PICC导管头端定位与并发症处理-2011年10月军总-2003版讲课.ppt

PICC 导管脱落至肺动脉 PICC 导管脱落至心脏，介入方法取出 上肢的内收和外展对PICC影响 Dr.Yang 上肢的内收和外展对PICC影响 目的：研究患者上肢由外展(abduction)变为内收(adduction)时，PICC导管头端的位置是否发生显著的移位 材料与方法：患者上肢成90度外展，在超声导引下，PICC导管从肱静脉或贵要静脉置入。患者前胸放置一根不透x线的标尺，患者在平静呼吸下，摄取数字式正位胸片，患者上肢从外展到内收后，拍摄另一张胸片。利用不透x线标尺和固定的骨性标志，测量导管头端的移位情况 上肢的内收和外展对PICC影响 结果：研究期间，61例患者接受了PICC导管置入，8例不包括在最终的研究之列。33例从右侧上肢，20例从左侧上肢置入PICC。最后，当上肢从外展位置回到内收位置时候，43例向足侧移动，7例向头侧移位，3例没有发生移动。对于那些向足侧移位的患者，平均移动的距离21mm（2－53mm)。右侧上肢比左侧上肢更倾向与移位。但是，没有获得统计学上的支持（p=0.29) 上肢的内收和外展对PICC影响 结论：在置入PICC导管时，当上肢从外展到内收时，导管头端更容易向足侧移位。58％以上的患者PICC导管移位20 mm以上，这种改变需要在最终导管头端定位时候考虑到 上肢的内收和外展对PICC影响 PURPOSE This study examines whether the tip of peripherally inserted central catheters (PICCs) moves significantly with changes in arm position from abduction to adduction. MATERIALS AND METHODS The catheters were inserted in the brachial or basilic veins under ultrasonographic guidance with the upper extremity in a 90° abducted position. A flexible, radiopaque ruler wasthen placed on the anterior chest and digital images were obtained with the arm abducted and adducted in a similar phase of quiet respiration. Catheter tip movement was measured with use of the radiopaque ruler and fixed, bony anatomic landmarks. RESULTS Sixty-one consecutive PICCs were placed and evaluated during the study period (eight patients were excluded). Thirtythree catheters were placed from the right arm and 20 from the left. Overall, 43 moved caudally, seven moved cephalad, and three did not move with movement of the arm from abduction to adduction. Of those that moved caudal, the mean distance of movement was 21 mm (range, 2–53 mm). Right arm PICCs tended to move more than left arm PICCs, but this did not attain significance (P = .29). CONCLUSIONS There is a tendency for the PICC tip to move in a caudal direction with the change in arm position from abduction to adduction; 58% of PICCs moved 20 mm or more. This change in position should be considered during final catheter tip positioning. PICC 导管置入的导向方法 透视导引放置 导管头端能够随时调整到位 性