Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for diff...Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inapp展开更多
目的系统评价植入式静脉输液港(VAP)与经外周静脉穿刺中心静脉置管(PICC)在肿瘤化疗患者中的应用效果。方法检索Co-chrane Library、Joanna Briggs Institute Library、MEDLINE、EMbase、Web of Knowledge、中国生物医学文献服务系统(C...目的系统评价植入式静脉输液港(VAP)与经外周静脉穿刺中心静脉置管(PICC)在肿瘤化疗患者中的应用效果。方法检索Co-chrane Library、Joanna Briggs Institute Library、MEDLINE、EMbase、Web of Knowledge、中国生物医学文献服务系统(CBM)、中国期刊全文数据库(CNKI)、万方数据资源系统及维普期刊资源整合服务平台(VIP)中关于肿瘤化疗患者应用VAP与PICC效果比较的随机对照试验、半随机对照试验、队列研究。由2位研究员按照纳入标准筛选文献、提取资料、评价质量,使用Rev Man 5.3软件对结局指标进行Meta分析与描述。结果共纳入5项随机对照试验、1项半随机对照试验、16项队列研究,共3 278例患者。Meta分析结果显示,VAP血栓发生率、导管相关性感染发生率均低于PICC[RR=0.31,95%CI(0.16,0.59);RR=0.39,95%CI(0.27,0.57)],但误入动脉发生率、气胸发生率均高于PICC[RR=8.70,95%CI(1.61,47.07);RR=6.12,95%CI(1.41,26.65)]。VAP患者生活质量B级以上的发生率较PICC高[RR=1.58,95%CI(1.38,1.82)]。描述性分析结果显示,VAP导管平均留置时间长于PICC。结论 VAP较PICC在延长导管留置时间、降低血栓及导管相关性感染发生率、改善肿瘤患者的生活质量方面具有优势,值得临床推广应用。但VAP置管过程中更应注意穿刺部位的解剖毗邻关系,以减少气胸及误入动脉的发生。展开更多
目的:经外周中心静脉置管(peripherally inserted central catheters,PICC)在恶性肿瘤化疗中的应用越来越广泛,其导管相关血栓的发生率也呈现上升的趋势,显著影响患者的治疗及生存质量。方法:回顾性分析2014年12月至2015年12月就诊于西...目的:经外周中心静脉置管(peripherally inserted central catheters,PICC)在恶性肿瘤化疗中的应用越来越广泛,其导管相关血栓的发生率也呈现上升的趋势,显著影响患者的治疗及生存质量。方法:回顾性分析2014年12月至2015年12月就诊于西安交通大学第一附属医院的286例进行PICC置管的恶性肿瘤患者相关临床资料,并对潜在的危险因素进行最小绝对收缩选择算子(least absolute shrinkage and selection operator,LASSO)回归分析,最终构建列线图模型。结果:286例PICC置管患者中,72例出现导管相关血栓。将研究所纳入的27个潜在的血栓相关危险因素进行LASSO回归分析,结果显示进行外周血管穿刺时是否应用超声引导、患者既往是否接受过经外周静脉化疗、置管期间是否存在其他合并症以及置管时的血浆D-二聚体含量为影响PICC置管患者发生导管相关血栓的危险因素,最终应用上述风险因素构建列线图预测模型,其C-index指数为0.688,拟合曲线和校正后地拟合曲线均位于10%的误差范围内。结论:结合穿刺技术、既往治疗,合并症以及D二聚体等因素所构建的列线图可以较准确的预测PICC相关血栓形成的风险,为临床诊疗工作的开展提供一定的理论基础和数据支持。展开更多
