心电监护仪在新生儿经下肢静脉置入中心静脉导管中定位效果的随机对照研究

Efficiency of electrocardiogram monitor for positioning the catheter tip in the central catheter placement via lower extremity veins in neonates: a randomized controlled study

摘要:

目的 探讨心电监护仪辅助定位法在新生儿通过下肢静脉进行经外周静脉穿刺的中心静脉导管（peripherally inserted central venous catheter，PICC）置管中的应用效果。 方法 选取2020年1月至2022年1月入住新生儿重症监护室（neonatal intensive care unit，NICU）经下肢静脉行PICC置管患儿120例，按随机数字表法分为对照组和观察组，每组60例。对照组患儿行体表测量+术后胸部X线检查定位；观察组患儿行体表测量+心电定位+术后胸部X线检查定位。收集并比较2组患儿的一般资料、置管一次性到位率及置管耗时，并评估心电定位效率。 结果 观察组置管一次性到位率高于对照组（92% vs 75%；P<0.05），且置管耗时短于对照组［26.5±3.0）min vs（31.8±2.8）min；P<0.05］。心电监护仪辅助定位技术在新生儿经下肢静脉行PICC置管中具有较高的灵敏度（90.9%）和特异度（100%）。 结论 在新生儿经下肢静脉行PICC置管过程中，利用心电监护仪辅助判断导管尖端位置，可提高置管一次性到位率，减少置管耗时，并具有良好的定位效率。

Abstract:

Objective To study the efficiency of electrocardiogram (ECG) monitor for positioning the catheter tip in the placement of peripherally inserted central venous catheterization (PICC) via lower extremity veins in neonates. Methods A total of 120 neonates who were admitted to the neonatal intensive care unit from January 2020 to January 2022 and received PICC via lower extremity veins were enrolled and divided into a control group and an observation group using a random number table (n=60 each). The neonates in the control group were given body surface measurement and postoperative chest X-ray localization, and those in the observation group were given body surface measurement, ECG-guided positioning, and postoperative chest X-ray localization. The two groups were compared in terms of general information, one-time success rate of PICC placement, and time spent on PICC placement, and the efficiency of ECG-guided positioning was evaluated. Results Compared with the control group, the observation group had a higher one-time success rate of PICC placement (92% vs 75%; P<0.05) and a shorter time spent on PICC placement [(26.5±3.0) min vs (31.8±2.8) min; P<0.05]. ECG-guided positioning had a sensitivity of 90.9% and a specificity of 100% in the PICC placement via lower extremity veins in neonates. Conclusions ECG monitor helps to determine the position of catheter tip in the PICC placement via lower extremity veins in neonates and can improve the one-time success rate of PICC placement and reduce the time spent on PICC placement, with a good positioning efficiency.