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

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.%Objective To examine the use of peripherally inserted central catheters(PICCs)in a tertiary pediatric setting.Methods The recruited patients with PICC line for intermediate-to long-term fluid infusion were collected from the Pulmonology and Gastroenterology Departments of Children's Hospital of Fudan University from Dec.2015 to Feb.2017.Data of indications,complications,efficacy of PICC and reasons for catheter removal were collected and analyzed.Results 60 cases with PICC insertions(1 case was a child with PICC contraindication)were included in the analysis.There were 38 male cases and 22 female cases with age of 34 days to 14 years.The indications for PICC insertion included long-term parenteral nutrition(45/60,75.0%),expected long-term(>6 days)intravenous medication infusion(9/60,15.0％)and insufficiency of peripheral venous access(6/60,10％).Catheter indwelling time was(17.2±10.7)d,while total indwelling time was 1 033 catheter days.Complications occurred in 22 cases(22.3/1000 catheter days),including 7 malposition,6 catheter blockage,3 phlebitis,3 catheter breakage,2 arterial puncture,1 vasospasm,1 case of failing venous reflux.42 cases(70％)were planned on catheter removal,while 5 cases(8.3％)were unplanned on catheter removal,13 cases(21.7％)were transferred to the other ward or discharged with the catheter.The average PICC procedure time was(68.2±43.5)min,and catheter-related expenditure/hospitalization expenditure ratio was 0.07.Conclusion As an applicable venous access,PICCs provide convenience in patients requiring intermediate-to long-term intravenous infusion.Meticulous post procedure care is important for minimizing unexpected line removal and catheter related complications.