| 徐柳,季福婷,杨宾.X线平片测量法在新生儿经下肢静脉行PICC置入术的应用[J].上海护理,2021,21(9): |
| X线平片测量法在新生儿经下肢静脉行PICC置入术的应用 |
| Measurement Method of X ray Plain Film for PICC Catheterization in Neonatal Lower Veins |
| 投稿时间：2020-08-17 修订日期：2021-08-26 |
| DOI： |
| 中文关键词: 新生儿 经外周静脉穿刺中心静脉置管 测量方法 下肢静脉 X线 |
| 英文关键词:neonatal peripherally inserted central catheter measuring method lower veins X ray |
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| 中文摘要: |
| 目的：探讨新生儿经下肢静脉血管行外周中心静脉置管术（peripherally inserted central catheter, PICC），通过新生儿胸腹部正位x线平片利用特定骨性结构测量定位以计算得出PICC导管在体内血管内行径的长度，以此评价其对于预估导管头端位置准确性的临床指导意义。
方法：回顾性收集并分析2018年1月至2019年12月间，在新生儿科病房内因病情需要，经患儿下肢静脉血管置入PICC管成功的新生儿共82例。传统体表测量法：所有82例新生儿置管前均以传统体表长度测量方法估算相应的长度，之后行PICC置管术，术后即刻行x线摄片定位，并视导管位置深浅判断是否需要调整。
x线平片测量定位法：测量时选取患儿置管前的胸腹部正位片，测量从第8胸椎上缘水平－第4腰椎水平－腹股沟区（拟穿刺侧）的分段长度并计算总长度，并与传统体表测量法进行比较。
结果：82例新生儿单下肢PICC置入成功率为100%。但一次性PICC位置满意率不高，仅为53.7%（44/82例）；其中腹股沟区一次性置管位置满意率为59.3%（35/59）略高于腘窝区39.1%（9/23）；余下38例导管异位中有24例为插管过深、经摄片定位后重新拔出适当距离以调整导管头端位置，调整置管的长度范围为5-40mm，平均11.8mm；另有14例为一次性插管位置较浅，无法进一步调整。传统体表法导管长度预估值范围为：100-185mm，平均值141.72±20.09mm；平片定位法导管长度预估值范围为：108.6-169.1mm，平均值131.23±14.53mm；两组方法之间进行配对t检验，t值为7.83，p<0.05，说明两者间存在差异，有统计学意义。另在X线平片上以最终调整位置的导管尖端为起点，测量其至第4腰椎－腹股沟区的分段长度并计算总长度，并与传统体表测量法所得值进行配对t检验比较，t值为0.815，p=0.417（>0.05），说明两者间无显著差异。
结论：新生儿经下肢PICC置管成功率高，但一次性位置满意率总体不高，穿刺前如采用胸腹部摄片测量相应骨性结构的长度对于判断导管尖端位置更为准确直观，对于评估所需导管实际长度及提高导管尖端一次性到位率有积极的指导意义。 |
| 英文摘要: |
| Objective: To investigate the peripherally inserted central catheter (PICC) of neonates through the veins of the lower extremities, we calculate the position of the PICC catheter through the frontal x-ray film of the neonate’s chest and abdomen, then the length of PICC in the internal blood vessel of the body is used to evaluate its clinical guiding significance for predicting the accuracy of the catheter tip position.
Methods: From January 2018 to December 2019, a total of 82 newborns who were successfully placed with PICC tubes through the veins of the lower extremities in the neonatal ward were collected and analyzed retrospectively. Traditional body surface measurement method: All 82 newborns used traditional body surface length measurement method to estimate the corresponding length before intubation, then PICC catheterization was performed, and X-ray radiography was performed immediately after the operation, and the catheter position was judged according to the depth need to adjust.
Measurement method of X-ray plain film: select the frontal radiograph of the chest and abdomen before the tube is placed in the child, measure the segmental length from the upper edge of the 8th thoracic vertebra-the level of the 4th lumbar vertebra-the inguinal area (the side to be punctured) and calculate all together. The total length is compared with the traditional body surface measurement method.
Results: The success rate of single lower limb PICC placement in 82 newborns was 100%. However, the one-time PICC position satisfaction rate is not high, only 53.7% (44/82 cases); among them, the one-time PICC position satisfaction rate in the groin area is 59.3% (35/59) slightly higher than the popliteal area 39.1% (9/ 23); 24 of the remaining 38 cases of ectopic catheters were intubated too deep. After the film was positioned, the catheter was pulled out an appropriate distance to adjust the position of the catheter tip. The length of the catheter was adjusted to 5-40mm, with an average of 11.8mm; Another 14 cases had shallow intubation position and could not be adjusted further. The estimated range of catheter length by traditional body surface method is: 100-185mm, the average value is 141.72±20.09mm; the estimated value range of catheter length by flat film positioning method is: 108.6-169.1mm, the average value is 131.23±14.53mm; A paired t-test was performed between the two methods, the t-value was 7.83, p<0.05, indicating that there is a difference between the two methods, which is statistically significant. In addition, on the plain X-ray film, starting from the tip of the catheter at the final adjustment position, measure the segmental length from the fourth lumbar vertebrae to the inguinal area and calculate the total length. The paired t-test is compared with the value obtained by traditional body surface measurement. The value is 0.815, p=0.417 (>0.05), indicating that there is no significant difference between the two methods.
Conclusion: The success rate of neonatal PICC catheterization through lower limbs is high, but the one-time position satisfaction rate is generally not high. Before puncture, it is more accurate and intuitive to judge the position of the catheter tip by using chest and abdomen photography to measure the length of the corresponding bony structure. The actual length of the required catheter and the improvement of the one-time placement rate of the catheter tip have positive guiding significance. |
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