ʻO ka palekana a me ka pololei o ka hōʻoia ʻana i ke kūlana PICC ma lalo o ke alakaʻi ECG

Yufang Gao,1,* Yuxiu Liu,1,2,* Hui Zhang,1,* Fang Fang,3 Lei Song4 1 Keena Hooponopono Halemai, Halemai Hoohui o ke Kulanui o Qingdao, Qingdao, Kina;2 Keʻena o nā kahu hānai kaiaulu, Kula o nā kahu hānai, Weifang Medical University, Weifang;3 Ke Keʻena Hematology, Halemai Hoʻohui ʻia o ke Kulanui ʻo Qingdao, Qingdao, Lepupalika Kanaka o Kina;4 Intensive Care Unit, Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China He mea nui ia no ka hoʻohana ʻana i nā catheters.ʻO nā hihi X-ray postoperative, ʻo ia nā hana "gold standard" i ʻike ʻia e ka tip PICC, hiki ke hoʻolōʻihi i ka mālama ʻana i ka IV no nā maʻi, nā kumukūʻai kiʻekiʻe, a alakaʻi i ka ʻike radiation no nā maʻi a me nā limahana.Hāʻawi ka Intracavitary electrocardiogram (IC-ECG) i kahi hoʻokomo PICC i ka manawa maoli i ka wā o ke kaʻina hoʻokomo e hōʻoia i ka hoʻohana nui ʻia.Eia nō naʻe, no nā poʻe maʻi me ka ECG ʻili kino kino, e like me nā maʻi me ka fibrillation atrial (AF), ʻaʻole i hōʻike ʻia ka palekana a me ka pololei o ka ECG.Pahuhopu: E hoʻoholo i ka palekana a me ka pololei o ka ʻenehana IC-ECG i ka hōʻoia ʻana i ke kūlana PICC tip o nā maʻi AF.ʻO nā maʻi a me nā ʻano hana: Ua mālama ʻia kahi noiʻi cohort i loko o kahi 3,600-moe aʻo a me ka halemai kuhikuhi kula kiʻekiʻe ma Qingdao, People's Republic of Kina.Ua kiʻi ka haʻawina i nā poʻe maʻi makua me AF i koi i ka infusion PICC mai Iune 2015 a Mei 2017. No kēlā me kēia maʻi AF i hoʻokomo ʻia, ua hoʻohana ʻia ʻo ECG e ʻike i ke kūlana piko o ka PICC i ka wā o ka catheterization, a ua hana ʻia nā kukui X e hōʻoia i ke kūlana piko. ʻo ia ka "pae gula" ma hope o ka hoʻokomo ʻana o PICC.E hoʻohālikelike i ka maikaʻi a me ka pololei o ka hoʻonohonoho ʻana i ka tip catheter alakaʻi ECG a me ka hōʻoia ʻana o ka pahu X-ray.Nā hualoaʻa: Ua kākau inoaʻia he 118 PICC i nā maʻi 118 me ka fibrillation atrial (58 kāne a me 60 wahine, he 50-89 makahiki).ʻAʻohe pilikia e pili ana i ka catheterization.Ke komo ka catheter i ka 1/3 haʻahaʻa o ka vena cava kiʻekiʻe, hiki i ka amplitude o ka nalu f i kona kiʻekiʻe.