Zhong Haiyan, Wang Mengze, Gui Yang, Yang Lei, Zhao Qianhao
Department of Neurosurgery, Kunming Children's Hospital, Kunming, China.
Front Surg. 2023 Jan 9;9:1056664. doi: 10.3389/fsurg.2022.1056664. eCollection 2022.
As a substitute for a scalp needle, the intravenous indwelling needle is easy to operate and easy to use. it is not only conducive to the rescue of critically ill children, improves nursing efficiency, but also avoids pain caused by repeated venipuncture. However, cases of indwelling needle catheter breaking and remaining in scalp vessels are rarely reported. This study collected 12 cases of scalp vein indwelling needle rupture and retention in scalp vessels in our center from January 2012 to January 2022. It was found that there were 7 males and 5 females, with an average age of 19.17 ± 8.96 months. The average length of the severed end was 15.00 ± 1.54 mm. In 8 cases, the catheter was broken during the haircut, and in 2 cases, the wall structure was damaged and broken after repeated folding of the catheter. In 2 cases, the children did not cooperate during extubation, the head twisted violently and the catheter was broken.5 cases tried to extract it by manipulation and hemostatic forceps, of which 4 cases were successful, and 1 case was successfully removed after the completion of three-dimensional computerized tomography (3D-CT) imaging positioning. The remaining 7 cases were removed by operation, and the success rate of the first operation was 100% in 4 cases who chose 3D-CT. The other 3 cases chose ordinary CT plain scan positioning, the success rate of the first operation was 66.6%, and one child was successfully removed after the second operation after the failure of the operation plus 3D-CT scan positioning. All the children were in stable condition after the operation and were discharged smoothly. When the broken catheter is relatively shallow and the scalp is not completely closed, we could choose the preliminary positioning of B-ultrasound or ordinary CT, and then try to remove it by manual squeezing combined with hemostatic forceps. However B-ultrasound and ordinary CT could not meet the requirements of accurate location, 3D-CT has a very important localization value for surgery, which can improve the success rate and help successfully remove the ruptured catheter.
静脉留置针作为头皮针的替代产品，操作简便、使用方便。它不仅有利于危重症患儿的抢救，提高护理效率，还能避免反复静脉穿刺带来的疼痛。然而，留置针导管断裂并残留于头皮血管的病例鲜有报道。本研究收集了2012年1月至2022年1月期间我院中心12例头皮静脉留置针断裂并残留于头皮血管的病例。发现男性7例，女性5例，平均年龄19.17±8.96个月。断端平均长度为15.00±1.54 mm。其中8例在理发时导管断裂，2例因导管反复折叠导致管壁结构受损而断裂。2例患儿在拔管时不配合，头部剧烈扭动导致导管断裂。5例尝试通过手法和止血钳取出，其中4例成功，1例在完成三维计算机断层扫描（3D-CT）成像定位后成功取出。其余7例通过手术取出，4例选择3D-CT的患儿首次手术成功率为100%。另外3例选择普通CT平扫定位，首次手术成功率为66.6%，1例患儿在手术失败后经3D-CT扫描定位后二次手术成功取出。所有患儿术后病情稳定，顺利出院。当断裂导管位置较浅且头皮未完全闭合时，可先选择B超或普通CT初步定位，然后尝试通过手法挤压结合止血钳取出。然而B超和普通CT无法满足精确定位的要求，3D-CT对手术具有非常重要的定位价值，可提高成功率并有助于成功取出断裂的导管。
