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Objective:To early identify and manage secondary malposition of peripherally inserted central catheter (PICC), and to reduce other PICC related complications.Methods:A total of 8 509 patients were included form January 2017 to December 2018 in intravenous therapy department in the Second Affiliated Hospital of Medical College of Zhejiang University. PICC was implanted and the original tip location was in the superior vena cava (SVC). The function and complications of the catheter were evaluated during the indwelling process. X-ray was taken for every abnormal patient to confirm the route and tip position of the catheter. Tip malposition were adjusted by external manipulation (pulling out part of the catheter, changing body position, external percussion, rapid flushing with 0.9% sodium chloride) when patients’ situation were allowed.Results:A total of 31 cases of PICC secondary malposition were early identified, 27 of them were treated with external manual reduction. Totally 19 cases succeeded, and 8 cases failed. The success rate was 70.4%. There was no other complication during the process. 3 cases were found venous thrombosis, and 1 case was unable to do external manipulation due to his poor situation.Conclusion:X-ray is a simple and easy method to identify secondary malposition of PICC. Using external manipulation to adjust the tip position back to SVC is effective, and the complications are few, which is worthy of clinical application.
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Objective To detect the effect of the ball compressor method to prevent jugular vein malposition in peripherally inserted central catheter insertion (PICC). Methods Convenient sampling method was used to recruit 1 358 patients with PICC insertions during October 2017 to September 2018 in Second affiliated hospital Zhejiang University, school of medicine. 681 were included in experimental group, and 677 patients were included in control group. The control group used traditional turning head to the PICC insertion side or fingers compression to block the entrance of jugular vein to prevent jugular vein malposition in control group. While in experimental group, rugby- shape ball compression were used to block jugular vein to reduce jugular vein malposition. The rate of jugular vein malposition in the first try of catheterization was calculated in both groups. Results The rate of jugular vein malposition in the first try of catheterization was 19.1% (130/681) in experimental group and 23.5% (159/677) in control group respectively. There is statistically significant difference between two groups (χ2=3.917, P=0.047 8). Conclusion Rugby- shape ball compression could reduce jugular vein malposition in the first try of catheterization effectively.
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Objective To discuss and summarize the nursing care of a patient with difficult extubation due to asymptomatic thrombosis of PICC. Methods By observing the local and global conditions, psychological tests, chest X-ray localization and vascular ultrasound, using critical thinking, the causes of difficult extubation were analyzed; after active anticoagulation and thrombolytic therapy, intermittent extubation of PICC; after extubation, continuous nursing was done. Results After the above nursing measures were implemented, PICC was removed intermittently within 24 hours, and after 3 months vascular ultrasound was showing that the thrombus in the blood vessel had been completely organized. Conclusion When we encounter difficulties in PICC removal, it is not necessary to extubate the PICC forcibly. It is necessary to analyze the causes and implement correct nursing measures to improve the success rate of extubation.
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Objective@#To discuss and summarize the nursing care of a patient with difficult extubation due to asymptomatic thrombosis of PICC.@*Methods@#By observing the local and global conditions, psychological tests, chest X-ray localization and vascular ultrasound, using critical thinking, the causes of difficult extubation were analyzed; after active anticoagulation and thrombolytic therapy, intermittent extubation of PICC; after extubation, continuous nursing was done.@*Results@#After the above nursing measures were implemented, PICC was removed intermittently within 24 hours, and after 3 months vascular ultrasound was showing that the thrombus in the blood vessel had been completely organized.@*Conclusion@#When we encounter difficulties in PICC removal, it is not necessary to extubate the PICC forcibly. It is necessary to analyze the causes and implement correct nursing measures to improve the success rate of extubation.
ABSTRACT
Objective@#To detect the effect of the ball compressor method to prevent jugular vein malposition in peripherally inserted central catheter insertion (PICC).@*Methods@#Convenient sampling method was used to recruit 1 358 patients with PICC insertions during October 2017 to September 2018 in Second affiliated hospital Zhejiang University, school of medicine. 681 were included in experimental group, and 677 patients were included in control group. The control group used traditional turning head to the PICC insertion side or fingers compression to block the entrance of jugular vein to prevent jugular vein malposition in control group. While in experimental group, rugby- shape ball compression were used to block jugular vein to reduce jugular vein malposition. The rate of jugular vein malposition in the first try of catheterization was calculated in both groups.@*Results@#The rate of jugular vein malposition in the first try of catheterization was 19.1%(130/681) in experimental group and 23.5% (159/677) in control group respectively. There is statistically significant difference between two groups (χ2=3.917, P=0.047 8).@*Conclusion@#Rugby- shape ball compression could reduce jugular vein malposition in the first try of catheterization effectively.
ABSTRACT
Based on the hospital information systems and the hospital network,a software for patients with peripherally inserted central catheter (PICC) was developed and applied in clinical practice,which achieved the share of PICC information within the hospital,saved nursing time effectively,made the clinical data more standardized,systematical and objective.