ʻAʻohe ʻokoʻa helu helu ma waena o ka hōʻoia kūlana kiʻekiʻe X-ray PICC a me IC-ECG PICC hōʻoia kūlana kiʻekiʻe ma nā maʻi AF (χ2=1.31, P=0.232).Ke hoʻohana nei i ka ʻoki ʻoki o ka hoʻololi nalu f ≥ 0.5 cm, ua ʻike ʻia ʻo 0.94 ka naʻau, ʻo 0.71 ka kikoʻī, ʻo 0.98 ka waiwai wānana maikaʻi, a ʻo 0.42 ka waiwai wānana maikaʻi ʻole.ʻO 0.909 ka wahi ma lalo o ka mea hoʻokipa e hana ana (95% CI: 0.810–1.000).Ka hopena: ʻO ka ʻenehana alakaʻi ECG kahi ʻenehana palekana a pololei e hiki ke hoʻohana ʻia e hōʻoia i ke kūlana o ka piko PICC o nā maʻi AF, a hiki ke hoʻopau i ka pono o nā pahu X-ray postoperative i nā maʻi AF.Hua'ōlelo: peripheral central venous catheter, PICC, tip position, electrocardiogram, electrocardiogram, nā maʻi me ka atrial fibrillation
ʻO ka hoʻonohonoho ʻana i ka piko kūpono o ka catheter kikowaena peripherally inserted central catheter (PICC) he mea nui ia e pale aku i nā pilikia pili i ka catheter e like me ka neʻe ʻana, venous thrombosis, a i ʻole arrhythmia.1 PICC tip positioning, postoperative chest X-ray, electrocardiogram (ECG), a me kekahi mau 'ike loea hou i hōʻike 'ia, e like me Sherlock 3CG® Tip Confirmation System (Bard Access Systems, Inc., Salt Lake City, UT, USA), i hoʻohui i ka Magnetic ka hoʻopaʻa ʻana a me ka ʻenehana hōʻoia ʻana o ka PICC ma muli o ka ECG a me ka ʻōnaehana uila conduction wire.3
ʻO Chest X-ray ka mea maʻamau i hoʻohana ʻia e hōʻoia i ke kūlana o ka piko PICC a ʻōlelo ʻia e like me ke kūlana gula.4 ʻO kekahi o nā palena o nā hihi X ʻo ia ka hōʻoia ʻana ma hope o ka hoʻopaʻa ʻana i hiki ke alakaʻi i ka mālama intravenous (IV).5 Eia kekahi, inā ʻike hewa ʻia ke kūlana o ka piko PICC e nā kukui X ma hope o ke kaʻe ʻana, pono e hana hou ʻia nā hana catheter a me nā pahu X-ray, kahi e hoʻolōʻihi ai i ka mālama maʻi a me ka hoʻohana hou ʻana i ka manawa, a hoʻonui i nā kumukūʻai.Eia kekahi, ma muli o ka hoʻopau ʻia ʻana o ka pono o ka ʻaʻahu, hiki ke hoʻopiʻi ʻia, me nā maʻi koko pili i ka catheter.6,7 ʻO ka manawa hou, ke kumukūʻai, a me ka hōʻike ʻana i ka radiation i pili i nā loiloi radiological ua hopena i nā PICC hiki ke waiho wale ʻia i nā halemai.1
Ua hōʻike mua ʻia ke ʻano hana ECG no ka hoʻonohonoho ʻana i ka piko o ka venous catheter (CVC) ma 1949. 8 Hāʻawi ka Intracavitary ECG-alakaʻi PICC i ka hōʻoia ʻana o ka piko i ka wā hoʻokomo.Ke piʻi aʻe nei nā hōʻike e hiki ke pololei ka hoʻonohonoho ʻana i ka tip PICC alakaʻi ʻia e ECG e like me nā ʻano X-ray.5,9-11 Ua hōʻike ʻia ka loiloi ʻōnaehana a Walker e hiki ke hoʻopau ʻia ka hoʻonohonoho ʻana i ka ECG i ka pono o nā pahu X-ray postoperative, ʻoi aku hoʻi ma ka hoʻokomo ʻana i ka laina PICC.6 ECG-alakaʻi

