心电监护仪在新生儿PICC置管中的定位效果

Efficiency of electrocardiogram monitor for positioning the catheter tip in peripherally inserted central catheter placement in neonates

摘要:

目的 探讨心电监护仪辅助定位法在新生儿经外周静脉置入中心静脉导管（PICC）置管中的应用效果。方法 选取2015年1月至2017年12月入住新生儿重症监护室（NICU）的经上肢静脉PICC置管患儿160例，按随机数字表法分为观察组和对照组，每组80例。对照组患儿行体表测量+术后X线胸片定位；观察组患儿行体表测量+心电定位+术后X线胸片定位。比较两组患儿一般资料、置管一次性到位率及操作耗时。结果 两组患儿性别构成、胎龄、置管日龄、疾病类型及穿刺部位的比较差异无统计学意义（P > 0.05）。观察组置管一次性到位率高于对照组（95% vs 79%； P < 0.05）；观察组PICC置管耗时短于对照组（P < 0.05）。心电监护仪定位技术具有较高的敏感性（97%）和特异性（100%）。结论 在新生儿PICC置管过程中，利用心电监护仪辅助判断导管尖端位置，能提高置管一次性到位率，并可节省置管耗时。

Abstract:

Objective To study the efficiency of electrocardiogram (ECG) monitor for positioning the catheter tip in the placement of peripherally inserted central catheter (PICC) in neonates. Methods A total of 160 neonates who were admitted to the neonatal intensive care unit (NICU) from January 2015 to December 2017 and underwent the PICC placement via the veins of upper extremity were enrolled. They were randomly divided into an observation group and a control group, with 80 neonates in each group. The neonates in the control group were given body surface measurement and postoperative X-ray localization, while those in the observation group were given body surface measurement, ECG localization, and postoperative X-ray localization. The two groups were compared in terms of general information, onetime success rate of PICC placement, and time spent on PICC placement. Results There were no significant differences between the two groups in sex composition, gestational age, age in days at the time of PICC placement, disease type, and site of puncture (P > 0.05). Compared with the control group, the observation group had a significantly higher one-time success rate of PICC placement (95% vs 79%; P < 0.05) and a significantly shorter time spent on PICC placement (P < 0.05). Localization under an ECG monitor during PICC placement had a sensitivity of 97% and a specificity of 100%. Conclusions During the PICC placement in neonates, the use of ECG monitor to determine the position of catheter tip can improve the one-time success rate of placement and reduce the time spent on placement.