Pu Lingling, Zhang Youcheng, Chen Weibing, Meng Hongyan
Department of Operating Room Nursing, Huai'an Maternal and Child Health Care Hospital Affiliated to Yangzhou University, Huai'an, China.
Department of Pediatric Surgery, Huai'an Maternal and Child Health Care Hospital Affiliated to Yangzhou University, Huai'an, China.
Front Pediatr. 2025 Jul 16;13:1638983. doi: 10.3389/fped.2025.1638983. eCollection 2025.
Indwelling venous catheters, including peripheral intravenous catheters (PIVCs), are vital in pediatric care for delivering medications and fluids. However, catheter fractures, though rare (incidence 0%-2.1%), pose serious risks such as pulmonary embolism or cardiac arrhythmias if fragments migrate. While central venous catheter fractures are well-documented, PIVC fractures are underreported despite their widespread use.
This report details two pediatric cases of PIVC fractures. In the first, a 1-day-old female neonate experienced a fractured left axillary catheter. Nursing staff promptly applied compression and immobilization, enabling successful surgical retrieval of a 3.5 cm fragment within 6 h, with no complications. In the second, a 1-year-old male infant had a right temporal vein catheter fracture, unrecognized for 6 days due to initial oversight, resulting in localized inflammation. CT angiography and ultrasound confirmed fragment locations, guiding surgical removal of a 1.5 cm fragment.
These cases highlight the rarity of PIVC fractures and the pivotal role of nursing vigilance in early detection-marked by signs like resistance during flushing or swelling. Timely interventions, such as compression and immobilization, prevent fragment migration and improve outcomes, as seen in the neonate, contrasting with the delayed case. Risk factors include excessive manipulation, improper site preparation (e.g., unshaved hair), and patient agitation. Preventive measures-thorough hair removal, secure fixation, daily inspections, and agitation management-are critical. Nursing education, standardized protocols, and vascular access teams enhance safety.
PIVC fractures in pediatrics, though uncommon, demand nursing alertness and swift action. This series underscores the need for preventive strategies and training to optimize patient safety and outcomes.
留置静脉导管，包括外周静脉导管（PIVC），在儿科护理中对于给药和输液至关重要。然而，导管断裂虽罕见（发生率为0% - 2.1%），但如果碎片迁移，会带来严重风险，如肺栓塞或心律失常。虽然中心静脉导管断裂已有充分记录，但PIVC断裂尽管使用广泛，却报告不足。
本报告详细描述了两例儿科PIVC断裂病例。第一例，一名1日龄女新生儿左腋静脉导管断裂。护理人员立即进行压迫和固定，在6小时内成功通过手术取出3.5厘米的碎片，无并发症。第二例，一名1岁男婴右颞静脉导管断裂，因最初疏忽6天未被发现，导致局部炎症。CT血管造影和超声确定了碎片位置，指导手术取出1.5厘米的碎片。
这些病例凸显了PIVC断裂的罕见性以及护理警觉在早期检测中的关键作用，早期检测以冲洗时阻力或肿胀等迹象为标志。及时干预，如压迫和固定，可防止碎片迁移并改善结果，如新生儿病例所示，与延迟处理的病例形成对比。风险因素包括过度操作、不当的部位准备（如未剃毛发）和患者躁动。预防措施——彻底去除毛发、牢固固定、每日检查和控制躁动——至关重要。护理教育、标准化方案和血管通路团队可提高安全性。
儿科PIVC断裂虽不常见，但需要护理人员保持警觉并迅速采取行动。本系列病例强调了预防策略和培训的必要性，以优化患者安全和治疗结果。
