Cardella J F, Cardella K, Bacci N, Fox P S, Post J H
Department of Radiology, Pennsylvania State University Hospital, Hershey 17033, USA.
J Vasc Interv Radiol. 1996 Jan-Feb;7(1):5-13. doi: 10.1016/s1051-0443(96)70724-8.
To compare bedside insertion of peripherally inserted central catheters (PICCs) by specially-trained nurses with insertion by cardiovascular and interventional radiologists.
Nurses performed 327 bedside insertions with a palpatory, through-the-needle technique in 301 patients. Radiologists performed 542 insertions with a venographic-fluoroscopic direct puncture and sheath technique in 354 patients.
A total of 869 PICCs were inserted in 655 patients. Compared with the first interval of the study (reported previously), bedside technical success improved from 74% to 82.6%, technical success decreased from 98.6% to 98.2%, and the service interval for a given PICC decreased from 72.7 to 28.1 days (because PICCs were used instead of peripheral intravenous lines). Rates of thrombophlebitis and infection remained low. Device failure continued to be a problem. About 25% of patients needed insertion of more than one PICC to complete therapy.
Bedside insertion by specially trained nurses is less costly than insertion by radiologists, but radiologists are needed for difficult initial insertions, PICC salvage, and PICC exchange.
比较经过专门培训的护士在床边插入外周静脉中心导管（PICC）与心血管和介入放射科医生插入PICC的情况。
护士采用触诊式、经针技术对301例患者进行了327次床边插入操作。放射科医生采用静脉造影透视直接穿刺和鞘管技术对354例患者进行了542次插入操作。
655例患者共插入869根PICC。与研究的第一个时间段（先前已报道）相比，床边技术成功率从74%提高到82.6%，总体技术成功率从98.6%降至98.2%，给定PICC的使用间隔从72.7天降至28.1天（因为使用了PICC而非外周静脉输液）。血栓性静脉炎和感染发生率仍然较低。装置故障仍然是一个问题。约25%的患者需要插入不止一根PICC才能完成治疗。
经过专门培训的护士在床边插入PICC的成本低于放射科医生，但对于困难的初次插入、PICC挽救和PICC更换仍需要放射科医生。
