Loughran S C, Borzatta M
Mission Hospital Regional Medical Center, Mission Viejo, California, USA.
JPEN J Parenter Enteral Nutr. 1995 Mar-Apr;19(2):133-6. doi: 10.1177/0148607195019002133.
The establishment of reliable central venous access is essential in the management of patients with major complications, including pneumothorax and hemopneumothorax. Although peripherally inserted central catheters (PICCs) offer advantages over traditional central venous approaches, PICC lines are associated with a number of insertion and maintenance problems, including clotting and catheter fracture. These complications often result in catheter removal before completion of prescribed therapy.
We conducted a retrospective descriptive study in a convenience sample of 322 consecutively placed PICC lines. Study variables included size of catheter, tip placement, infused solutions, patient diagnosis, and unit of line placement. The rationale for line discontinuance as well as for complication rates is described.
Complication rates for infection and central venous thrombosis were less than 1%. Phlebitis occurred in 9.7% of patients, and catheter fracture occurred in 9.7% of patients. Two distinct clusters of phlebitis, early and late development, were observed. Early phlebitis is attributable to the mechanics of insertion, and late phlebitis is attributable to chemical and patient-specific causes. Catheter fractures were primarily related to tearing of the catheter during insertion or traction on the catheter-hub junction (51.6%).
The majority of published data about PICC lines is in the area of chemotherapy or antibiotic infusion. Our study supports the use of PICC lines in patients receiving a variety of solutions, primarily parenteral nutrition. With an experienced, team approach to catheter placement and maintenance, PICC lines provide reliable, cost-effective venous access and reduce many of the complications of central venous access in a variety of clinical settings.
建立可靠的中心静脉通路对于治疗包括气胸和血气胸在内的重大并发症患者至关重要。尽管经外周静脉穿刺中心静脉导管（PICC）比传统的中心静脉通路具有优势，但PICC导管存在一些插入和维护问题，包括凝血和导管断裂。这些并发症常常导致在规定治疗完成前拔除导管。
我们对322根连续放置的PICC导管进行了一项回顾性描述性研究，样本选取方便。研究变量包括导管尺寸、尖端位置、输注溶液、患者诊断以及置管科室。描述了导管拔除的理由以及并发症发生率。
感染和中心静脉血栓形成的并发症发生率低于1%。9.7%的患者发生了静脉炎，9.7%的患者发生了导管断裂。观察到静脉炎有两个不同的类型，即早期和晚期。早期静脉炎归因于插入操作，晚期静脉炎归因于化学因素和患者个体因素。导管断裂主要与插入过程中导管撕裂或导管-接头连接处的牵拉有关（51.6%）。
关于PICC导管的大多数已发表数据集中在化疗或抗生素输注领域。我们的研究支持在接受多种溶液（主要是肠外营养）的患者中使用PICC导管。通过经验丰富的团队方法进行导管放置和维护，PICC导管在各种临床环境中提供可靠、经济高效的静脉通路，并减少了许多中心静脉通路的并发症。
