经外周穿刺中心静脉导管在普通儿科病房中长期输液患儿应用的可行性研究

发布时间：2018-01-12 01:26

本文关键词：经外周穿刺中心静脉导管在普通儿科病房中长期输液患儿应用的可行性研究　出处：《中国循证儿科杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的分析经外周穿刺中心静脉导管(PICC)在普通儿科病房中需中长期输液患儿中应用的必要性及可行性,为普通儿科病房开展PICC置管提供依据。方法纳入2015年12月至2017年2月在复旦大学附属儿科医院呼吸和消化科病房住院的符合PICC适应证且监护人同意PICC置管的连续病例,对置管原因、并发症、导管结局及相关效应指标进行分析。结果 60例PICC置管患儿(其中1例为禁忌证置管)进入本文分析,男38例,女22例,年龄1月4 d至14岁。置管原因包括输注胃肠外营养(PN)45例(75.0%),静脉输液6 d 9例(15.0%),可预计的外周静脉通道无可选择的风险6例(10.0%)。导管实际留置时间(17.2±10.7)d,总留置时间为1 033导管日。22例患儿出现并发症23例次(22.3例次/1 000导管日)。其中,导管异位7例次,导管堵塞6例次,静脉炎3例次,导管破/断裂3例次,误伤动脉2例次,静脉痉挛1例次,静脉回流受阻1例次。经原位治疗后18例次导管继续使用,5例次拔管。导管结局:计划拔管42例(70.0%),非计划拔管5例(8.3%),包括导管破/断裂、导管堵塞无法再通各2例,无法纠正的静脉回流受阻1例,带管转科/出院13例(21.7%)。平均穿刺时间(68.2±43.5)min,PICC置管费用/住院总费用为7%。结论普通儿科病房中长期输液患儿行PICC置管必要且可行,使用中需加强并发症的预防和处理。
[Abstract]:Objective to analyze the necessity and feasibility of the application of central venous catheter (PICCC) through peripheral puncture in children who need medium and long term infusion in general pediatric ward. To provide the basis for PICC catheterization in general pediatrics wards. Methods to include PICC adaptation in respiratory and digestive wards of pediatrics hospital affiliated to Fudan University from December 2015 to February 2017. A continuous case in which the guardian consents to the placement of PICC. Results 60 cases of children with PICC catheterization (including 1 case of contraindications) were analyzed in this paper, 38 cases were male and 22 cases were female. The causes of catheterization included 45 patients with parenteral nutrition (PNN) and 45 patients with parenteral nutrition (PNN), and 9 patients were given intravenous infusion for 6 days (n = 9). The estimated risk of no choice of peripheral venous passage was 10.0 in 6 cases. The actual indwelling time of catheter was 17.2 卤10.7 days. The total indwelling time was 1 033 catheter days. 22 cases had complications 23 times, 22.3 cases per 1 000 ducts, including 7 cases of ectopic ducts and 6 cases of catheter blockage. There were 3 cases of phlebitis, 3 cases of catheter rupture / rupture, 2 cases of artery injury, 1 case of venous spasm and 1 case of obstruction of venous reflux. Catheter outcome: planned extubation was performed in 42 cases (70.0%) and unplanned extubation in 5 cases (8.3%), including rupture / rupture of the catheter and obstruction of the catheter (2 cases). There were 1 case of obstruction of venous reflux which could not be corrected, and 13 cases were transferred to department with tube / discharged from hospital. The average puncture time was 68.2 卤43.5 minutes. The total cost of PICC catheterization / hospitalization was 70.Conclusion PICC catheterization is necessary and feasible for children in general pediatrics ward, and the prevention and treatment of complications should be strengthened.
【作者单位】：复旦大学附属儿科医院;
【分类号】：R473.72
【正文快照】： 经外周穿刺中心静脉导管(PICC)作为中长期输液导管,在儿科领域多用于血液肿瘤科需要化疗的患儿[1]和新生儿科外周静脉穿刺困难、输注胃肠外营养(PN)、输注刺激性药物的患儿[2]。随着儿科专科医院普通病房专科化程度、危重复杂度越来越高,静脉通路的建设日渐重要。但国内由于主

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