Nursing care of a patient with peripherally inserted central catheterization via the upper limb after bilateral innominate vein and superior vena cava artificial vascular replacement

doi:10.3761/j.issn.0254-1769.2026.09.005

Abstract

Abstract:

This case report details the nursing experience of peripherally inserted central catheter（PICC） placement via the left upper limb basilic vein in a patient following bilateral innominate vein and superior vena cava artificial vascular replacement. The key nursing points included：before catheterization，the vascular access was reasonably selected based on the patient’s therapeutic needs. A multidisciplinary team was established to comprehensively assess the feasibility and safety of PICC insertion through the artificial vascular segment and to formulate an individualized catheterization plan. During the procedure，vital signs were closely monitored. A modified catheter advancement technique was adopted，and intracavitary electrocardiography（IC-ECG） was combined with chest X-ray for tip localization to reduce the risks of vascular injury and catheter malposition. During the indwelling period，systematic strategies for bleeding and thrombosis prevention were implemented. The patient was also instructed on home management to improve catheter maintenance quality. Finally，the PICC was successfully placed in a single attempt. The catheter remained in place for 113 days without any related complications.

Key words: Artificial Vascular Replacement, Multidisciplinary Team, Peripherally Inserted Central Catheter, Nursing Care

摘要：

总结1例双侧无名静脉及上腔静脉人工血管置换术后患者经左上肢贵要静脉置入PICC的护理经验。护理要点：置管前，根据患者的治疗需求，合理选择血管通路，并组建多学科团队，全面评估经人工血管段置入PICC的可行性与安全性，制订个体化置管方案；置管过程中，加强生命体征监测，采用改良送管方法、联合使用心腔内电图与胸部X线定位技术，降低血管损伤与导管异位的发生风险；留置期间，实施系统化的出血与血栓预防策略，并指导患者进行居家管理，提高导管维护质量。该例患者一次性成功置入PICC，导管共留置113 d，未发生相关并发症。

关键词: 人工血管置换, 多学科团队, 经外周静脉置入中心静脉导管, 护理

HE Juan, ZHAO Leilei, YE Guanjun, YU Yanfen, FU Xiaojun, ZHOU Qin. Nursing care of a patient with peripherally inserted central catheterization via the upper limb after bilateral innominate vein and superior vena cava artificial vascular replacement[J]. Chinese Journal of Nursing, 2026, 61(9): 1187-1191.

何娟, 赵蕾蕾, 叶冠军, 余艳芬, 傅晓君, 周琴. 1例双侧无名静脉及上腔静脉人工血管置换术后患者经上肢置入PICC的护理[J]. 中华护理杂志, 2026, 61(9): 1187-1191.

