摘要
目的探讨预测PICC置入长度的简单准确方法，提高临床PICC尖端最佳位置的到位率。方法选择符合腔内心电图引导PICC置管患者419例，将导管送入穿刺点到右锁骨胸锁面最高点水平距离（A段）后继续送入静脉的长度标记为B段，监护仪Ⅱ导联P波振幅开始增高、达QRS波30％～50％、达到QRS波50％～80％、双向P波的波形分别为P1、P2、P3、P4波，其对应的导管B段长度用B1、B2、B3、B4表示。观察记录P波各形态对应的导管B段的长度。固定导管在P3波并行站立位x线摄片。对只出现P1或P1和P2波患者，经验法送入A段＋7cm。对导管尖端位置及其对应的置入B段长度进行分析。结果92．36％（387／419）的患者P1、P2、P3、P4波形态典型，其对应的B1、B2、B3、B4段中位长度分别为3，5，7，10cm；4组之间导管B段长度比较差异有统计学意义（H=1527．290，P〈0.01）；97．16％（376／387）患者导管尖端位于第三前肋间隙。7．64％（32／419）的患者只出现P1或P1和P2波，x线正位片显示29例导管尖端位于第三前肋间隙，其侧位片示导管在胸骨后方垂直向下。结论PICC预置长度方法是穿刺侧手臂外展与躯体成90°，穿刺点至右锁骨胸锁面最高点水平距离＋7cm。该方法预测置管长度简单准确，导管尖端在最佳位置率高。值得推广应用。
Objective To explore a simple and precise method in predicting the preset length of PICC in order to improve the probability Of reaching the best position in clinical practice. Methods The study investigated 419 patients who were eligible to receive PICC with IEGM guidance. The horizontal distance from the puncture point to the peak of the right collarbone sternoclavieular was reported as A length and the subsequent length into the vein was reported as B length. The P wave amplitude of lead II began to rise and reached to 30% -50% of QRS wave, then 50% -80% of QRS wave. The two-way P wave was reported as P1, P2, P3, P4 wave and its corresponding catheter length was reported as B1, B2, B3, B4. Observing the B length with different P waves and taking X-ray in an erect position at P3 wave. In addition, the A length increased extra 7cm for patients with no P3 wave. The position of the catheter tip and the corresponding B length were the main outcomes. Results Approximately 92.36% （387/419） of the participants had typical P1, P2, P3, P4 wave and the B length were 3 cm, 5 em, 7 cm and 10 em（ H = 1 527. 290, P 〈 0. O1 ）. Approximately 97.16% （376/387） of the patients＇ catheter tips were located in the third intercostal space. Approximately 7.64% （32/419） of the patients had no P3 wave and the X-ray demonstrated that 29 cases＇ catheter tip was vertical downward in the third intercostal space and behind the sternum. Conclusions The method of predicting the preset length of PICC not only is simple and precise but also has a high probability of reaching the best position in clinical practice. That is, the puncture side arm abducts until vertical to the body and the horizontal distance is 7cm from the puncture point to the peak of the right collarbone sternoclavicular.
出处
《中华现代护理杂志》
2016年第20期2940-2943,共4页
Chinese Journal of Modern Nursing
关键词
经外周置入中心静脉导管
腔内心电图
置管长度
方法改良
Peripherally inserted central catheter
Intraeardiac eleetrogram
Catheter length
Modified method