Hoʻomaʻamaʻa ʻia ke kūlana kiʻekiʻe o PICC i ka manawa maoli i ka wā o ka catheterization, me ka ʻole o ka hoʻoponopono postoperative a i ʻole repositioning.Hiki ke hoʻohana koke ʻia ka PICC ma hope o ke kau ʻana me ka hoʻokaʻulua ʻole i ka mālama ʻana i ka maʻi.9
ʻO ka maʻamau o kēia manawa no ka wahi piko PICC he hapakolu o ka vena cava kiʻekiʻe (SVC) a me ka vena cava-atrial junction (CAJ).10,11 I ka hoʻokokoke ʻana o ka piko o ka PICC i ka node sinus ma CAJ, hoʻomaka ka hawewe P e piʻi a hiki i kona amplitude kiʻekiʻe ma CAJ.I kona hele ʻana ma ka ʻaoʻao ʻākau, hoʻomaka ka nalu P e hoʻohuli, e hōʻike ana ua hoʻokomo ʻia ka PICC i kahi mamao loa.ʻO ke kūlana kiʻekiʻe PICC maikaʻi ke kūlana kahi e hōʻike ai ka ECG i ka amplitude P nui loa.No ka mea, ʻo ka hoʻonohonoho ʻana o ka piko PICC ma lalo o ke alakaʻi ECG i manaʻo ʻia he ala palekana, hilinaʻi, a hiki ke hoʻohana hou ʻia, hiki ke hoʻohana ʻia i nā poʻe maʻi me ka fibrillation atrial (AF) me ka ʻole o nā hawewe P i ka ECG?Hele mai kā mākou hui noiʻi mai ka Halemai Hoʻohui o ke Kulanui ʻo Qingdao a hoʻokomo ma kahi o 5,000 PICC i kēlā me kēia makahiki.Ua kūpaʻa ka hui noiʻi i ke aʻo ʻana i nā PICC.I loko o kā mākou noiʻi ʻana, ua ʻike mākou i ka nalu f o nā maʻi AF i ka wā o ke kaʻina hoʻonohonoho PICC tip positioning kekahi mau loli maopopo.No laila ua ʻimi ka hui i kēia.
Ua mālama ʻia kēia noiʻi cohort prospective ma ka Halemai Hoʻohui ʻia o ke Kulanui ʻo Qingdao, kahi haukapila referral tertiary me nā moena ʻoi aku ma mua o 3,600 mai Iune 2015 a hiki i Mei 2017. helu ʻae ʻia QDFYLL201422).Ua kākau inoa ʻia nā maʻi āpau i kākau ʻia.
ʻO nā pae hoʻohālikelike e like me kēia: 1) ʻO nā maʻi e pono ai ka PICC, nona ka ECG e hōʻike i ka nalu AF ma mua o ka hoʻokomo ʻana o PICC;2) Ma luna o 18 mau makahiki;3) Hiki i nā maʻi ke ʻae i ka nānā ʻana i ka X-ray.ʻO nā pae hoʻohālikelike e like me kēia: 1) Nā maʻi me nā maʻi noʻonoʻo a i ʻole ka ʻili;2) ʻO nā maʻi me ka pacemakers;3) ʻO nā maʻi e hoʻohana ana i nā ʻano catheters ʻē aʻe.
