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X线透视引导下经外周静脉置入中心静脉导管误入胸壁静脉处置一例

超声引导下颈内静脉阻断法预防经外周静脉置入中心静脉导管异位颈内静脉的效果观察

目的　观察超声引导下颈内静脉阻断对预防外周静脉置入中心静脉导管（PICC）时发生颈内静脉异位的效果。 方法　2011年6月－12月将326例PICC置管的患者随机分为观察组和对照组各163例，观察组在送管时运用B型超声引导下阻断颈内静脉；对照组在送管时采用传统的偏头压肩法阻断颈内静脉。置管后通过胸部X线片比较两组患者导管异位率。 结果　观察组发生导管异位2例，对照组发生12例，两组导管异位率差异有统计学意义（χ2=7.537，P=0.006）。 结论　超声引导下颈内静脉阻断法对预防PICC置管时发生导管异位于颈内静脉具有较高的临床意义。

Clinical Efficacy of Comfeel Transparent Paste in Treating Peripheral Inserted Central Cathether-associated Allergic Dermatitis

ObjectiveTo investigate the efficacy and nursing strategy of Comfeel transparent paste in treating peripheral inserted central catheter (PICC)-associated allergic dermatitis. MethodsSixty patients with PICC puncture-associated local allergic dermatitis treated between June 2011 and March 2013 were randomly divided into experimental group and control group with 30 patients in each group. The experimental group was treated with dexamethasone sodium phosphate and Comfeel transparent paste, while the control group was treated with dexamethasone sodium phosphate and 3M transparent dressing. The curative effect was compared between the two methods. ResultsTwelve patients were cured with a curing rate of 40.0% in the control group and 22 patients were cured, and the curing rate was 73.3% in the experimental group. The difference between them was significant (P<0.05). ConclusionTreatment with dexamethasone sodium phosphate and Comfeel transparent paste for PICC-associated allergic dermatitis is quite effective, and the patients felt comfortable with low pains. In addition, it reduces the extubation rate of PICC and improves the care quality.

Investigation of Caregivers' Self-nursing Ability for Children with Peripherally Inserted Central Catheter

ObjectiveTo investigate the knowledge and need of caregivers who perform self-nursing for children with peripherally inserted central catheter (PICC), in order to provide evidence for health education for children in-patients and children discharged from hospital with central venous catheter. MethodsSelf-designed questionnaire was used to investigate 364 caregivers who performed nursing for 162 PICC pediatric in-patients bwtween December 2013 and July 2015. The investigation was carried out on the general information, nursing knowledge, and the acquisition approach of caregivers' existing nursing knowledge. ResultsThe majority of indwelling PICC pediatric caregivers were elderly people, and the common care model was alternate caring carried out by core family members. The children were cared by the elderly in 59 families (36.42%). Twenty-one families had the parents of the children as the major caregivers (12.96%), and alternate caring by parents and the elderly happened in 82 families (50.62%). The total score of the investigation was ranged from 5 to 29 with an average of 11.37±5.68. Nineteen children were discharged with catheter, whose caregivers got a score from 6 to 11, averaging 8.41±4.33. ConclusionThe ratio of self-nursing knowledge in caregivers for pediatric PICC patients is generally low, especially in those caregivers for patients discharged with central venous catheter. Nursing administrators should pay attention to training of the nurses, trying to improve the knowledge of nurses on PICC health education. Different forms of health education should be carried out for different caregivers. Finally, health education model should also be continuously improved to raise the quality of PICC pediatric nursing.

新生儿外周静脉置入中心静脉导管堵管原因分析

目的探讨新生儿经外周静脉置入中心静脉导管（PICC）堵塞原因，寻求措施以减少堵管发生率。 方法对2010年1月－2013年3月97例留置PICC发生管道堵塞的患儿资料进行分析，总结堵管原因并提出护理对策。 结果97例PICC置管患儿中，17例发生堵管，发生率17.5%，堵管后再通成功12例。低年资护士维护者堵管发生较多；夜间堵管较多。 结论针对新生儿PICC堵管的主要原因给予相应护理干预能降低PICC堵管率。

运用改良塞丁格技术经外周静脉置入中心静脉导管临床应用实践

目的　总结运用改良塞丁格技术实现经外周静脉置入中心静脉导管（PICC）的方法与经验。 方法　2009年11月－2012年3月对51例肿瘤患者应用改良塞丁格技术置入PICC，其中10例在超声引导下施行。 结果　50例首次操作置管成功，1例首次置管失败，1周后再次置入成功，无重要并发症。 结论　改良塞丁格技术行PICC 置管具有良好的临床实用性、安全性和可靠性。

Causes, Prevention and Nursing of the Complication in Critically Ill Neurosurgical Patients with Peripherally Inserted Central Catheter

