【摘要】 目的探讨床旁X线摄影在新生儿脐静脉置管术(UVC)定位的应用及异位原因分析。方法对410例行脐静脉置管术(UVC)患儿的临床资料进行分析,通过床旁X线摄影了解UVC导管及导管尖端的位置及UVC操作中存在的问题及其异位原因,通过集束化护理寻求解决办法。结果 410例UVC中异位88例,异位率21.46%。路径异位53例,其中50例X线摄影定位均显示导管尖端进入肝内静脉,3例置入脐动脉。位点异位38例,10例置管过深, 22例置管过浅;6例X线定位显示导管尖端在静脉内导管卷曲未进入下腔静脉。外拔至门静脉以下作为外周静脉导管使用70例,10例置管过深,则外拔至标准位置仍作为中心静脉导管使用;其余5例及置入脐动脉者3例直接拔除导管,结扎残留脐带。置管技术开展第1年异位率高达39.73%(29/73),机械通气患儿UVC异位明显高于nCPAP组及未行呼吸支持患儿17.65%(6/34)。结论新生儿UVC异位率与患儿的胎龄、体重及呼吸支持方式明显相关,也与置管术者熟练程度明显相关,集束化护理可有效减少UVC异位率及并发症。更多还原

【Abstract】 Objective To explore the application value of bedside X-ray in positioning neonatal umbilical venous catheters(UVC) and the ectopic cause as well as whether Bundles of Care can better reduce the rate of ectopic sites, prevent and treat the complications. Methods The clinical data and cathetering process of a cohort of 410 neonates, who underwent UVC, were retrospectively analyzed in this work. By means of bedside X-ray we, detected the location of UVC catheter and its tip, analyzed the problems in UVC procedure and the ectopic cause, and found out the possible solutions via Bundles of Care. Results Of 410 neonates subjected to UVC, 88 were ectopic, with the ectopic rate of 21.46%. 53 cases were the route ectopic, of which 50 showed the catheter tip entering the intrahepatic vein by X-ray and 3 were inserted into the umbilical artery. 38 cases were site ectopic, 10 were too deep and 22 were too shallow. X-ray localization showed that the catheter tip was curled in the venous catheter without entering the inferior vena cava in 6 cases. 70 cases were used as peripheral venous catheters when extruded below the portal vein, and 10 cases were used as central veins when extruded to the standard position. The remaining 5 cases and 3 cases of umbilical artery implantation were directly removed and the residual umbilical cord was ligated. In the first year of catheterization, the ectopic rate was 39.73%(29/73), and the heterotopic UVC of mechanically ventilated children was significantly higher than that of nCPAP group and neonates without respiratory support(17.65%, 6/34). Conclusion The ectopic rate of newborn UVC was significantly correlated with the gestational age, weight and respiratory support mode of the neonates, as well as with the proficiency of the catheterization operator. Bundles of Care could effectively reduce the ectopic rate of UVC and the occurrence of complications.更多还原