目的探讨循证护理在预防晚期胃癌患者发生经外周静脉植入中心静脉导管(peripherally inserted central catheters,PICC)术后并发症的效果。方法选择2009年1月至2010年3月,在福州总医院肿瘤科住院首次PICC的晚期胃癌患者62例,采用随机数...目的探讨循证护理在预防晚期胃癌患者发生经外周静脉植入中心静脉导管(peripherally inserted central catheters,PICC)术后并发症的效果。方法选择2009年1月至2010年3月,在福州总医院肿瘤科住院首次PICC的晚期胃癌患者62例,采用随机数字表法将其分为观察组(N=38)和对照组(N=24),观察组患者按照循证护理方案进行护理,对照组患者按照常规护理方案进行护理,观察两组患者首次穿刺成功率及PICC置管后第1、2个月时并发症的发生情况。结果两组患者在首次穿刺成功率上的差异无统计学意义(P>0.05)。PICC术后1个月内,两组患者均未出现导管脱落情况,且两组患者在发生静脉炎、皮肤过敏及感染上的差异均无统计学意义(均P>0.05)。术后第2个月,两组患者在发生静脉炎、皮肤过敏、感染上的差异均有统计学意义(均P<0.05)。结论经循证后制定的方案比常规护理方案在降低PICC置管并发症的发生率更为有效,是值得推广的好方法。展开更多
目的观察SiteRite5血管超声引导系统结合微插管鞘技术对血管条件差的患者行上臂中心静脉置管(peripherally inserted central catheters,PICC)的效果。方法选择某院2009年1-11月需行PICC置管的血管条件差的139例患者,按其入院时间的先...目的观察SiteRite5血管超声引导系统结合微插管鞘技术对血管条件差的患者行上臂中心静脉置管(peripherally inserted central catheters,PICC)的效果。方法选择某院2009年1-11月需行PICC置管的血管条件差的139例患者,按其入院时间的先后分为对照组(N=67)与观察组(N=72)。观察组患者采用美国巴德SiteRite5血管超声引导系统评估血管,利用微插管鞘技术行上臂PICC穿刺;对照组患者在普通超声下穿刺血管行PICC。比较两组患者一次穿刺成功率、总穿刺成功率、穿刺并发症的发生率和患者的舒适情况。结果观察组患者一次穿刺成功率为97.2%,总穿刺成功率为100%,术后机械性静脉炎、深静脉血栓、局部感染等并发症的发生率为0,与对照组相比,差异均有统计学意义(均P<0.01)。观察组患者穿刺时置管处疼痛情况与对照组患者相比,差异有统计学意义(P<0.01)。结论采用SiteRite5血管超声引导系统和微插管鞘技术行上臂PICC穿刺,操作更加安全,提高了一次穿刺成功率,有效降低了置管并发症发生率,减少了患者疼痛,有较好的临床价值。展开更多
文摘Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inapp
文摘目的系统评价植入式静脉输液港(VAP)与经外周静脉穿刺中心静脉置管(PICC)在肿瘤化疗患者中的应用效果。方法检索Co-chrane Library、Joanna Briggs Institute Library、MEDLINE、EMbase、Web of Knowledge、中国生物医学文献服务系统(CBM)、中国期刊全文数据库(CNKI)、万方数据资源系统及维普期刊资源整合服务平台(VIP)中关于肿瘤化疗患者应用VAP与PICC效果比较的随机对照试验、半随机对照试验、队列研究。由2位研究员按照纳入标准筛选文献、提取资料、评价质量,使用Rev Man 5.3软件对结局指标进行Meta分析与描述。结果共纳入5项随机对照试验、1项半随机对照试验、16项队列研究,共3 278例患者。Meta分析结果显示,VAP血栓发生率、导管相关性感染发生率均低于PICC[RR=0.31,95%CI(0.16,0.59);RR=0.39,95%CI(0.27,0.57)],但误入动脉发生率、气胸发生率均高于PICC[RR=8.70,95%CI(1.61,47.07);RR=6.12,95%CI(1.41,26.65)]。VAP患者生活质量B级以上的发生率较PICC高[RR=1.58,95%CI(1.38,1.82)]。描述性分析结果显示,VAP导管平均留置时间长于PICC。结论 VAP较PICC在延长导管留置时间、降低血栓及导管相关性感染发生率、改善肿瘤患者的生活质量方面具有优势,值得临床推广应用。但VAP置管过程中更应注意穿刺部位的解剖毗邻关系,以减少气胸及误入动脉的发生。