目的　探讨神经外科危重患者经外周静脉置入中心静脉导管（PICC）的常见并发症发生原因，同时总结并发症有效预防措施及护理对策。 方法　纳入2009年9月－2012年9月期间行PICC的190例神经外科重症住院患者，统计并发症发生率，对其原因进行分析，并开展针对性预防和护理。 结果　本组患者PICC置管后有75例发生不同类型并发症，其中置管时并发症17例，包括导管异位8例，送管困难6例，穿刺失败3例，发生率为9%；导管留置期间并发症58例，包括穿刺点渗血、渗液16例，意外拔管12例，静脉炎10例，导管部分脱出9例，导管堵塞7例，导管相关性感染3例，导管相关性静脉血栓1例，发生率为30.5%。根据其发生的不同原因，采取积极的治疗和护理措施，并发症得以治愈，降低了并发症发生率。 结论　规范护理流程，加强临床培训，熟悉和掌握PICC并发症的预防和护理措施，可提高PICC置管、使用的安全性。

弹力绷带在经外周静脉置入中心静脉导管置管中的固定作用及效果

目的　讨论弹力绷带在经外周静脉置入中心静脉导管（PICC）置管中的固定作用及对减少局部渗血、渗液和预防机械性静脉炎的效果。 方法　选择2011年6月－2012年3月在某三甲医院重症医学科（ICU）行PICC置管的100例患者，按穿刺时间先后顺序单号纳入对照组，双号归于试验组,每组各50例。对照组置管后在穿刺局部放置8层无菌方纱，外用 10 cm×12 cm的透明敷料外固定；试验组在对照组的基础上增加弹力绷带固定,分别观察两组患者置管后24、72 h局部渗血、渗液、机械性静脉炎的发生情况。 结果　在24、72 h两个时间点，试验组渗血、渗液发生率少于对照组（χ2=4.57，P＜0.05）；静脉炎发生率在24 h时低于对照组（χ2=4.00，P＜0.05），但在72 h差异无统计学意义。 结论　PICC置管患者使用弹力绷带固定不仅可防止穿刺点渗血渗液，减少机械性静脉炎的发生，而且可减轻护士工作量，值得临床推广使用。

妇科化学治疗患者经外周静脉置入中心静脉导管并发症原因分析

目的 探讨妇科行化学治疗（化疗）患者经外周静脉置入中心静脉导管（peripherally inserted central catheter，PICC）并发症的影响因素。 方法 收集 2015 年 6 月—2016 年 6 月接受化疗并需要置入 PICC 的妇科肿瘤患者。观察患者并发症、拔管原因、导管头端位置、穿刺次数、置管部位、置管时间及拔管时间。 结果 920 例患者成功接受 PICC 置管，其中随访中死亡 25 例，失访 83 例。104 例患者因并发症而提前拔管，其 PICC 留置时间中位数为 62 d，并发症以静脉炎[41.35%（43/104）]和血栓形成[25.96%（27/104）] 最常见。左上肢置管[12.68%（53/418）]与右上肢置管[12.94%（51/394）]的并发症发生率比较差异无统计学意义（χ2=0.013，P>0.05），肘前窝静脉置管[12.95%（72/556）] 与上臂静脉置管[12.50%（32/256）] 的并发症发生率比较差异无统计学意义（χ2=0.032，P>0.05）。导管头端位于非上腔静脉者[28.57%（8/28）] 较位于上腔静脉者[12.24%（96/784）] 并发症发生率更高，多次（≥2次）穿刺者[30.19%（16/53）] 较 1 次穿刺成功者[11.59%（88/759）] 并发症发生率更高，差异均有统计学意义（χ2=5.074、15.338，P<0.05）。 结论 妇科化疗患者 PICC 置管后并发症较常见。但 PICC 仍是一种较安全、经济、能家庭护理的静脉通路。

Implementation and Effects of Continuous Quality Improvement in the Care of Peripherally Inserted Central Catheter

ObjectiveTo evaluate the clinical effects of continuous quality improvement (CQI) in the care of peripherally inserted central catheter (PICC). MethodsWe retrospectively analyzed the clinical data of 40 patients who received PICC treatment in our hospital between January and December 2011, and then we found out the main problems of PICC catheter care, analyzed the related factors for complications of PICC, and formulated corresponding nursing countermeasures. PICC receivers between January and December 2012 were regarded as controls. Then, we compared the complication incidence and satisfaction of patients between the two groups before and after the implementation of CQI. ResultsAfter the implementation of CQI, complication incidence was significantly lower (P<0.05). The satisfaction degree of patients toward caring rose to 87.8%, which was statistically significant (P<0.05). ConclusionThe implementation of CQI is beneficial to reduce complications of PICC treatment, and patients'satisfaction rate is also significantly increased.