Abstract:

Objective To explore the application efficacy and safety of oblique ultrasound-guided techniques in PICC puncture，in order to provide guidance and references for clinical application. Methods Through convenient sampling，654 patients from a tertiary A hospital in Zhejiang Province from March to December 2022 were selected as the study subjects. The random numbers were generated through Excel table functions and they were randomly grouped into 3 groups：A，B，and C. The ultrasound short axis method，long axis method，and oblique axis method were employed to guide PICC puncture catheterization，respectively. The success rate of PICC puncture，the number of subcutaneous adjustments of the puncture needle，puncture time，and the occurrence of puncture complications （such as hematoma，puncture of the posterior wall of blood vessels，accidental injury to arteries，and accidental injury to nerves） were recorded during the catheterization process in 3 groups. Results A total of 654 patients completed the study，including 215 in group A，219 in group B，and 220 in group C. The success rate of first-time puncture in the group C（86.36%） was higher than that in group A（73.95%） and group B（63.93%），and there was a statistically significant difference among 3 groups（P<0.001）. The subcutaneous adjustment frequency of the puncture needle was 1（1，1） in group C，1（1，2） in group A，and 1（1，2） in group B. The difference between 3 groups was statistically significant（P<0.001）；the puncture time of group C was shorter than that of group A and group B，and the difference was statistically significant（P<0.001）. There was a statistically significant difference in the puncture time between 3 groups（P<0.017）；the pairwise comparison of the number of subcutaneous needle adjustments and the success rate of a puncture between 3 groups showed that there was a statistical difference between group C and group A，and between group C and group B（P<0.017），while there was no statistical difference between group A and group B（P>0.017）.There was statistical significance（P<0.05） among 3 groups in terms of complications such as accidental nerve injury and puncture of the contralateral vascular wall by puncture needle，but there was no statistical significance in terms of accidental arterial injury and hematoma occurrence among 3 groups. Conclusion Compared with the short axis approach and the long axis approach，the ultrasound oblique axis approach guided PICC puncture has statistical differences in the success rate of a puncture and the incidence of puncture complications，etc. It is recommended to use the ultrasound oblique axis approach during PICC puncture.

Key words: Ultrasound Guidance, Oblique Axis Plane, Peripherally Inserted Central Venous Catheter, Nursing Care

摘要：

目的 探讨超声斜轴平面引导技术在PICC穿刺术中的应用效果及安全性，以期为临床应用提供指导和借鉴。 方法 通过便利抽样，选择浙江省某三级甲等医院2022年3月—12月的654例患者作为研究对象。通过Excel表函数产生随机数进行随机分组，分为A、B、C 3组，分别采用超声短轴平面、长轴平面、斜轴平面引导PICC穿刺置管。记录并比较3组置管过程中PICC一次穿刺成功率、穿刺针皮下调整次数、穿刺时间以及穿刺并发症（血肿、穿破血管后壁、误伤动脉、误伤神经等）的发生情况。 结果 共654例患者完成了该研究，A组215例，B组219例，C组220例。C组的一次穿刺成功率为86.36%，高于A组的73.95%和B组的63.93%，3组比较差异具有统计学意义（P<0.001）。C组穿刺针皮下调整次数为1（1，1）次，A组为1（1，2）次，B组为1（1，2）次，3组比较差异具有统计学意义（P<0.001）；C组穿刺时间比A组和B组短，差异具有统计学意义（P<0.001）。3组穿刺时间两两比较，差异具有统计学意义（P<0.017）；而3组穿刺针皮下调整次数和一次穿刺成功率的两两比较结果为C组与A组、C组与B组比较，差异具有统计学意义（P<0.017），A组与B组比较，差异无统计学意义（P>0.017）。3组在误伤神经和穿破血管后壁等并发症方面比较，具有统计学意义（P<0.05），但3组在误伤动脉和血肿发生方面比较，差异无统计意义（P>0.005）。 结论 超声斜轴平面引导PICC穿刺的一次穿刺成功率高于短轴平面引导和长轴平面引导，其穿刺并发症发生率低于短轴平面引导和长轴平面引导，建议PICC置管时使用超声斜轴平面引导穿刺。

关键词: 超声引导, 斜轴平面, 经外周静脉置入中心静脉导管, 护理