中西医结合护理 (Jul 2023)
Influential factors and countermeasures of the difficulty in inserting peripheral inserted central venous catheter among elderly patients (高龄患者经外周静脉置入中心静脉导管时送管困难影响因素及对策)
Abstract
Objective To investigate the influencing factors and countermeasures of the difficulty in inserting peripheral inserted central venous catheter(PICC) among elderly patients. Methods A total of 172 patients over 80 years old who received PICC catheterization from January 2020 to January 2022 were selected. Selection of catheter access and abnormal conditions of catheter placement were analyzed. The rate of difficulty in inserting PICC was observed and compared between patients with different body mass index (BMI), selection of catheter access, history of central venous catheter placement and limb joint contractures. Results Patients with BMI < 18. 5 kg/m2 had a higher incidence of difficulty in inserting PICC compared with BMI ≥ 18. 5 kg/m2 (P＜0. 01). The incidence of difficulty in inserting PICC via cephalic vein was significantly higher than that via basilic vein and brachial vein (P＜0. 01). Patients with multiple history of central vein catheterization had a significantly higher incidence of difficulty in inserting PICC than those without history of central vein catheterization (P＜0. 01). The rate of difficulty in inserting PICC in patients with limb joint contractures was significantly higher than that in patients with limb joint abduction (P< 0. 05). Conclusion There is a relatively high risk of difficulty in inserting PICC among elderly patients with BMI lower than 18. 5 kg/m2, catheter placed via the cephalic vein, multiple history of central vein catheterization and limb joint contractures. It is required to adequately evaluate patients’ condition before catheterization and select the catheter access reasonably. Operators should be familiar with catheterization skills and able to improve the success rate of catheterization. (目的 探讨高龄患者经外周静脉置入中心静脉导管(PICC)时送管困难的影响因素及对策。方法 回顾性分析2020年1月—2022年1月医院收治的行PICC置管的172例80岁以上高龄患者的临床资料, 统计患者置管静脉选择和置管过程中发生的异常情况, 总结处理方法。比较分析患者不同体质指数(BMI)、置管静脉选择、既往中心静脉置管史、肢体挛缩等情况下送管不畅发生率。结果 BMI＜18. 5 kg/m2的患者送管不畅发生率更高(P＜0. 05); 经头静脉置管患者送管不畅发生率高于经贵要静脉及肱静脉置管(P＜0. 01); 有多次中心静脉置管史患者送管不畅发生率较无置管史者增高(P＜0. 01); 穿刺肢体挛缩患者送管不畅发生率高于穿刺肢体充分外展患者(P＜0. 05)。结论 高龄患者BMI＜18. 5 kg/m2、经头静脉置管、有多次中心静脉置管史、肢体挛缩等情况下, 置管过程中出现送管不畅风险较高。在置管前应充分评估患者, 合理选择静脉, 同时操作者熟练掌握送管技巧, 提高置管成功率。)
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