Monsky Wayne L, Garza Armando S, Loh Shaun, Link Daniel P
Department of Radiology, University of California, Davis Medical Center, Sacramento, CA, USA.
J Vasc Access. 2010 Apr-Jun;11(2):100-5. doi: 10.1177/112972981001100203.
The placement of a peripherally inserted central catheter (PICC) for neonatal or pediatric patients may at times be technically challenging. We describe an alternate method of placing a PICC in neonatal and pediatric patients with difficult venous access.
An Amplatz gooseneck snare is advanced from the femoral vein to the basilic vein, as a target for puncture and guidewire positioning, allowing PICC placement. Between 1999 and 2006, 44 PICCs were placed in the manner described. The medical records were reviewed allowing for up to 7 yrs of patient follow-up.
Ninety-five percent of PICCs were successfully placed using the snare technique. Two placements were aborted and two procedural complications occurred. The review revealed no evidence of osteomyelitis, nerve injury, deep venous thrombosis or leg length discrepancy.
This technique offers an alternate method for PICC placement in neonatal and pediatric patients when conventional methods are unsuccessful. The technique avoids the need for intermediate to long-term jugular, subclavian or femoral vein access.
为新生儿或儿科患者放置外周静脉穿刺中心静脉导管（PICC）有时在技术上具有挑战性。我们描述了一种在静脉通路困难的新生儿和儿科患者中放置PICC的替代方法。
将一个Amplatz鹅颈圈套器从股静脉推进至贵要静脉，作为穿刺和导丝定位的目标，从而实现PICC的放置。在1999年至2006年期间，以所述方式放置了44根PICC。对病历进行了回顾，患者随访时间长达7年。
95%的PICC使用圈套器技术成功放置。两次放置中止，发生了两例操作并发症。回顾显示没有骨髓炎、神经损伤、深静脉血栓形成或腿长差异的证据。
当传统方法不成功时，该技术为新生儿和儿科患者的PICC放置提供了一种替代方法。该技术避免了中长期颈静脉、锁骨下静脉或股静脉通路的需求。
