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

doi:10.3761/j.issn.0254-1769.2025.13.004

摘要/Abstract

摘要：

目的比较一针式与两针式皮下隧道法在肿瘤患者PICC置管中的应用效果，为护士合理选择置管方法提供参考。方法采用定点连续抽样法，选取2022年6月—2023年12月在南宁市某三级甲等综合医院肿瘤内科接受PICC置管的肿瘤患者作为研究对象，根据患者实际接受的置管方式，将患者分为一针式皮下隧道组和两针式皮下隧道组。通过1 ∶ 1倾向性评分匹配后进行对比分析，比较两组导管相关并发症发生率、疼痛评分及置管总时间。结果经倾向性评分匹配后，两组均纳入79例患者。结果显示，一针式皮下隧道组导管相关性血栓发生率、疼痛评分均低于两针式皮下隧道组，置管总时间少于两针式皮下隧道组，差异具有统计学意义（P<0.05）。结论采用一针式皮下隧道法置管可有效降低肿瘤患者导管相关性血栓发生率和置管过程中的疼痛感，同时可缩短置管总时间。

关键词: 皮下隧道, 经外周穿刺中心静脉导管, 并发症, 肿瘤护理

Abstract:

Objective To compare the clinical effects of single-puncture and double-puncture subcutaneous tunneling techniques for PICC placement in cancer patients，and to provide references for nurses in selecting appropriate catheterization methods. Methods A continuous sampling method was adopted to select cancer patients who underwent PICC placement in the Department of Oncology at a tertiary general hospital in Nanning from June 2022 to December 2023. According to the actual catheterization technique received by patients，they were assigned to either the single-puncture or double-puncture subcutaneous tunneling group. After 1 ∶ 1 propensity score matching （PSM），the 2 groups were compared in terms of catheter-related complication rates，pain scores and total catheterization time. Results After propensity score matching，79 patients were included in each group. The results showed that the incidence of catheter-related thrombosis，pain scores，and total catheterization time in the one-needle subcutaneous tunneling group were significantly lower than those in the two-needle subcutaneous tunneling group，with statistically significant differences（P<0.05）. Conclusion The one-needle subcutaneous tunneling method can effectively reduce the incidence of catheter-related thrombosis and pain during catheterization in cancer patients，while also shortening the total catheterization time.

Key words: Subcutaneous Tunneling, Peripherally Inserted Central Catheter, Complications, Oncology Nursing

卢婷, 韦洁静, 应燕萍, 麻玲霞, 陈小丽, 徐谊. 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): 1558-1562.

LU Ting, WEI Jiejing, YING Yanping, MA Lingxia, CHEN Xiaoli, XU Yi. Comparison of the application effects of single-needle and double-needle subcutaneous tunneling methods in PICC placement for tumor patients[J]. Chinese Journal of Nursing, 2025, 60(13): 1558-1562.

