新生儿重症监护中使用的非中心外周静脉穿刺中心静脉导管：并发症发生率及导管使用寿命与尖端位置的关系
Non-central peripherally inserted central catheters in neonatal intensive care: complication rates and longevity of catheters relative to tip position.
作者信息
Goldwasser Bernard, Baia Catalina, Kim Mimi, Taragin Benjamin H, Angert Robert M
机构信息
Department of Radiology, Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway South, Building 1, Room 4N15, Bronx, NY, 10461, USA.
Department of Neonatology, Sheridan Healthcare of Texas, Southlake, TX, USA.
出版信息
Pediatr Radiol. 2017 Nov;47(12):1676-1681. doi: 10.1007/s00247-017-3939-1. Epub 2017 Aug 1.
BACKGROUND
Peripherally inserted central catheters (PICCs) represent a mainstay of intravascular access in the neonatal intensive care setting when long-term vascular access is needed. Ideally, PICCs should be inserted and maintained in a central position with the tip ending in the superior or inferior vena cava. This is not always achievable, and sometimes the tip remains in a peripheral location. Higher complication rates have been reported with non-central PICCs; however these findings have not been confirmed in a solely neonatal series and PICCs with tips in peripheral veins have not been studied.
OBJECTIVE
To compare complication rates and length of catheter duration related to PICC position in neonates.
MATERIALS AND METHODS
We conducted a retrospective analysis of all PICCs inserted in term and preterm infants in a tertiary neonatal intensive care unit between May 2007 and December 2009. A single pediatric radiologist reinterpreted the catheter tip site on initial anteroposterior (AP) chest radiographs and categorized sites as central (superior vena cava, inferior vena cava, brachiocephalic vein), intermediate (subclavian, axillary, common or external iliac veins), or peripheral (veins peripheral to axillary or external iliac veins). We analyzed complication rates and length of catheter duration among the three categories.
RESULTS
We collected data on a total of 176 PICCs. Infants with PICCs in a central location had a significantly lower complication rate (18/97, 19%) than those with the PICC tip in an intermediate (24/64, 38%) or peripheral (9/15, 60%) locations (P=0.0003). Length of catheter duration was noted to be longest with central, intermediate with intermediate, and shortest with peripheral PICC tip locations (17.7±14.8 days for central vs. 11.4±10.7 days for intermediate vs. 5.4±2.5 days for peripheral, P=0.0003).
CONCLUSION
A central location is ideal for the tip of a PICC. When this is not achievable, an intermediate location is preferable to a more peripheral position.
背景
当需要长期血管通路时，外周静脉穿刺中心静脉导管（PICC）是新生儿重症监护环境中血管通路的主要方式。理想情况下，PICC应插入并保持在中心位置，尖端位于上腔或下腔静脉。但这并非总能实现，有时尖端会留在外周位置。据报道，非中心位置的PICC并发症发生率较高；然而，这些发现尚未在单一的新生儿系列研究中得到证实，且尖端位于外周静脉的PICC尚未得到研究。
目的
比较新生儿中与PICC位置相关的并发症发生率和导管留置时间。
材料与方法
我们对2007年5月至2009年12月在一家三级新生儿重症监护病房为足月儿和早产儿插入的所有PICC进行了回顾性分析。由一名儿科放射科医生重新解读初始前后位（AP）胸部X线片上的导管尖端位置，并将位置分类为中心位置（上腔静脉、下腔静脉、头臂静脉）、中间位置（锁骨下静脉、腋静脉、髂总静脉或髂外静脉）或外周位置（腋静脉或髂外静脉以外的静脉）。我们分析了这三类中的并发症发生率和导管留置时间。
结果
我们总共收集了176根PICC的数据。导管尖端位于中心位置的婴儿并发症发生率（18/97，19%）显著低于尖端位于中间位置（24/64，38%）或外周位置（9/15，60%）的婴儿（P=0.0003）。导管留置时间在导管尖端位于中心位置时最长，中间位置次之，外周位置最短（中心位置为17.7±14.8天，中间位置为11.4±10.7天，外周位置为5.4±2.5天，P=0.0003）。
结论
PICC的尖端位于中心位置是理想的。当无法实现时，中间位置比更外周的位置更可取。
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