上臂输液港置入患者行心腔内电图定位失败的处理和原因分析
Management and cause analysis of intracavitary ECG-guided implantation failure of upper arm infusion ports
梁晓红 1蔡燕 1杨静 1石艳1
作者信息
- 1. 重庆医科大学附属第二医院妇科(重庆,400010)
- 折叠
摘要
目的 总结4例上臂输液港置入患者行心腔内电图定位失败的处理及原因,提出防范对策.方法 4例妇科肿瘤患者在输液港置入术中行心腔内电图定位,2例术中见特征性高尖P波,1例术中P波振幅增高,未出现双向P波,1例术中P波振幅不变,术后胸部X线片均示导管尖端异位.分别根据胸部X线片或心腔内电图P波外撤导管,采用生理盐水推注、颈内静脉阻断、前端导丝回撤、呼吸配合等送管方法.结果 4例均复位成功.结论 外撤导管后重新送管不当、未有效识别异常心腔内电图P波变化特点是IC-ECG定位失败的主要原因.上臂输液港置入术中心腔内电图定位导管尖端位置,应密切观察P波振幅和形态,警惕导管打折或异位.
Abstract
Objective To summarize the management and analyze the causes for intracavitary ECG-guided implantation failure of up-per arm infusion ports,and to propose proactive nursing strategies.Methods In 4 cases of gynecological tumor patients undergoing infusion port implantation,intracavitary ECG was used for tip positioning.Two cases showed characteristic high and sharp P waves during the procedure,one case showed an increase in P wave amplitude,and one case showed unchanged P wave amplitude.Post-insertion chest X-ray imaging revealed misplaced catheter tips in all cases.The catheters were pulled back based on chest X-ray results or the characteristics of intracavitary ECG P waves.A slew of methods,including saline flushing,internal jugular vein blockade,pulled back of the guide wire,and coordinated breathing,were used for catheter repositioning.Results Successful cathe-ter repositioning was achieved in the 4 cases.Conclusion Improper catheter reinsertion after guide wire pulled back,failure to effec-tively identify abnormal changes in intracavitary ECG P waves were the main reasons for IC-ECG guided implantation failure.During intracavitary ECG-guided tip positioning,medical staff should keep a close eye on P-wave amplitude and morphology to guard against catheter bending or misplacement.
关键词
输液港/中心静脉装置/静脉置管/静脉治疗/心腔内电图/导管异位/定位失败/导管调整Key words
infusion port/central venous device/intravenous catheterization/intravenous therapy/intracavitary electrocar-diogram/catheter dislocation/failure of positioning/catheter adjustment引用本文复制引用
基金项目
重庆医科大学附属第二医院护理骨干科研资助计划(2021)(2021-04)
出版年
2024
NETL
NSTL
万方数据