文摘目的:经外周中心静脉置管(peripherally inserted central catheters,PICC)在恶性肿瘤化疗中的应用越来越广泛,其导管相关血栓的发生率也呈现上升的趋势,显著影响患者的治疗及生存质量。方法:回顾性分析2014年12月至2015年12月就诊于西安交通大学第一附属医院的286例进行PICC置管的恶性肿瘤患者相关临床资料,并对潜在的危险因素进行最小绝对收缩选择算子(least absolute shrinkage and selection operator,LASSO)回归分析,最终构建列线图模型。结果:286例PICC置管患者中,72例出现导管相关血栓。将研究所纳入的27个潜在的血栓相关危险因素进行LASSO回归分析,结果显示进行外周血管穿刺时是否应用超声引导、患者既往是否接受过经外周静脉化疗、置管期间是否存在其他合并症以及置管时的血浆D-二聚体含量为影响PICC置管患者发生导管相关血栓的危险因素,最终应用上述风险因素构建列线图预测模型,其C-index指数为0.688,拟合曲线和校正后地拟合曲线均位于10%的误差范围内。结论:结合穿刺技术、既往治疗,合并症以及D二聚体等因素所构建的列线图可以较准确的预测PICC相关血栓形成的风险,为临床诊疗工作的开展提供一定的理论基础和数据支持。
文摘目的探讨循证护理在预防晚期胃癌患者发生经外周静脉植入中心静脉导管(peripherally inserted central catheters,PICC)术后并发症的效果。方法选择2009年1月至2010年3月,在福州总医院肿瘤科住院首次PICC的晚期胃癌患者62例,采用随机数字表法将其分为观察组(N=38)和对照组(N=24),观察组患者按照循证护理方案进行护理,对照组患者按照常规护理方案进行护理,观察两组患者首次穿刺成功率及PICC置管后第1、2个月时并发症的发生情况。结果两组患者在首次穿刺成功率上的差异无统计学意义(P>0.05)。PICC术后1个月内,两组患者均未出现导管脱落情况,且两组患者在发生静脉炎、皮肤过敏及感染上的差异均无统计学意义(均P>0.05)。术后第2个月,两组患者在发生静脉炎、皮肤过敏、感染上的差异均有统计学意义(均P<0.05)。结论经循证后制定的方案比常规护理方案在降低PICC置管并发症的发生率更为有效,是值得推广的好方法。
文摘目的观察SiteRite5血管超声引导系统结合微插管鞘技术对血管条件差的患者行上臂中心静脉置管(peripherally inserted central catheters,PICC)的效果。方法选择某院2009年1-11月需行PICC置管的血管条件差的139例患者,按其入院时间的先后分为对照组(N=67)与观察组(N=72)。观察组患者采用美国巴德SiteRite5血管超声引导系统评估血管,利用微插管鞘技术行上臂PICC穿刺;对照组患者在普通超声下穿刺血管行PICC。比较两组患者一次穿刺成功率、总穿刺成功率、穿刺并发症的发生率和患者的舒适情况。结果观察组患者一次穿刺成功率为97.2%,总穿刺成功率为100%,术后机械性静脉炎、深静脉血栓、局部感染等并发症的发生率为0,与对照组相比,差异均有统计学意义(均P<0.01)。观察组患者穿刺时置管处疼痛情况与对照组患者相比,差异有统计学意义(P<0.01)。结论采用SiteRite5血管超声引导系统和微插管鞘技术行上臂PICC穿刺,操作更加安全,提高了一次穿刺成功率,有效降低了置管并发症发生率,减少了患者疼痛,有较好的临床价值。
