Wang Dan, Niu Fangfang, Gao Huining, Yu Mingkai, Li Yuhang, Xu Liqun, Cao Huizhi, Wang Lili, Liu Jinhua, Ding Xue, Wang Ying, Yu Chen, Li Huiyan, Yu Kaijiang, Wang Changsong
Anesthesiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
Critical Care Medicine, Tumor Hospital of Harbin Medical University, Harbin, China.
BMJ Open. 2019 Oct 31;9(10):e027278. doi: 10.1136/bmjopen-2018-027278.
The aim of this study was to identify the prevalence of peripherally inserted central catheter (PICC) malposition and the influence of guide wire removal on tip location in PICCs and determine whether related factors, including age, sex, side of insertion and brand of catheter, influence the PICC tip location.
Single-centre research institute in China recruiting patients from the hospital.
A total of 837 adult patients with inserted PICCs were recruited from October 2016 to May 2017.
This was a cross-sectional study aiming to identify the prevalence of PICC malposition and the influence of guide wire removal on tip location in PICCs. A linear regression model and a variance of factorial design analysis were performed. The PICC tip location was documented on a postinsertion chest X-ray. Multivariable analyses were performed based on the following related factors: age, sex, side of insertion and brand of catheter.
The tip location moved a mean of 17.4 mm among the 837 included patients. The prevalence of PICC malposition was 83.6% (700/837), while 16.4% (137/837) of PICCs remained in correct location. The mean movement caused by guide wire removal without an adjusted tail end was (-1.95±26.90) mm. The difference between tail end adjustment movement and actual tip position movement in each PICC was (33.0±17.1) mm in type C, which was significantly higher than the findings for type A (12.8±13.3) mm and type B (12.9±12.7) mm.
PICC malposition is a frequent event. Different catheter brands were associated with different ranges of movement in tip location after guide wire removal. The age and sex of the patients and the insertion side did not influence the extent of movement.
本研究旨在确定经外周静脉穿刺中心静脉导管（PICC）位置不当的发生率，以及拔除导丝对PICC尖端位置的影响，并确定包括年龄、性别、穿刺侧和导管品牌在内的相关因素是否会影响PICC尖端位置。
中国一家单中心研究机构，从医院招募患者。
2016年10月至2017年5月共招募了837例插入PICC的成年患者。
这是一项横断面研究，旨在确定PICC位置不当的发生率以及拔除导丝对PICC尖端位置的影响。进行了线性回归模型和析因设计方差分析。PICC尖端位置在插入后的胸部X光片上记录。基于以下相关因素进行多变量分析：年龄、性别、穿刺侧和导管品牌。
在纳入的837例患者中，尖端位置平均移动了17.4毫米。PICC位置不当的发生率为83.6%（700/837），而16.4%（137/837）的PICC位置正确。未调整尾端的导丝拔除引起的平均移动为（-1.95±26.90）毫米。C型PICC中，每个PICC的尾端调整移动与实际尖端位置移动之间的差异为（33.0±17.1）毫米，显著高于A型（12.8±13.3）毫米和B型（12.9±12.7）毫米的结果。
PICC位置不当是常见情况。不同的导管品牌与拔除导丝后尖端位置的不同移动范围相关。患者的年龄、性别和穿刺侧不影响移动程度。
