心电监护仪在新生儿PICC置管中的定位效果

凌其英; 陈虹; 唐敏; 屈艺; 唐彬秩

doi:10.7499/j.issn.1008-8830.2018.05.005

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中国当代儿科杂志 ›› 2018, Vol. 20 ›› Issue (5) : 363-367. DOI: 10.7499/j.issn.1008-8830.2018.05.005

论著·临床研究

心电监护仪在新生儿PICC置管中的定位效果

凌其英¹, 陈虹¹, 唐敏¹, 屈艺², 唐彬秩¹

作者信息 +

Efficiency of electrocardiogram monitor for positioning the catheter tip in peripherally inserted central catheter placement in neonates

LING Qi-Ying¹, CHEN Hong¹, TANG Min¹, QU Yi², TANG Bin-Zhi¹

Author information +

文章历史 +

摘要

目的探讨心电监护仪辅助定位法在新生儿经外周静脉置入中心静脉导管（PICC）置管中的应用效果。方法选取2015年1月至2017年12月入住新生儿重症监护室（NICU）的经上肢静脉PICC置管患儿160例，按随机数字表法分为观察组和对照组，每组80例。对照组患儿行体表测量+术后X线胸片定位；观察组患儿行体表测量+心电定位+术后X线胸片定位。比较两组患儿一般资料、置管一次性到位率及操作耗时。结果两组患儿性别构成、胎龄、置管日龄、疾病类型及穿刺部位的比较差异无统计学意义（P > 0.05）。观察组置管一次性到位率高于对照组（95% vs 79%； P < 0.05）；观察组PICC置管耗时短于对照组（P < 0.05）。心电监护仪定位技术具有较高的敏感性（97%）和特异性（100%）。结论在新生儿PICC置管过程中，利用心电监护仪辅助判断导管尖端位置，能提高置管一次性到位率，并可节省置管耗时。

Abstract

Objective To study the efficiency of electrocardiogram (ECG) monitor for positioning the catheter tip in the placement of peripherally inserted central catheter (PICC) in neonates. Methods A total of 160 neonates who were admitted to the neonatal intensive care unit (NICU) from January 2015 to December 2017 and underwent the PICC placement via the veins of upper extremity were enrolled. They were randomly divided into an observation group and a control group, with 80 neonates in each group. The neonates in the control group were given body surface measurement and postoperative X-ray localization, while those in the observation group were given body surface measurement, ECG localization, and postoperative X-ray localization. The two groups were compared in terms of general information, onetime success rate of PICC placement, and time spent on PICC placement. Results There were no significant differences between the two groups in sex composition, gestational age, age in days at the time of PICC placement, disease type, and site of puncture (P > 0.05). Compared with the control group, the observation group had a significantly higher one-time success rate of PICC placement (95% vs 79%; P < 0.05) and a significantly shorter time spent on PICC placement (P < 0.05). Localization under an ECG monitor during PICC placement had a sensitivity of 97% and a specificity of 100%. Conclusions During the PICC placement in neonates, the use of ECG monitor to determine the position of catheter tip can improve the one-time success rate of placement and reduce the time spent on placement.

导出引用

凌其英, 陈虹, 唐敏, 屈艺, 唐彬秩. 心电监护仪在新生儿PICC置管中的定位效果[J]. 中国当代儿科杂志. 2018, 20(5): 363-367 https://doi.org/10.7499/j.issn.1008-8830.2018.05.005

LING Qi-Ying, CHEN Hong, TANG Min, QU Yi, TANG Bin-Zhi. Efficiency of electrocardiogram monitor for positioning the catheter tip in peripherally inserted central catheter placement in neonates[J]. Chinese Journal of Contemporary Pediatrics. 2018, 20(5): 363-367 https://doi.org/10.7499/j.issn.1008-8830.2018.05.005

参考文献

[1] Smazal AL, Kavars AB, Carlson SJ, et al. Peripherally inserted central catheters optimize nutrient intake in moderately preterm infants[J]. Pediatr Res, 2016, 80(2):185-189.
[2] Zhou LJ, Xua HZ, Xu MF, et al. An accuracy study of the intracavitary electrocardiogram (IC-ECG) guided peripherally inserted central catheter tip placement among neonates[J]. Open Med (Wars), 2017, 12:125-130.
[3] Wang G, Guo L, Jiang B, et al. Factors influencing intracavitary electrocardiographic P-wave changes during central venous catheter placement[J]. PLoS One, 2015, 10(4):e0124846.
[4] 徐兵, 杨丽娟, 戴明红. 心电监护仪在新生儿PICC导管尖端定位中的应用[J]. 蚌埠医学院学报, 2015, 40(10):1432-1434.
[5] 刘丹妮, 姜红, 刘红梅, 等. PICC定位技术——心房内心电导联确定新生儿PICC导管尖端位置的应用[J]. 中国小儿急救医学, 2015, 22(12):869-871.
[6] 赵京雷, 于新颖, 范玲. 改良心房内心电导联技术在极低出生体质量儿PICC定位中的应用[J]. 中国医科大学学报, 2017, 46(10):954-957.
[7] 吴文理, 陈佩仪, 宋燕伶, 等. 腔内心电图技术用于新生儿PICC置管头端定位的效果观察[J]. 实用医学杂志, 2016, 32(20):3443-3445.
[8] 楼晓芳, 吕华, 马美芳, 等.经外周置入中心静脉导管在危重新生儿中的应用研究[J]. 护士进修杂志, 2007, 22(23):2119-2122.
[9] Rossetti F, Pittiruti M, Lamperti M, et al. The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients:results of an Italian multicenter study[J]. J Vasc Access, 2015, 16(2):137-143.
[10] 姜红, 杨凡, 姜楠, 等. 早产儿上肢外周中心静脉置管术后体位对导管尖端定位的影响:附二例临床分析[J]. 中国小儿急救医学, 2015, 22(1):63-65.
[11] Oliver G, Jones M. ECG or X-ray as the ‘gold standard’ for establishing PICC-tip location?[J].Br J Nurs, 2014, 23(Suppl 19):S10-S16.
[12] Zhou L, Xu H, Liang J, et al. Effectiveness of intracavitary electrocardiogram guidance in peripherally inserted central catheter tip placement in neonates[J]. J Perinat Neonatal Nurs, 2017, 31(4):326-331.
[13] Baldinelli F, Capozzoli G, Pedrazzoli R, et al. Evaluation of the correct position of peripherally inserted central catheters:anatomical landmark vs. electrocardiographic technique[J]. J Vasc Access, 2015, 16(5):394-398.
[14] Lee JH, Bahk JH, Ryu HG, et al. Comparison of the bedside central venous catheter placement techniques:landmark vs electrocardiogram guidance[J]. Br J Anaesth, 2009, 102(5):662-666.