng LC, Feng YL, Wang BZ, et al. Research progress of shoulder joint rehabilitation equipment[J]. J Mech Transm, 2024, 48(7):167-176.
[13]	杨明玉, 于丽, 程艳爽, 等. 四个极限体位对PICC尖端位置改变的影响[J]. 中华现代护理杂志, 2016, 22(11):1546-1548.
	Yang MY, Yu L, Cheng YS, et al. Impact of four kinds of limit body position to PICC catheter tip position[J]. Chin J Mod Nurs, 2016, 22(11):1546-1548.
[14]	Ullman AJ, Chopra V, Brown E, et al. Developing appropriateness criteria for pediatric vascular access[J]. Pediatrics, 2020, 145(Suppl 3):S233-S242.
[15]	Lu YY, Hao CY, He WB, et al. Experimental research on pre-venting mechanical phlebitis arising from indwelling needles in intravenous therapy by external application of mirabilite[J]. Exp Ther Med, 2018, 15(1):276-282.
[16]	中华护理学会静脉输液治疗专业委员会. 静脉导管常见并发症临床护理实践指南[J]. 中华现代护理杂志, 2022, 28(18):2381-2395.
	Chinese Nursing Association of Intravenous Infusion Therapy Specialized Committee. Clinical nursing practice guidelines for common complications of intravenous catheters[J]. Chin J Mod Nurs, 2022, 28(18):2381-2395.
[17]	Doyle SC, Bergin NM, Young R, et al. Diagnostic accuracy of ultrasound for localising peripherally inserted central catheter tips in infants in the neonatal intensive care unit:a systematic review and meta-analysis[J]. Pediatr Radiol, 2022, 52(12):2421-2430.
[18]	刘金明, 赖玉娥, 唐英姿, 等. 床旁B超动态定位技术在极早产儿PICC中的应用[J]. 华夏医学, 2023, 36(5):173-178.
	Liu JM, Lai YE, Tang YZ, et al. Application of bedside B-mode ultrasound dynamic localization technique in PICC placement for extremely preterm infants[J]. Acta Med Sin, 2023, 36(5):173-178.
[19]	Hanks J, Myers B. Validity,reliability,and efficiency of a standard goniometer,medical inclinometer,and builder’s inclinometer[J]. Int J Sports Phys Ther, 2023, 18(4):989-996. DOI PMID
[20]	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.
[21]	黄学良, 杜小群. 探讨床旁超声心动图导管尖端定位在减少新生儿PICC置管异位中的应用[J]. 妇幼护理, 2024, 4(7):1759-1761.
	Huang XL, Du XQ. Application of bedside echocardiographic catheter tip localization in reducing the occurrence of PICC catheter misplacement in neonates[J]. J Matern Child Nurs, 2024, 4(7):1759-1761.
[22]	Pires ABM, Lima AFC. Direct cost of peripheral catheterization by nurses[J]. Rev Bras Enferm, 2019, 72(1):88-94. DOI PMID
[23]	Beleza LO, Brasil GDC, Margatho AS, et al. Prevention of complications related to peripherally inserted central catheter insertion techniques in newborns:systematic review and network meta-analysis[J]. Rev Lat Am Enfermagem, 2024, 32:e4161.