介入法在难置型外周中心静脉置管中的应用分析

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1、临床放射学杂志2011年第30卷第9期·1373·介入治疗介入法在难置型外周中心静脉置管中的应用分析*赵建新，朱晓黎，孙鸽【摘要】目的回顾分析介入法在难置型外周中心静脉置管(PICC)中的应用价值及安全性。资料与方法2008年1月至2010年11月经PICC专科护士会诊或操作后在床边直视下直接穿刺置入PICC管困难或失败的52例患者，在DSA下运用改良塞丁格技术置入三向瓣膜PICC管。对静脉显影不佳者采用顺行浅静脉造影穿刺靶静脉，对静脉迂曲或变异者采用微导丝导引法置管。结果52例患者中50例成功置入PICC管，置管成功率96．1%。其中46例一次成功置管，4例第一次置入失

2、败，第二次置入成功;全部病例均采用改良塞丁格穿刺技术，21例采用顺行浅静脉造影穿刺法，4例因头静脉注入深静脉角度过锐或腋静脉-锁骨下静脉段狭窄，走行迂曲而使用微导丝导引克服血管迂曲后置管成功，2例因双侧肘正中静脉缺如，头静脉及贵要静脉狭窄、闭塞置管失败。50例置管患者中，平均留管时间73天，2例(4．0%)发生深静脉血栓，其中1例(2．0%)发生致命性肺栓塞;1例(2．0%)发生无菌性静脉炎。结论DSA导引下运用介入方法提高了PICC的置管成功率，减少了床边置管的盲目性。【关键词】外周中心静脉置管介入ApplicationofInterventionalVenousAcces

3、sintheDifficultCasesofPeripherallyInsertedCentralVenousCathetersZHAOJianxin，ZHUXiaoli，SUNGe，etal．DepartmentoftheFirstAffiliatedHospitalofSuzhouUniversity，JiangsuSuzhou215000，P．R．China【Abstract】ObjectiveToretrospectivelyanalyzethesafetyandsuccessrateofinterventionvenousaccessinpatientswithdi

4、fficultinsertionofperipherallyinsertedcentralvenouscatheters(PICC).MaterialsandMethodsFromJanuary2008toNovember2010，fiftytwopatientswereinsertedPICClineusingtheantegradevenographyandpuncturedtargetveinunderthefluoroscopy．AllofthemwereevaluatedasdifficultinsertionofPICClineunderdirectvisionb

5、ytheclinicalPICCnursespecialists＇sconsultationorfailedofinsertionattheblindbedsideinsertions．Microguidewirewereusedinpatientswithvenoustortuosityormutant.Results50in52patientsweresuccessfullyplacedPICClineswitha96．1%successrate．TheaverageperiodofPICCwere73daysin50patients．Amongthem，46patien

6、tsweresuccessfullyinsertedatthefirstprocedureand4wassucceedatthesecondtrial．Improvedseldinger’spuncturesetswereusedinallprocedureswhile21werecombinedwithantegradevenography．Fourpatientsusedthemicroguidewireduringtheprocedure．Complicationsinthisstudyincluded2casesofdeepveinthrombosis(4．0%)，1

7、caseoffatalpulmonaryembolism(2．0%)and1caseofa-septicphlebitis(2．0%).ConclusionApplicationofinterventionalvenousaccessissaftyandcanobviouslyimprovethesuccessrateofPICClineinsertion，itcanalsodecreasetheblindnessofbedsidecatheterization．【Keywords】Peripheral