图/表 2

参考文献 21

[1]	Mielke D, Wittig A, Teichgräber U. Peripherally inserted central venous catheter(PICC) in outpatient and inpatient oncological treatment[J]. Support Care Cancer, 2020, 28(10):4753-4760.
[2]	Liu RX, Xu HQ, Pu LH, et al. Clinical characteristics of peripherally inserted central catheter-related complications in cancer patients undergoing chemotherapy:a prospective and observational study[J]. BMC Cancer, 2023, 23(1):894.
[3]	Lingegowda D, Gehani A, Sen S, et al. Centrally inserted tunnelled peripherally inserted central catheter:off-label use for venous access in oncology patients[J]. J Vasc Access, 2020, 21(5):773-777.
[4]	王艾君, 郑杏, 许小芬, 等. 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 AJ, Zheng X, Xu XF, et al. Application of one-insertion subcutaneous tunneling technique for power PICC placement via ultrasound[J]. Chin J Nurs, 2019, 54(11):1707-1711.
[5]	韦洁静, 李周伟, 卢婷, 等. 两针式皮下隧道法在PICC置管病人中的临床应用效果[J]. 全科护理, 2022, 20(12):1599-1602.
	Wei JJ, Li ZW, Lu T, et al. Clinical application effect of the two-needle subcutaneous tunnel method in patients with PICC catheterization[J]. Chin Gen Pract Nurs, 2022, 20(12):1599-1602.
[6]	Gorski LA. Update:the 2024 infusion therapy standards of practice[J]. Home Healthc Now, 2024, 42(4):198-205.
[7]	Kleidon TM, Horowitz J, Rickard CM, et al. Peripherally inserted central catheter thrombosis after placement via electrocardiography vs traditional methods[J]. Am J Med, 2021, 134(2):e79-e88.
[8]	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.
[9]	李祥云, 王洁, 刘畅, 等. 迷你中等长度导管在不同部位置入效果的比较研究[J]. 中华护理杂志, 2024, 59(20):2437-2443.
	Li XY, Wang J, Liu C, et al. Comparison of the effects of different insertion sites for mini-midline catheters[J]. Chin J Nurs, 2024, 59(20):2437-2443.
[10]	刘文静, 琚慧, 张佳, 等. PICC尖端心腔内电图定位技术在高龄老年患者中的应用效果[J]. 中国护理管理, 2022, 22(4):485-489.
	Liu WJ, Ju H, Zhang J, et al. Effects of the intracardiac electrocardiogram method for positioning the tip of peripherally inserted central catheter in senior elderly patients[J]. Chin Nurs Manag, 2022, 22(4):485-489.
[11]	刘齐芬, 刘兴玲, 张淑珍, 等. PICC隧道针及皮下隧道建立方法的改良及应用[J]. 中华护理杂志, 2022, 57(5):532-535.
	Liu QF, Liu XL, Zhang SZ, et al. Improvement and application of PICC subcutaneous tunnel needle[J]. Chin J Nurs, 2022, 57(5):532-535.
[12]	陈一丹, 端烨, 唐迎迎, 等. 2021版输液治疗实践标准之导管相关皮肤损伤解读[J]. 军事护理, 2022, 39(8):89-92.
	Chen YD, Duan Y, Tang YY, et al. Interpretation of catheter-associated skin injury of infusion therapy of standards 2021[J]. Mil Nurs, 2022, 39(8):89-92.
[13]	Low XZ, Tay KH, Leong S, et al. Repurposing the power injectable peripherally inserted central catheter as a tunnelled,non-cuffed,centrally inserted central venous catheter in oncological patients for short-to mid-term vascular access:a pilot study[J]. J Vasc Access, 2021, 22(3):457-461.
[14]	郑燕芳, 刘云娥, 祝成红, 等. 经上臂高位隧道式外周静脉穿刺中心静脉置管在血管通路困难老年患者中的应用[J]. 军事护理, 2024, 41(10):17-20.
	Zheng YF, Liu YE, Zhu CH, et al. Application of tunnel PICC catheterization through upper arm in elder patients with vascular access difficulties[J]. Mil Nurs, 2024, 41(10):17-20.
[15]	王艾红, 陈静, 魏晓旭, 等. 肿瘤化疗患者隧道式与非隧道式置入PICC并发症发生情况的Meta分析[J]. 护士进修杂志, 2023, 38(17):1586-1591.
	Wang AH, Chen J, Wei XX, et al. Meta analysis of implantable venous access tunnel and nontunnel PICC complications of cancer patients undergoing chemotherapy[J]. J Nurses Train, 2023, 38(17):1586-1591.
[16]	Fabiani A, Dreas L, Sanson G. Tunnelling a midline catheter:when the traffic light shifts from yellow to green[J]. J Vasc Ac-cess, 2018, 19(6):667-671.
[17]	Giustivi D, Gidaro A, Baroni M, et al. Tunneling technique of PICCs and midline catheters[J]. J Vasc Access, 2022, 23(4):610-614.
[18]	周腾腾. 上臂隧道式经外周置入中心静脉导管在胃肠肿瘤患者中的应用效果研究[D]. 石家庄: 河北医科大学, 2024.
	Zhou TT. Study on the application effect of upper arm tunnel peripherally inserted central venous catheter in patients with gastrointestinal tumor[D]. Shijiazhuang: Hebei Medical University, 2024.
[19]	Ostroff MD, Moureau NL. Report of modification for peripherally inserted central catheter placement:subcutaneous needle tunnel for high upper arm placement[J]. J Infus Nurs, 2017, 40(4):232-237.
[20]	Kim IJ, Shim DJ, Lee JH, et al. Impact of subcutaneous tunnels on peripherally inserted catheter placement:a multicenter retrospective study[J]. Eur Radiol, 2019, 29(5):2716-2723.
[21]	钟娟平. 隧道式PICC在肿瘤化疗患者中的应用效果研究[D]. 兰州: 兰州大学, 2023.
	Zhong JP. Study on the application effect of tunnel PICC in tumor chemotherapy patients[D]. Lanzhou: Lanzhou University, 2023.