Abstract:

Objective To explore the occurrence of tip malposition of peripherally inserted central catheters（PICCs） and the possibility of spontaneous correction among neonates. Methods Incidence of PICC tip malposition in neonates with upper and lower limb catheterization from June 2015 to May 2018 was retrospectively reviewed and compared. The rate of spontaneous correction of tip malposition via different veins was calculated and reasons were analyzed. Results A total of 425 cases of neonatal PICC catheterization，and 72 cases had tip malposition，of which 22 cases were spontaneously corrected to the optimal position of superior and inferior vena cava within 48 h. The rate of malposition via upper limb was significantly higher than that via lower limb（P<0.01），however，the spontaneous correction rate via upper limb was also significantly higher than lower limb（P<0.01），especially the rate via internal jugular vein was as high as 71.4%. Conclusion Part of tip malposition of PICCs can be spontaneous corrected. PICCs with tip malposition identified by initial X-ray were not recommended for withdrawal or removal，which can be used as a peripheral vein. Imaging?guided catheter tracking within 24h after catheterization can be performed to determine spontaneous correction. PICCs without spontaneous correction can be re-catheterized，or used as peripheral venous catheter.

Key words: Catheterization, Peripheral, Malposition, Spontaneous Correction, Neonatal Nursing

摘要：

目的 探讨新生儿PICC尖端异位发生及自发矫正情况。 方法 回顾2015年6月—2018年5月新生儿经上、下肢静脉置管PICC尖端异位发生率,并进行比较分析。统计异位至不同静脉的PICC尖端异位自发矫正率,并分析原因。 结果 共425例新生儿行PICC置管,72例发生导管尖端异位,其中22例置管48 h内PICC尖端自发矫正至最佳的上、下腔静脉位置;经上肢静脉置管的PICC尖端异位率明显高于经下肢静脉置管（P<0.01）,但经上肢静脉置管的PICC尖端异位自发矫正率也明显高于经下肢静脉置管（P<0.01）,尤其是异位至颈内静脉的PICC尖端异位自发矫正率高达71.4%。 结论 部分异位PICC尖端可以自发矫正,首次X线片定位结果显示尖端异位的PICC导管,不建议轻易退管或拔管,可以先当作外周静脉导管使用,置管后24 h内进行影像学导管尖端定位跟踪,确定其是否自行复位,如未能复位再重新置管或拔出部分导管后作为外周静脉导管使用。

关键词: 导管插入术, 外周, 异位, 自发矫正, 新生儿护理