Abstract:Objective To explore the effect of early transthoracic wall ultrasonography in neonatal peripherally inserted central catheter (PICC) catheterization. Methods A total of 66 neonates who underwent PICC catheterization in Jieyang People′s Hospital of Guangdong Province from June 2018 to May 2019 were enrolled. According to the random number table method, they were divided into experimental group (33 cases) and control group (33 cases). After the conventional puncture was placed in the control group, the X-ray film was positioned at the tip position; after the B-ultrasound of the chest wall was placed in the experimental group, the conventional puncture was performed, and the X-ray film was positioned at the tip position. The catheterization time, catheterization completion and complications were compared between the two groups. Results The operation time of PICC in the experimental group was shorter than that in the control group, and the difference was statistically significant (P < 0.05). The PICC catheterization in the experimental group was better than the control group, and the difference was statistically significant (P < 0.05). The incidence of complications after PICC catheterization was lower than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion The application of B-ultrasound positioning in the chest wall is effective in the placement of neonatal PICC, and its complication rate is lower but the safety is stronger.
[1] 吴凯平,朱青.经B超引导心电定位PICC置管护理90例分析[J].中西医结合心血管病杂志:电子版,2019(14):160-160.
[2] Bernasconi F,Zanaboni C,Dato A,et al. Atypical use of PICC in infants and small children:a unicentric experience [J]. J Vasc Access,2017,18(6):535-539.
[3] Johnston AJ,Bishop SM,Martin L,et al. Defining peripherally inserted central catheter tip position and an evaluation of insertions in one unit [J]. Anaesthesia,2013, 68(5):484-491.
[4] 刘春丽,刘腊根,陈传英,等.PICC置管实时尖端定位方法的现状及进展[J].护理学报,2017,24(9):39-42.
[5] Pittiruti M,Hamilton H,Biffi R,et al. ESPEN Guidelines on Parenteral Nutrition:central venous catheters (access,care,diagnosis and therapy of complications) [J]. Clinical Nutrition,2009,28(4):365-377.
[6] Bidgood C. Improving the patient experience with real-time PICC placement confirmation [J]. Brit J Nurs,2016, 25(10):539-543.
[7] 郭玲,秦英,王国蓉,等.B超引导下经胸壁段腋静脉与PICC、颈内静脉置管准确性与安全性比较研究[J].四川医学,2019,40(2):53-56.
[8] 张娟,刘萍,苏美华,等.乳腺癌患者PICC置管异位的预防与处理[J].中国临床研究,2019,32(2):148-150.
[9] 王辉,丁玲,胡秀娟,等.超声引导下肘上PICC置管术在肿瘤患者中的临床应用[J].护理实践与研究,2019,16(8):162-163.
[10] 郑学风,李银玲,申秋霞,等.PICC致机械性静脉炎的原因及护理对策[J].当代护士:上旬刊,2019,26(2):159-161.
[11] Barton A. Confirming PICC tip position during insertion with real-time information [J]. Brit J Nurs,2016,25 Suppl 2:S17-S21.
[12] Subramanian S,Moe DC,Vo JN. Ultrasound-guided tunneled lower extremity peripherally inserted central catheter placement in infants [J]. J Vasc Interv Radiol,2013,24(12):1910-1913.
[13] 张瑜.超声引导下外周中心静脉置管导管尖端位置判断方法的临床研究[D].锦州:锦州医科大学,2016.
[14] Tauzin L,Sigur N,Joubert C,et al. Echocardiography allows more accurate placement of peripherally inserted central catheters in low birthweight infants [J]. Acta Paediatr,2013,102(7):703-706.
[15] Jain A,Mcnamara PJ,Ng E,et al. The use of targeted neonatal echocardiography to confirm placement of peripherally inserted central catheters in neonates [J]. Am J Perinat,2012,29(2):101-106.
[16] 冯小芳,张丽萍,胡卫洁,等.一例早产儿下肢静脉机化物形成致PICC拔管困难的处理体会[J].中国实用护理杂志,2019,35(18):1413-1416.
[17] 王亚丽,张丽军,成志勇,等.儿童与成人急性白血病患者外周静脉留置中心静脉导管置管并发症的差异[J].临床与病理杂志,2017,37(2):241-244.
[18] Van Den Hoogen A,Brouwer MJ,Gerards LJ,et al. Removal of percutaneously inserted central venous catheters in neonates is associated with the occurrence of sepsis [J]. Acta Paediatr,2008,97(9):1250-1252.
[19] Mollee P,Jones M,Stackelroth J,et al. Catheter-associated bloodstream infection incidence and risk factors in adults with cancer:a prospective cohort study [J]. J Hosp Infect,2011,78(1):26-30.
[20] Barrier A,Williams DJ,Connelly M,et al. Frequency of peripherally inserted central catheter complications in children [J]. J Pediat Inf Dis Soc,2012,31(5):519-521.
[21] 谢巧庆,迟春昕.新生儿经外周静脉置入中心静脉导管相关并发症分析及护理对策[J].中华医院感染学杂志,2013,23(3):583-584.
[22] 林颖,林琴,钱小芳,等.极低出生体重早产儿经不同静脉途径留置中心静脉导管的应用评价[J].中国新生儿科杂志,2013,28(1):42-44.
[23] Levy I,Bendet M,Samra Z,et al. Infectious complications of peripherally inserted central venous catheters in children [J]. Pediat Inf Dis J,2010,29(5):426-429.