关键词: 导管插入术, 外周, 耐高压注射型, 皮下隧道, 护理

Abstract:

Objective To compare the application effect and safety of the three tunnel establishment methods in tunneled Power PICC catheterization. Methods Non-randomized historical control study design was employed. From June 2021 to August 2022，a total of 351 patients with malignant tumors in a tertiary A hospital in Xiamen，Fujian Province were recruited as participants，and were classified into group A，group B and group C according to the three different tunnel establishment methods of Power PICC catheterization. For group A，the subcutaneous tissue at the tunnel site was separated by 0.5% lidocaine after local anesthesia at the vascular puncture point and the skin exit site of the catheter to establish the tunnel. For group B，the subcutaneous tissue at the tunnel site was separated by normal saline after local anesthesia at the vascular puncture point and the skin exit site of the catheter to establish the tunnel. On the basis of Group B，group C adjusted the direction of tunnel travel to establish tunnel. The total intraoperative bleeding，the degree of pain，incidence of bleeding within 24 hours after catheterization，the degree of arm comfort after three months of catheterization，catheter dislocation rate within three months after catheterization of the three groups were evaluated. Meanwhile，the occurrence of local anesthesia drugs adverse reactions was recorded. Results There were no significant differences in total intraoperative bleeding，the degree of pain and incidence of bleeding within 24 hours after catheterization in the three groups（P>0.05）. Besides，there were significant differences in the degree of arm comfort after three months of catheterization and catheter dislocation rate within three months after catheterization in the three groups（P<0.05）. In addition，pairwise comparison showed that there was no significant difference between group A and group B（P>0.05） but significant differences between group C and group A，as well as group B（P<0.05）. In group A，one patient（0.96%） had allergic reactions to local anesthesia，while no local anesthesia drugs adverse reaction was occurred in the other two groups. Conclusion In tunneled Power PICC catheterization，it recommends that the subcutaneous tissue should be separated by normal saline，and the tunnel should be established by offsetting 30°-45° to the radial side. Such practice is proved to be high safety，and can improve the comfort of patients with tubes and worth application in clinical practice.

Key words: Catheterization, Peripheral, High Pressure Injection Resistant Type, Tunnel, Nursing Care