Nursing care of 44 cases of PICC patients with initial catheter malposition in superior vena cava

doi:10.3761/j.issn.0254-1769.2021.06.017

Abstract

Abstract:

This article summarizes the experience in the identification and treatment of 44 cases of patients with initial superior vena cava malposition occurred during peripherally inserted central catheter （PICC） line catheteriza-tion. The 1 370 patients with PICC catheterization in a tertiary hospital in Hangzhou from January to May 2020,among which 44 cases developed initial superior vena cava malposition with the occurrence rate of 3.2%. We were able to reposition in 43 cases through treatment guided by the B-scan ultrasonography and comprehensive analysis of the shape and amplitude of the P wave in intracavitary electrocardiogram. We observed in 1 case that the catheter was mistakenly delivered malposition to Azygos vein. The success rate is 97.7%.

Key words: Cathetorization, Vena Cava,Superior, Malposition, Nursing Care

摘要：

总结44例PICC置管患者原发性上腔静脉内异位的识别与处理经验。2020年1月—5月杭州市某三级甲等医院1 370例PICC置管患者中,44例发生原发性上腔静脉内异位,发生率为3.2%。结合腔内心电图P波形态、振幅改变以及B超影像综合分析、调整PICC尖端位置,43例复位成功,1例异位于奇静脉,复位成功率为97.7%。

关键词: 导管插入术, 腔静脉,上, 异位, 护理

FENG Feng,XU Hongxia,WANG Ling,XU Zhe,WU Xiaoli,JIANG Li,JIN Aiyun. Nursing care of 44 cases of PICC patients with initial catheter malposition in superior vena cava[J]. Chinese Journal of Nursing, 2021, 56(6): 904-906.

封凤,徐红霞,王铃,胥喆,伍潇丽,蒋莉,金爱云. 44例PICC原发性上腔静脉内异位患者的护理[J]. 中华护理杂志, 2021, 56(6): 904-906.

References 10

[1]	Infusion Nurses Society. Infusion therapy standards of practice[J]. J Infus Nurs, 2016,39(1S):S38.
[2]	张平, 何卫娥. 经外周静脉置入中心静脉导管原发性异位的研究进展[J]. 中华护理杂志, 2015,50(12):1498-1501.
	Zhang P, He WE. Research progress on initial catheter malposition of peripherally inserted central catheters[J]. Chin J Nurs, 2015,50(12):1498-1501.
[3]	Tomaszewski KJ, Ferko N, Hollmann SS, et al. Time and resources of peripherally inserted central catheter insertion procedures:a comparison between blind insertion/chest X-ray and a real time tip navigation and confirmation system[J]. Clinicoecon Outcomes Res, 2017,9:115-125. DOI URL
[4]	Qiu XX, Guo Y, Fan HB, et al. Incidence,risk factors and clinical outcomes of peripherally inserted central catheter spontaneous dislodgment in oncology patients:a prospective cohort study[J]. Int J Nurs Stud, 2014,51(7):955-963. DOI URL
[5]	赵林芳, 曹秀珠, 陈春华, 等. 心内心电图特异性P波形态变化在瓣膜式PICC头端定位中的应用研究[J]. 中华护理杂志, 2015,50(11):1374-1378.
	Zhao LF, Cao XZ, Chen CH, et al. The specific P-waveform of intracavitary ECG method for positioning the tip of valved peripherally inserted central catheters[J]. Chin J Nurs, 2015,50(11):1374-1378.
[6]	李红, 王俊, 沈钎清. 43例疑难重症高龄患者PICC导管尖端异位处理与反思[J]. 西南国防医药, 2019,29(9):961-963.
	Li H, Wang J, Chen QQ. Treatment of PICC catheter tip ectopic in 43 patients with severe and severe senile[J]. Med J Natl Defending Forces Southwest China, 2019,29(9):961-963.
[7]	冯毕龙, 姚述远, 周素军, 等. PICC置管过程中腔内心电图的变化及其对置管操作的指导作用[J]. 中华护理杂志, 2010,45(1):26-28.
	Feng BL, Yao SY, Zhou SJ, et al. The changes and role of intracavitary electrocardiogram in the placement of peripherally inserted central venous catheters[J]. Chin J Nurs, 2010,45(1):26-28.
[8]	盛叶, 赵锐祎, 单燕敏. 导丝部分外撤结合生理盐水推注在预防PICC异位中的应用效果[J]. 中华护理杂志, 2018,53(S1):15-18.
	Sheng Y, Zhao RY, Shan YM. Effect of partial withdrawal of guide wire combined with saline injection in the prevention of PICC catheter malposition[J]. Chin J Nurs, 2018,53(S1):15-18.
[9]	朱玉萍, 徐红霞, 金爱云. 超声引导PICC导管尖端异位的临床判断与处理[J]. 中华护理杂志, 2013,48(11):1021-1022.
	Zhu YP, Xu HX, Jin AY. Clinical judgment and treament of ectopic tip of PICC guided by ultrasound[J]. Chin J Nurs, 2013,48(11):1021-1022.
[10]	刘春丽, 江定飚, 陈传英, 等. 中心静脉血管通路尖端位置移动相关因素研究进展[J]. 中华护理杂志, 2019,54(4):562-567.
	Liu CL, Jiang DB, Chen CY, et al. Research progress on the factors related to the tip movement of central vascular access devices[J]. Chin J Nurs, 2019,54(4):562-567.

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