Hoʻokomo ʻia ka PICC ma lalo o ke alakaʻi ultrasound e nā kahu PICC ʻoihana ma lalo o nā kūlana aseptic maʻamau.ʻEhā French (Fr) single-lumen distal valved silicone Bard Groshong® PICC (Bard Access Systems, Inc.) i hoʻohana ʻia i ke aʻo ʻana.Hoʻohana ʻia ka Bard Site Rite 5 Ultrasound Machine Ultrasound System (Bard Access Systems, Inc.) e ana a loiloi i nā veins pili i ka wahi hoʻokomo.Hoʻokomo ʻia nā PICC āpau me ka hoʻohana ʻana iā Groshong® NXT ClearVue ma o ka ʻenehana Seldinger i hoʻomaikaʻi ʻia.Ma hope o ka hoʻokomo ʻana i ka paipu, holoi i ka PICC āpau me 10 mL o ka paʻakai maʻamau, a uhi i ka puka o ka catheter me kahi lole ma hope o ka hoʻomaʻemaʻe ʻana i ka ʻili.E nānā mau i ka pahu X-ray e hōʻoia i ke kūlana o ka piko catheter.10
Wahi a ka Association of Infusion Nurses, aia ka wahi i ʻōlelo ʻia ma ka hapakolu haʻahaʻa o ka SVC kokoke i ka puka o ka atrium ʻākau.11 Wahi a nā hōʻike, ma kahi o 4 knm (95% CI: 3.8-4.3 cm) ma lalo o ka carina ma ka piko o ka CVC e hopena i kahi kokoke i ka CAJ.ʻO ka awelika lōʻihi o ka SVC he 7.1 knm.12 Ma kēia haʻawina, ua hoʻohana mākou i ke ʻano X-ray ma ke ʻano he "pae gula" no ka hōʻoia ʻana i ke kūlana o ka piko PICC.I ka wā o ka nānā ʻana i ka X-ray, aia nā maʻi a pau i kahi kūlana kuʻekuʻe, me ko lākou mau lima pololei i ke kino, ʻaʻole i hanu ikaika e pale aku i ka hiki ʻana o ka piko ma muli o ke kū a i ʻole ka inhalation ikaika.Hoʻohana mākou i ka carina ma ke ʻano he ʻāina anatomical kahi e ana ai i ka piko PICC.I kā mākou aʻo ʻana, ʻo ke kūlana maikaʻi loa i manaʻo ʻia he 1.6-4 cm ma lalo o ka carina.Ua loiloi ʻia ka ʻikepili X-ray 12,13 e 2 radiologists kaawale.Inā ʻaʻole kūlike nā hoʻoholo, e nānā hou ke kolu o ka radiologist i nā hopena X-ray a hōʻoia i ka hoʻoholo.
Ua loaʻa ka ECG ma lalo o ke aʻo ʻana ma o ka mea i kapa ʻia ʻo "saline technique", e hoʻohana ana i kahi kolamu o ka wai paʻakai i loko o ka catheter ma ke ʻano he electrode intraluminal.13 ʻO nā transducers Braun® a me kahi hoʻololi no ka hoʻololi ʻana mai ka nānā ʻana i ka ECG ma luna o ke kino i ka nānā ʻana i ka intracavity ECG (IC-ECG) i ka noiʻi.Hoʻohui ʻia ʻekolu mau electrodes ʻili (lima ʻākau [RA], lima hema a me ka wāwae hema) i ke alakaʻi II.Ke komo ka piko o ka catheter i ka SVC, e hoʻopili i ka catheter i ka mea hoʻohui o ka transducer, a laila e hoʻokomo mau i ka paʻakai maʻamau ma o ka PICC.Hōʻike ka electrocardiogram o nā maʻi me ka fibrillation atrial i nā nalu f ma kahi o nā hawewe P.Me ka hohonu o ka piko o ka catheter, ua hoʻololi pū ʻia ka nalu f.Ke komo ka catheter i ka SVC, piʻi aʻe ka nalu f, e like me ka hoʻololi ʻana o ka nalu P, ʻo ia hoʻi, ke komo ka catheter i ka SVC, piʻi mālie ka amplitude o ka nalu f.Ke komo ka catheter i ka 1/3 haʻahaʻa o ka SVC, hiki i ka amplitude hawewe f i kona waiwai nui, a ke komo ka catheter i ka atrium ʻākau, e emi ana ka amplitude hawewe f.
No kēlā me kēia hoʻokomo PICC, e hōʻiliʻili i kēia mau ʻikepili: 1) ʻikepili maʻi, me ka makahiki, ke kāne, ka maʻi maʻi, kahi未标题-1


Ka manawa hoʻouna: Dec-20-2021