外周静脉穿刺中心静脉导管：早产儿并发症的发生率取决于穿刺部位。
Peripherally inserted central venous catheters: frequency of complications in premature newborn depends on the insertion site.
作者信息
Panagiotounakou P, Antonogeorgos G, Gounari E, Papadakis S, Labadaridis J, Gounaris A K
机构信息
NICU-General Hospital 'Agios Panteleimon', Piraeus, Greece.
Department of Dietetics and Nutritional Science, Athens, Greece.
出版信息
J Perinatol. 2014 Jun;34(6):461-3. doi: 10.1038/jp.2014.36. Epub 2014 Mar 13.
OBJECTIVE
The use of peripherally inserted central venous catheters (PICC lines) has reduced the mortality and morbidity of premature newborns. The usual sites of insertion are the veins in the upper arms but other locations are being used as well.
STUDY DESIGN
To examine whether using the axillary vein as a site of insertion of a PICC line affects the frequency of complications. Our study has a clinical trial design. A total of 62 neonates that had a PICC line inserted were recruited and randomly divided equally in two groups: in Group A (mean birth weight, standard deviation (s.d.)=1353 (142) g), the PICC line was inserted through the axillary vein, and in Group B (birth weight=1308 (112) g), the PICC line was inserted in other sites further from the axillary vein. The outcomes measured were the total PICC line-related complications, the reason for removing the catheter, the number of total attempts until successful insertion and the mean duration of stay of the catheter. The likelihood of having an adverse outcome was assessed with Mantel-Haenszel odds ratio (OR).
RESULTS
Premature neonates with axillary PICC lines were 12 times less likely to have line-related complications (inflammation, blockage, edema, infection) as compared with any other site of insertion (OR= 95%, confidence interval (CI)=0.10 (0.01 to 0.8)) and they were seven times more likely to have the PICC line removed because they achieved full enteral nutrition as compared with the other causes (OR 95%, confidence interval (CI)=10.35 (4.88 to 21.96)). There was no statistical difference between the two groups in the number of attempts until successful PICC line insertion (P=0.667) and the mean duration of stay of the PICC line (P=0.97).
CONCLUSION
The use of the axillary vein as a site of insertion of a PICC line was correlated with significantly less complications in premature newborns as opposed to the other sites of insertion.
目的
使用外周静脉穿刺中心静脉导管（PICC 导管）降低了早产新生儿的死亡率和发病率。通常的穿刺部位是上臂静脉，但也有其他部位被采用。
研究设计
为了研究将腋静脉作为 PICC 导管的穿刺部位是否会影响并发症的发生率。我们的研究采用临床试验设计。共招募了 62 例插入 PICC 导管的新生儿，并将其随机平均分为两组：A 组（平均出生体重，标准差（s.d.）=1353（142）g），PICC 导管经腋静脉插入；B 组（出生体重 =1308（112）g），PICC 导管插入距离腋静脉较远的其他部位。测量的结果包括与 PICC 导管相关的总并发症、拔除导管的原因、成功插入前的总尝试次数以及导管的平均留置时间。采用 Mantel-Haenszel 优势比（OR）评估出现不良结局的可能性。
结果
与其他任何穿刺部位相比，经腋静脉插入 PICC 导管的早产新生儿发生与导管相关并发症（炎症、堵塞、水肿、感染）的可能性低 12 倍（OR = 95%，置信区间（CI）=0.10（0.01 至 0.8）），并且与其他原因相比，因实现完全肠内营养而拔除 PICC 导管的可能性高 7 倍（OR 95%，置信区间（CI）=10.35（4.88 至 21.96））。两组在成功插入 PICC 导管的尝试次数（P = 0.667）和 PICC 导管的平均留置时间（P = 0.97）方面无统计学差异。
结论
与其他穿刺部位相比，将腋静脉作为 PICC 导管的穿刺部位与早产新生儿明显较少的并发症相关。
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