Yufang Gao,1,* Yuxiu Liu,1,2,* Hui Zhang,1,* Fang Fang,3 Lei Song4 1 Hospital Management Office, Affiliated Hospital yeQingdao University, Qingdao, China;2 Dhipatimendi reCommunity Nursing, Chikoro cheNursing, Weifang Medical University, Weifang;3 Dhipatimendi reHematology, Affiliated Hospital yeQingdao University, Qingdao, People's Republic of China;4 Intensive Care Unit, Affiliated Hospital yeQingdao University, Qingdao, People's Republic of China Izvo zvakakosha pakushandiswa kwekatheta.Postoperative chest X-rays, inova "yegoridhe mwero" maitiro anozivikanwa nePICC tip, anogona kukonzera kunonoka kwakanyanya muIV kurapwa kwevarwere, kudhura kwakanyanya, uye kutungamirira mukuratidzwa kwemwaranzi kune varwere nevashandi.Intracavitary electrocardiogram (IC-ECG) inotungamirirwa PICC kuiswa inopa nguva chaiyo-nguva yekukurudzira panguva yekuisa nzira yekusimbisa kuti yakashandiswa zvakanyanya.Nekudaro, kune varwere vane abnormal body surface ECG, sevarwere vane atrial fibrillation (AF), kuchengetedzeka uye kurongeka kweECG hakuna kutaurwa.Chinangwa: Kuona kuchengetedzeka uye kurongeka kweIC-ECG tekinoroji mukusimbisa iyo PICC tip chinzvimbo chevarwere veAF.Varwere uye nzira: Chidzidzo cheboka chinotarisirwa chakaitwa muchipatara che3,600-yemubhedha uye chepamusoro chekutumira chipatara muQingdao, People's Republic of China.Chidzidzo chacho chakatora varwere vakuru vane AF vaida infusion yePICC kubva munaJune 2015 kusvika May 2017. Pamurwere wega wega weAF akabatanidzwa, ECG yakashandiswa kuona nzvimbo yePICC panguva ye catheterization, uye X-rays yakaitwa kusimbisa kuti nzvimbo yepip. yaive "yegoridhe chiyero" mushure mekuiswa kwePICC.Enzanisa kushanda uye kurongeka kweECG-inotungamirirwa catheter tip positioning uye chifuva X-ray kusimbisa.Migumisiro: Zvose zve118 PICCs zvakanyoreswa muvarwere ve118 vane atrial fibrillation (58 varume uye 60 vakadzi, vane makore 50-89 makore).Iko hakuna matambudziko ane chekuita necatheterization.Kana iyo catheter ichipinda muzasi 1/3 yepamusoro vena cava, iyo amplitude ye f wave inosvika pakureba kwayo.Pakanga pasina mutsauko wehuwandu pakati peiyo X-ray PICC tip chinzvimbo verification uye IC-ECG PICC tip chinzvimbo chekuongorora muvarwere veAF (χ2 = 1.31, P = 0.232).Kushandisa iyo yakatemwa-kubvisa f wave shanduko ≥ 0.5 cm, yakaonekwa kuti kunzwisiswa kwaive 0.94, iyo chaiyo yaive 0.71, iyo yakanaka yekufungidzira kukosha yaive 0.98, uye iyo yakaipa yekufungidzira kukosha yaive 0.42.Iyo nzvimbo iri pasi peanogamuchira inoshanda maitiro curve yaive 0.909 (95% CI: 0.810-1.000).Mhedziso: ECG-inotungamirwa tekinoroji ndiyo yakachengeteka uye yakarurama tekinoroji inogona kushandiswa kuonesa nzvimbo yePICC tipi yevarwere veAF, uye inogona kubvisa kudiwa kwepostoperative chest X-ray muvarwere veAF.Keywords: peripheral central venous catheter, PICC, tip chinzvimbo, electrocardiogram, electrocardiogram, varwere vane atrial fibrillation
Iyo chaiyo tipi yekumisikidza yeperipherally yakaiswa yepakati catheter (PICC) yakakosha kudzivirira matambudziko ane catheter akadai sekutamiswa, venous thrombosis, kana arrhythmia.1 PICC tip yekumisikidza, postoperative chest X-ray, electrocardiogram (ECG), uye mamwe akashumwa matekinoroji, akadai seSherlock 3CG® Tip Confirmation System (Bard Access Systems, Inc., Salt Lake City, UT, USA), iyo inobatanidza Magnetic. yekutevera uye ECG-yakavakirwa PICC tip yekusimbisa tekinoroji 2 uye yemagetsi conduction waya system.3
