Jeon Eui-Yong, Cho Young K, Yoon Dae Y, Hwang Jin Ho
Department of Radiology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah - UAE.
Department of Radiology, Hallym University College of Medicine, Kangdong Seong-Sim Hospital, Seoul - Korea.
J Vasc Access. 2016 May 7;17(3):249-55. doi: 10.5301/jva.5000506. Epub 2015 Feb 5.
We investigated which arm and vein led to the most successful outcomes during non-fluoroscopic peripherallyinserted central catheter (PICC) insertion.
A total of 743 cases from July 2012 to March 2014 were retrospectively reviewed. We also analyzed the following: 1) accessed arm (right or left), 2) accessed vein (cephalic, basilic, or brachial), 3) primary and secondary success rates, 4) causes of failure (location of obstacles), and 5) problemsolving methods for catheter repositioning.
The primary success rate was 46.3% (344/743) with 49.4% (123/249) on the right arm and 44.7% (273/494) on the left arm. The secondary success rate was 53.7% (399/743) with 50.6% (126/249) on the right arm and 55.3% (273/494) on the left arm. The causes of failure were 100% (43/43) for the left cephalic vein, 61.5% (8/13) for the right cephalic vein, 50.6% (43/85) for the left brachial vein, and 51.1% (23/45) for the right brachial vein, 51.1% (187/366) for the left basilic vein, and 49.7% (95/191) for the right basilic vein. The failure rate through the left cephalic vein was significantly higher than that for other veins. The most common locations of obstacles were the subclavian vein (28.8%, 115/399), axillary vein (24.3%, 97/399), and brachiocephalic vein (19.3%, 77/399). The most common problem-solving methods were with guidewire assistance (74.7%, 298/399), venographic guidance (13.8%, 55/399), and fluoroscopic guidance (11.5%, 46/399).
Right-arm access through the basilic or brachial vein may be more appropriate for successful nonfluoroscopic PICC insertion compared with the access through the left arm and the cephalic vein.
我们研究了在非荧光透视下经外周静脉穿刺中心静脉置管（PICC）过程中，哪侧手臂及静脉能带来最成功的结果。
回顾性分析了2012年7月至2014年3月期间的743例病例。我们还分析了以下内容：1）穿刺的手臂（右侧或左侧）；2）穿刺的静脉（头静脉、贵要静脉或肱静脉）；3）一次成功率和二次成功率；4）失败原因（障碍物位置）；5）导管重新定位的解决方法。
一次成功率为46.3%（344/743），右侧手臂为49.4%（123/249），左侧手臂为44.7%（273/494）。二次成功率为53.7%（399/743），右侧手臂为50.6%（126/249），左侧手臂为55.3%（273/494）。左侧头静脉的失败率为100%（43/43），右侧头静脉为61.5%（8/13），左侧肱静脉为50.6%（43/85），右侧肱静脉为51.1%（23/45），左侧贵要静脉为51.1%（187/366），右侧贵要静脉为49.7%（95/191）。经左侧头静脉的失败率显著高于其他静脉。最常见的障碍物位置是锁骨下静脉（28.8%，115/399）、腋静脉（24.3%，97/399）和头臂静脉（19.3%，77/399）。最常见的解决方法是导丝辅助（74.7%，298/399）、静脉造影引导（13.8%，55/399）和荧光透视引导（11.5%，46/399）。
与通过左侧手臂和头静脉穿刺相比，通过右侧手臂的贵要静脉或肱静脉进行非荧光透视下PICC穿刺可能更合适。
