儿科外周置入中心静脉导管置管项目：单中心经验
A nurse-inserted peripherally inserted central catheter program in general pediatrics: a single-center experience.
机构信息
Department of Gastroenterology and Pulmonology, Children's Hospital of Fudan University, Shanghai, China.
Nursing department office, Children's Hospital of Fudan University, Shanghai, China.
出版信息
BMC Pediatr. 2023 Jan 14;23(1):21. doi: 10.1186/s12887-022-03809-x.
BACKGROUND
A peripherally inserted central catheter (PICC) with its tip preferably in the vena cava is essential in caring for patients with chronic conditions in general pediatrics. However, PICC-related complications are concerning and warrant further investigations.
OBJECTIVES
To share the experience of a nurse-inserted peripherally inserted central catheters (PICC) program initiated in a general pediatric department.
METHODS
A retrospective descriptive cohort study based on a prospectively collected database was conducted. All PICCs inserted in the departments of gastroenterology and pulmonology in a tertiary pediatric center from Dec. 2015 to Dec. 2019 were included in the study. Complications and risk factors were analyzed by comparing cases with and without complications. We also reported arm movements in correcting mal-positioned newly-inserted PICCs.
RESULTS
There were 169 cases with a median (IQR) age of 42(6, 108) months who received PICC insertion during a 4-year period. Inflammatory bowel disease was the leading diagnosis accounting for 25.4% (43/169) of all cases. The overall complication rate was 16.4 per 1000 catheter days with malposition and occlusion as the two most common complications. Multivariate models performed by logistic regression demonstrated that young age [p = 0.004, OR (95%CI) = 0.987(0.978, 0.996)] and small PICC diameter (1.9Fr, p = 0.003, OR (95%CI) = 3.936(1.578, 9.818)] were risk factors for PICC complications. Correction of malpositioned catheters was attempted and all succeeded in 9 eligible cases by using arm movements.
CONCLUSION
The nurse-inserted PICC program in general pediatrics is feasible with a low rate of complications. PICC tip malposition and occlusion were two major PICC-related complications when low age and small catheter lumina were major risk factors. Furtherly, arm manipulation potentially is an easy and effective approach for correcting malpositioned newly-inserted PICC catheters.
背景
在普通儿科中，为患有慢性疾病的患者提供最佳尖端位于腔静脉内的外周静脉置入中心导管（PICC）至关重要。但是，与 PICC 相关的并发症令人担忧，需要进一步研究。
目的
分享在普通儿科部门启动的护士插入外周静脉置入中心导管（PICC）计划的经验。
方法
基于前瞻性收集的数据库进行回顾性描述性队列研究。纳入 2015 年 12 月至 2019 年 12 月在一家三级儿科中心的胃肠病学和肺病学部门插入的所有 PICC。通过比较有和无并发症的病例来分析并发症和危险因素。我们还报告了纠正新插入 PICC 错位的手臂运动。
结果
在 4 年期间，有 169 例年龄中位数（IQR）为 42（6，108）个月的患者接受了 PICC 插入。炎症性肠病是最常见的诊断，占所有病例的 25.4%（43/169）。总体并发症发生率为每 1000 导管日 16.4 例，以错位和闭塞为最常见的两种并发症。通过逻辑回归进行的多变量模型表明，年龄较小（p=0.004，OR（95%CI）=0.987（0.978，0.996））和 PICC 直径较小（1.9Fr，p=0.003，OR（95%CI）=3.936（1.578，9.818））是 PICC 并发症的危险因素。通过手臂运动，在 9 例符合条件的患者中尝试并成功纠正了所有错位的导管。
结论
普通儿科中的护士插入 PICC 计划是可行的，并发症发生率低。当低龄和小导管腔是主要危险因素时，PICC 尖端错位和闭塞是两个主要的与 PICC 相关的并发症。进一步，手臂操作可能是一种简单有效的方法，用于纠正新插入的 PICC 导管错位。
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