Chest X-ray ndiyo inonyanya kushandiswa nzira yekuona nzvimbo yePICC tip uye inokurudzirwa seyegoridhe chiyero.4 Imwe yemiganhu yeX-rays ndeyokuti postoperative inosimbisa inogona kutungamirira kune intravenous (IV) kurapwa.5 Mukuwedzera, kana nzvimbo yePICC tip yakaonekwa zvisiri izvo ne-X-rays mushure mekuvhiyiwa, catheter operations uye chest X-rays inoda kudzokororwa, izvo zvichaita kuti kunonoka kurapwa kwemurwere uye kuwedzera nguva yekushandiswa, uye kuwedzera mari.Mukuwedzera, sezvo kuvimbika kwekupfekedza kunovhiringidzwa, zvinetso zvinogona kuitika, kusanganisira catheter-yakabatana nehutachiona hweropa.6,7 Nguva yakawedzerwa, mari, uye kuratidzwa kwemwaranzi kunobatanidzwa mukuongororwa kweradiological kwakaguma nePICCs inogona kuiswa muzvipatara chete.1
Nzira yeECG ye central venous catheter (CVC) tip positioning yakatanga kushumwa muna 1949. 8 Intracavitary ECG-inotungamirirwa nePICC kuiswa kunopa nguva chaiyo yekusimbisa mazano panguva yekuisa.Pane humbowo huri kuwedzera hunoratidza kuti ECG-inotungamirwa PICC tip positioning inogona kuva yakarurama senzira dzeX-ray.5,9-11 Walker's systematic review yakaratidza kuti ECG-based positioning inogona kubvisa kudiwa kwe postoperative chest X-rays, kunyanya panguva yePICC mutsara wekuisa.6 ECG-inotungamirirwa
PICC tip chinzvimbo inojekeswa munguva chaiyo panguva yecatheterization, pasina postoperative gadziriso kana repositioning.PICC inogona kushandiswa pakarepo mushure mekuiswa pasina kunonoka kurapwa kwemurwere.9
Iyo yazvino chiyero chePICC tip nzvimbo chikamu chimwe muzvitatu chepamusoro vena cava (SVC) uye yakaderera vena cava-atrial junction (CAJ).10,11 Sezvo muromo wePICC unosvika kune sinus node paCAJ, P wave inotanga kusimuka uye inosvika pakureba kwayo paCAJ.Sezvo ichipfuura nepakati peatrium yakarurama, P wave inotanga kupinduka, ichiratidza kuti PICC yakaiswa kure.Iyo yakakodzera PICC tip chinzvimbo inzvimbo iyo ECG inoratidza yakakura P amplitude.Sezvo kuiswa kwePICC tip pasi pekutungamirirwa kweECG kunoonekwa senzira yakachengeteka, yakavimbika, uye inoberekazve, inogona kushandiswa kune varwere vane atrial fibrillation (AF) pasina P mafungu muECG?Chikwata chedu chekutsvagisa chinobva kuAffiliated Hospital yeQingdao University uye inoisa anosvika zviuru zvishanu zvePICC gore rega rega.Chikwata chekutsvagisa chakazvipira kudzidza maPICC.Munguva yekutsvagisa kwedu, takaona kuti f wave yevarwere veAF panguva yePICC tip yekumisikidza maitiro zvakare ine dzimwe shanduko dziri pachena.Naizvozvo boka rakaongorora izvi.
Ichi chidzidzo cheboka chevanhu chakaitwa muAffiliated Hospital yeQingdao University, chipatara chepamusoro chepamusoro chine mibhedha inopfuura 3,600 kubva munaJune 2015 kusvika May 2017. Chirongwa chekutsvakurudza chakaongororwa uye chakabvumirwa neInstitutional Review Committee yeAffiliated Hospital yeQingdao University ( nhamba yemvumo QDFYLL201422).Vose vakanyoresa varwere vakasaina chibvumirano chakanyorwa chakanyorwa.
