成都市某醫學中心周邊置入中心靜脈導管合併症的現況及其相關護理

Complications With Peripherally Inserted Central Catheters – Observations and Nursing Experiences at One Medical Center in Chengdu

周邊置入中心靜脈導管（peripherally inserted central catheter, PICC）穿刺點在外周靜脈，置入過程安全，穿刺成功率高，尤其適用於需長期靜脈化學治療的惡性腫瘤患者，可有效減輕患者反復穿刺的痛苦，減少靜脈炎及化療物外滲所致的周圍組織壞死，患者帶管可以自由活動，提高患者的生活品質。本篇報導2007年9月至2008年10月，於本院腫瘤中心接受PICC置管的400例患者合併症的現況及其相關護理，一次性置管395例，二次置管5例，總的置管成功率98.8%，導管平均留置時間為122天（2～350天），導管留置期間無重複穿刺。在裝置過程中出現心慌不適1.5%（6/400），送管不暢3.8%（15/400），置入過程中局部滲血過多0.3%（1/400）；在留置過程中發生過敏性皮炎8%（32/400），機械性靜脈炎7.5%（30/400），導管阻塞9.5%（38/400），其中完全阻塞2%（8/400）、部分阻塞7.5%（30/400），導管相關性血液感染3%（12/400），靜脈血栓形成2%（8/400），上述合併症通過積極有效的處理均得到很好的控制。總言而之，護理人員透過術前充分評估患者、嚴格執行PICC置管操作規程、早期發現合併症患者，及時準確處理出現的問題，能確保PICC的安全性，能減少合併症發生。

Its peripheral vein puncture point, safe insertion procedure and high rate of success have made the peripherally inserted central catheter (PICC) a particularly suitable medical device for cancer patients who require long-term intravenous chemotherapy. PICC can help avoid the pain of repeat punctures as well as reduce incidence of cytotoxic drug extravasation-induced phlebitis and tissue necrosis. With PICC, patient activity is not limited, which improves quality of life. This paper reported on complications and subsequent nursing care provided to 400 cancer patients who received PICC in our center between September 2007 and October 2008. A total of 395 cases had successful PICC insertion on the first attempt and 5 cases achieved success immediately following the second insertion attempt (overall success rate: 98.8%). The average catheter dwell-in time was 122 days (range 2-350 days), during which time no patient required repeat puncture. During the insertion process, arrhythmia occurred in 1.5% (6/400), difficult catheter propelling in 3.75% (15/400), and excessive oozing of blood in 0.3% (1/400) of subjects. During the catheter dwell-in period, sensitizing dermatitis occurred in 8% (38/400), mechanical phlebitis in 7.5% (30/400), catheter occlusion in 9.5% (38/400) (including 2% [8/400] complete and 7.5% [30/400] partial occlusions), catheter associated hematogenous infection in 3% (12/400) and venous thrombosis in 2% (8/400) of subjects. All complications were well controlled with active and effective management. In conclusion, the safety of PICC can be maximized and complications reduced when nurses fully evaluate patients prior to their operation, strictly adhere to PICC operating guidelines, detect complications early, and manage problems promptly.