References 12

[12]	Sun H, Wang L, Nie SX. The ECG method for positioning the tip of peripherally inserted central catheter:results of a multicenter study[J]. Chin J Nurs, 2017, 52(8):916-920.
[13]	周玉洁, 李蓉梅, 袁玲, 等. 三种扩皮送鞘法在肿瘤患者PICC置管中的应用效果观察[J]. 护理学杂志, 2020, 35(6):43-45.
	Zhou YJ, Li RM, Yuan L, et al. The effect of application of three skin-expansion methods to cancer patients for advancement of introducer sheath in PICC insertion[J]. J Nurs Sci, 2020, 35(6):43-45.
[14]	李彩云, 柴长梅, 葛军, 等. 弹力绷带加压止血在预防PICC置管后穿刺点出血中的应用效果研究[J]. 全科护理, 2019, 17(24):3040-3042.
	Li CY, Chai CM, Ge J, et al. Study on the application effect of pressure hemostasis with elastic bandage in preventing bleeding at puncture point after PICC catheterization[J]. Chin Gen Pract Nurs, 2019, 17(24):3040-3042.
[15]	杜瑶, 陈大宇, 彭进, 等. 华法林预防肝移植术后人工血管重建的下腔静脉血栓有效性及安全性研究[J]. 药学与临床研究, 2022, 30(2):143-146,165.
	Du Y, Chen DY, Peng J, et al. Efficacy and safety of warfarin in preventing artificial vascular reconstructed inferior vena cava thrombosis after liver transplantation[J]. Pharm Clin Res, 2022, 30(2):143-146,165.
[16]	丁月华, 许俊芳, 殷荣华. 规律握球运动对肿瘤患者PICC置管腋静脉血液流速及并发症的影响[J]. 护理学杂志, 2020, 35(6):15-17.
	Ding YH, Xu JF, Yin RH. Influence of regular ball squeeze exercise on auxiliary venous flow velocity and complications in patients after PICC placement[J]. J Nurs Sci, 2020, 35(6):15-17.
[17]	代凤, 苏迅, 乔爱珍, 等. 不同握球时间对PICC置管患者腋静脉血液流速的影响[J]. 中华护理杂志, 2019, 54(5):721-724.
	Dai F, Su X, Qiao AZ, et al. Impact of ball holding duration on upper hemodynamics of axillary vein in patients with PICCs[J]. Chin J Nurs, 2019, 54(5):721-724.
[1]	中国医师协会肿瘤多学科诊疗专业委员会. 中国胸腺上皮肿瘤临床诊疗指南(2021版)[J]. 中华肿瘤杂志, 2021, 43(4):395-404.
	Multidisciplinary Diagnosis and Treatment Professional Committee of Tumor,Chinese Medical Doctor Association. Chinese guideline for clinical diagnosis and treatment of thymic epithelial tumors(2021 edition)[J]. Chin J Oncol, 2021, 43(4):395-404.
[2]	吴鑫, 侯磊, 许锋. 小口径人工血管的研究现状及展望[J]. 医用生物力学, 2024, 39(2):355-360.
	Wu X, Hou L, Xu F. Research progress and prospect of small-caliber artificial blood vessels[J]. J Med Biomech, 2024, 39(2):355-360.
[3]	国家健康委员会. 静脉治疗护理技术操作标准[S/OL]. (2024-02-01)[2026-01-22]. https://zs.kaipuyun.cn/stoken=&siteCode=bm24000006&searchWord=%E9%9D%99%E8%84%89%E6%B2%BB%E7%96%97%E6%8A%A4%E7%90%86%E6%8A%80%E6%9C%AF%E6%93%8D%E4%BD%9C%E6%A0%87%E5%87%86&button=.
	National Health Commission. Standard for intravenous therapy nursing technical operations[S/OL]. (2024-02-01)[2026-01-22]. https://zs.kaipuyun.cn/stoken=&siteCode=bm24000006&searchWord=%E9%9D%99%E8%84%89%E6%B2%BB%E7%96%97%E6%8A%A4%E7%90%86%E6%8A%80%E6%9C%AF%E6%93%8D%E4%BD%9C%E6%A0%87%E5%87%86&button=.
[4]	徐红霞, 封凤, 胥喆, 等. 1例上腔静脉置换患者经上肢PICC置管的护理[J]. 中华护理杂志, 2020, 55(1):127-130.
	Xu HX, Feng F, Xu Z, et al. Nursing care of a patient with superior vena cava replacement undergoing PICC catheterization through upper limbs[J]. Chin J Nurs, 2020, 55(1):127-130.
[5]	Chen HX, Zhang XX, Wang H, et al. Complications of upper extremity versus lower extremity placed peripherally inserted central catheters in neonatal intensive care units:a meta-analysis[J]. Intensive Crit Care Nurs, 2020, 56:102753.
[6]	徐溶, 王豪杰, 耿梦想, 等. 多孔聚四氟乙烯人工血管制备及功能化改性研究的进展[J]. 中国组织工程研究, 2024, 28(5):759-765.
	Xu R, Wang HJ, Geng MX, et al. Research advance in preparation and functional modification of porous polytetrafluoroethylene artificial blood vessels[J]. Chin J Tissue Eng Res, 2024, 28(5):759-765.
[7]	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.
[8]	董俊秀, 柯栋, 胡良柱, 等. 基于CT评估解剖压迫性左头臂静脉狭窄的解剖学因素及临床意义[J]. 中华解剖与临床杂志, 2021, 26(6):616-622.
	Dong JX, Ke D, Hu LZ, et al. The anatomic factors and the clinical significance of left innominate vein stenosis due to anatomic compression on CT[J]. Chin J Anat Clin, 2021, 26(6):616-622.
[9]	邵乐文, 胡晓蓉, 金爱云, 等. 113例肿瘤患者PICC置管过程中导管异位的识别与复位[J]. 中华护理杂志, 2018, 53(4):454-456.
	Shao LW, Hu XR, Jin AY, et al. Identification and repositioning of catheter malposition during PICC insertion in 113 cancer patients[J]. Chin J Nurs, 2018, 53(4):454-456.
[10]	中华护理学会. PICC尖端心腔内电图定位技术:T/CNAS 11—2020[S/OL]. (2021-02-01)[2026-01-22]. https://hltb.kxj.org.cn/index/tuanti/standard.html?team_standard_id=11.
	Chinese Nursing Association. PICC tip intracavitary electrocardiogram localization technology:T/CNAS 11—2020[S/OL]. (2021-02-01)[2026-01-22]. https://hltb.kxj.org.cn/index/tuanti/standard.html?team_standard_id=11.
[11]	Chen Y, Luo SL, Wang J, et al. The accuracy and safety of using the electrocardiogram positioning technique in localizing the peripherally inserted central catheter tip position:a systematic review and meta-analysis[J]. Nurs Open, 2022, 9(3):1556-1563.
[12]	孙红, 王蕾, 聂圣肖. 心电图引导PICC尖端定位的多中心研究[J]. 中华护理杂志, 2017, 52(8):916-920.