一针式皮下隧道法在经外周穿刺中心静脉置管中的应用

doi:10.3761/j.issn.0254-1769.2019.11.022

摘要/Abstract

摘要：

目的探讨超声引导下一针式皮下隧道法在肿瘤化疗患者Power PICC置管中的临床应用效果。方法采取回顾性研究方法,选取2016年1月—2018年12月入住山东省某三级甲等医院化疗科需置入Power PICC导管的963例肿瘤患者作为研究对象,按照置管方式分为试验组493例和对照组470例,试验组采取一针式皮下隧道法、对照组采取常规塞丁格穿刺技术进行置管,采用卡方检验对两组置管后并发症发生率进行比较,采用Cox多因素回归分析导管移位及导管堵塞的影响因素,并绘制生存曲线反应两组导管移位及导管堵塞的发生情况。结果一针式皮下隧道法可明显降低置管后导管移位及导管堵塞的发生率[aHR=0.304,95%CI（0.137,0.677）,P<0.01;aHR=0.304,95%CI（0.097,0.958）,P<0.05],一般人口学及疾病资料均对导管移位及导管堵塞无明显影响（P>0.05）。结论通过一针式皮下隧道进行Power PICC置管可明显减少置管后并发症,该方法是一种安全有效的Power PICC穿刺技术。

关键词: 皮下隧道, 超声, 经外周置入中心静脉导管, 并发症, 护理

Abstract:

Objective To explore the effect of one-insertion subcutaneous tunneling technique for Power peripherally inserted central catheter（PICC） placement via ultrasound.Methods A total of 963 patients with malignant tumors treated in our hospital from January 2016 to December 2018 were enrolled,including 493 patients in the experimental group and 470 patients in the control group. The experimental group adopted the one-insertion subcutaneous tunneling technique to place Power PICC,and the control group adopted the routine method. Chi-square test was used to analyze the incidence of complications in two groups;Cox regression were used to analyze the influencing factors of catheter extrusion and obstruction;survival curve was used to reflect the occurrence of catheter extrusion and obstruction in both groups.Results The incidence rates of catheter extrusion and obstruction in the experimental group were significantly lower than those in the control group[aHR=0.304,95%CI（0.137,0.677）,P<0.01;aHR=0.304,95%CI（0.097,0.958）,P<0.05]. Demographics and disease characteristics had no significant impacts on catheter extrusion and obstruction（P>0.05）.Conclusion One-insertion subcutaneous tunneling technique can effectively reduce complications after placement,which is a safe and effective technique to place Power PICC.

Key words: Subcutaneous Tunnel, Ultrasound, Peripherally Inserted Central Catheter, Complications, Nursing Care

王艾君, 郑杏, 许小芬, 栾晓嵘. 一针式皮下隧道法在经外周穿刺中心静脉置管中的应用[J]. 中华护理杂志, 2019, 54(11): 1707-1711.

WANG Aijun, ZHENG Xing, XU Xiaofen, LUAN Xiaorong. Application of one-insertion subcutaneous tunneling technique for Power PICC placement via ultrasound[J]. Chinese Journal of Nursing, 2019, 54(11): 1707-1711.

图/表 5

表1 两组一般资料的比较[例(百分比,%)]

表2 两组置管后并发症对比分析[例(百分比,%)]

表3 导管移位及导管堵塞影响因素分析

图1 两组导管移位生存曲线对比分析

图2 两组导管堵塞生存曲线对比分析

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