Failure in ultrasound-guided PICC placement:A five-year retrospective study
Objective To explore the causes and countermeasures of failure in ultrasound(US)-guided peripherally inserted central catheter(PICC),and elevated the success rate of PICC placement.Methods From January 2015 to December 2019,a total of 32 patients with failed placement in ultrasound-guided PICC were enrolled,which included 16 males and 16 females,aged 43-85 years old with mean age of 60.12 years old;body mass index(BMI)was 16.55-31.26 kg/m2 with mean BMI of 22.56 kg/m2.There were 32 cases of malignant tumor,12 of digestive system disease,8 of vascular disease,5 of hypertension,4 of heart disease and 2 of diabetes.The reason of placement were chemotherapy in 19 cases(59.4％)and intravenous nu-trition in 15(46.9％).The lesion was located at cervicothorax in 18 cases(56.3％),and at other parts in 14(43.7％).Tumor resection was performed in 21 cases(65.6％)and chemoradiotherapy in 19(59.4％).After failure placement,all of them were transferred to interventional operating room for digital subtraction angiography(DSA)to assist PICC reset/reset.The PICC-relat-ed indicators were counted to evaluate causes of ultrasound-guided PICC failure,and correlation between causes of failure and other indicators[age,gender,BMI,vascular history,lesion location(cervicothorax),previous related treatment,side and puncture target vein]was analyzed.Results The failure rate of left arm placement was 56.3％(18/32).The puncture of basilic vein ac-counted for 65.6％(21/32),which was more than cephalic vein and brachial vein(P＜0.001).The complicated injury with only mild spasm or small amount of thrombosis was 12.5％(4/32).The catheter misplacement was the main cause of catheter failure(84.4％,27/32).The axillary vein was the most displacement site(46.9％),the basilic vein(12.5％)and internal jugular vein(9.38％)were also common.All of them were replacement successfully with assistance of DSA.There was no significant corre-lation between catheter misplacement and age,gender,BMI,vascular history,lesion location(cervicothorax),previous related treatment,side and puncture target vein index(P＞0.05).Conclusion It is demonstrated that catheter misplacement is the pri-mary cause of US-guided PICC failure,mainly due to vascular variation.DSA-assisted reduction technique is an effective method to solve the failure of US-guided PICC,which significantly improves the success rate of placement.
ultrasound-guidedperipherally inserted central catheter(PICC)insertiondigital subtraction angiography(DSA)
NETL
NSTL
万方数据
维普