Maitiro ekubatanidzwa ndeaya anotevera: 1) Varwere vanoda PICC, avo ECG inoratidza AF wave pamberi pekuiswa kwePICC;2) Kupfuura makore gumi nemasere;3) Varwere vanogona kushivirira kuongororwa kweX-ray.Nzira dzekuregererwa ndedzinotevera: 1) Varwere vane zvirwere zvepfungwa kana zveganda;2) Varwere vane pacemakers;3) Varwere vanoshandisa chero mamwe marudzi emakateta 4) Varwere vanorwara nedoro uye iodophor.
PICC inoiswa pasi pe ultrasound kutungamira nenyanzvi PICC vanamukoti pasi peyakajairwa aseptic mamiriro.ina French (Fr) single-lumen distal valved silicone Bard Groshong® PICC (Bard Access Systems, Inc.) yakashandiswa muchidzidzo.Iyo Bard Site Rite 5 Ultrasound Machine Ultrasound System (Bard Access Systems, Inc.) inoshandiswa kuyera uye kuongorora tsinga dzakakodzera panzvimbo yekuisa.Ese maPICC anoiswa pachishandiswa Groshong® NXT ClearVue kuburikidza nekuvandudzwa kweSeldinger tekinoroji.Mushure mekuisa chubhu, sukurudza PICC yese ne10 mL yesaline yakajairwa, uye vhara musuwo wecatheter nekupfeka mushure mekuuraya hutachiona hweganda.Tarisa chipfuva X-rays nguva nenguva kuti uone nzvimbo yetip catheter.10
Zvinoenderana neSangano reInfusion Nurses, nzvimbo inokurudzirwa yekunongedza iri munzvimbo yezasi yechitatu yeSVC padyo nemusuwo weatrium yekurudyi.11 Maererano nemishumo, inenge 4 cm (95% CI: 3.8-4.3 cm) pasi pe carina pamucheto weCVC ichaguma nekuiswa pedyo neCAJ.Avhareji kureba kweSVC ndeye 7.1 cm.12 Muchidzidzo ichi, takashandisa nzira yeX-ray se "gold standard" yekusimbisa nzvimbo yePICC tip.Panguva yekuongorora kweX-ray, varwere vose vakanga vari munzvimbo isina kwavakarerekera, nemaoko avo akananga kumuviri, uye havana kufema zvakasimba kuti vadzivise zvingaita kuti tip dislocation nokuda kwechimiro kana inhalation yakasimba.Isu tinoshandisa carina seye anatomical landmark kubva kwairi kuyera iyo PICC tip.Muchidzidzo chedu, nzvimbo yakanakisisa inofungidzirwa kuva 1.6-4 cm pasi pe carina.12,13 X-ray data yakaongororwa ne2 radiologists zvakasiyana.Kana kutonga kusingaenderane, wechitatu radiologist acharamba achitarisa mhinduro dzeX-ray uye anosimbisa sarudzo.
Iyo ECG iri pasi pechidzidzo yakawanikwa kuburikidza neinonzi "saline technique", iyo inoshandisa column ye saline solution iri mu catheter se intraluminal electrode.13 Braun® transducers uye shanduko yekushandura kubva kumuviri wepamusoro ECG kutevera kune intracavity ECG (IC-ECG) kutevera) yakashandiswa mukutsvakurudza.Maelectrode matatu epamusoro (ruoko rwerudyi [RA], ruoko rworuboshwe uye gumbo rekuruboshwe) akabatana nemutungamiri II.Kana muromo wecatheter uchipinda muSVC, batanidza catheter kune chinongedzo chetransducer, uye woramba uchiisa saline yakajairika kuburikidza nePICC.Iyo electrocardiogram yevarwere vane atrial fibrillation inoratidza f mafungu panzvimbo peP mafungu.Nekudzika kwemuromo we catheter, f wave yakavewo neimwe shanduko.Apo catheter inopinda muSVC, f wave inova yakakwirira, yakafanana nekuchinja kweP wave, ndiko kuti, apo catheter inopinda muSVC, amplitude ye f wave inowedzera zvishoma nezvishoma.Apo catheter inopinda muzasi 1/3 yeSVC, f-wave amplitude inosvika pakukosha kwayo, uye apo catheter inopinda muatrium yakarurama, f-wave amplitude inoderera.
Pakuiswa kwePICC yega yega, unganidza data rinotevera: 1) data remurwere, kusanganisira zera, murume kana mukadzi, kuongororwa,
Nguva yekutumira: Zvita-20-2021