Chitetezo ndi kulondola kwa PICC nsonga yotsimikizira malo motsogozedwa ndi ECG

Yufang Gao,1,* Yuxiu Liu,1,2,* Hui Zhang,1,* Fang Fang,3 Lei Song4 1 Hospital Management Office, Affiliated Hospital of Qingdao University, Qingdao, China;2 Dipatimenti ya Community Nursing, School of Nursing, Weifang Medical University, Weifang;3 Dipatimenti ya Hematology, Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China;4 Chipatala Chothandizira, Chipatala Chogwirizana cha Qingdao University, Qingdao, People's Republic of China Ndikofunikira kugwiritsa ntchito ma catheters.Ma X-ray a postoperative pachifuwa, omwe ndi "golide wokhazikika" omwe amadziwika ndi nsonga ya PICC, angayambitse kuchedwa kwakukulu kwa chithandizo cha IV kwa odwala, kukwera mtengo, ndikupangitsa kuti odwala ndi ogwira nawo ntchito awonetsere.Intracavitary electrocardiogram (IC-ECG) yotsogoleredwa ndi PICC kuyika kumapereka chidziwitso cha nthawi yeniyeni panthawi yoyikapo kuti itsimikizire kuti yakhala ikugwiritsidwa ntchito kwambiri.Komabe, kwa odwala omwe ali ndi vuto la ECG pathupi, monga odwala omwe ali ndi vuto la atrial fibrillation (AF), chitetezo ndi kulondola kwa ECG sizinafotokozedwe.Cholinga: Kudziwa chitetezo ndi kulondola kwaukadaulo wa IC-ECG pakutsimikizira nsonga ya PICC ya odwala AF.Odwala ndi njira: Kafukufuku woyembekezeredwa wamagulu adachitika mu chipatala chophunzitsira cha mabedi 3,600 komanso chipatala chapamwamba ku Qingdao, People's Republic of China.Kafukufukuyu adalemba odwala achikulire omwe ali ndi AF omwe amafunikira kulowetsedwa kwa PICC kuyambira Juni 2015 mpaka Meyi 2017. Kwa wodwala aliyense wa AF wophatikizidwa, ECG idagwiritsidwa ntchito kuzindikira nsonga ya PICC panthawi ya catheterization, ndipo ma X-ray adachitidwa kuti atsimikizire kuti nsonga inali "golide muyezo" pambuyo pa kuyika kwa PICC.Yerekezerani mphamvu ndi kulondola kwa ECG motsogozedwa ndi catheter nsonga malo ndi pachifuwa X-ray kutsimikizira.Zotsatira: Chiwerengero cha 118 PICCs chinalembedwa kwa odwala 118 omwe ali ndi matenda a atrial fibrillation (58 amuna ndi 60 akazi, zaka 50-89 zaka).Palibe zovuta zokhudzana ndi catheterization.Pamene catheter imalowa m'munsi mwa 1/3 ya vena cava yapamwamba, matalikidwe a f wave amafika pamtunda wake.Panalibe kusiyana pakati pa X-ray PICC nsonga ya malo ndi chitsimikizo cha malo a IC-ECG PICC mwa odwala AF (χ2 = 1.31, P=0.232).Pogwiritsa ntchito malo odulidwa a f wave kusintha ≥ 0.5 masentimita, adawona kuti kukhudzidwa kunali 0.94, kutsimikizika kunali 0.71, mtengo wolosera bwino unali 0.98, ndipo mtengo wolosera wolakwika unali 0.42.Dera lomwe lili pansi pa mayendedwe a wolandila anali 0.909 (95% CI: 0.810-1.000).Kutsiliza: Ukadaulo wotsogozedwa ndi ECG ndiukadaulo wotetezeka komanso wolondola womwe ungagwiritsidwe ntchito kutsimikizira malo a PICC nsonga ya odwala AF, ndipo zitha kuthetsa kufunikira kwa X-ray yachifuwa pambuyo pa opaleshoni mwa odwala AF.Keywords: zotumphukira chapakati venous catheter, PICC, nsonga malo, electrocardiogram, electrocardiogram, odwala matenda fibrillation
Kuyika kolondola kwa nsonga ya catheter yapakati (PICC) ndikofunikira kuti tipewe zovuta zokhudzana ndi catheter monga kusamuka, venous thrombosis, kapena arrhythmia.1 PICC tip positioning, postoperative chest X-ray, electrocardiogram (ECG), ndi matekinoloje atsopano, monga Sherlock 3CG® Tip Confirmation System (Bard Access Systems, Inc., Salt Lake City, UT, USA), yomwe imagwirizanitsa Magnetic kutsatira ndi ECG-based PICC tip kutsimikizira luso 2 ndi magetsi conduction waya dongosolo.3
X-ray pachifuwa ndiye njira yomwe imagwiritsidwa ntchito kwambiri kutsimikizira malo a nsonga ya PICC ndipo imalimbikitsidwa ngati muyezo wagolide.4 Chimodzi mwa zolephera za X-ray ndikuti kutsimikizira pambuyo pa opaleshoni kungayambitse chithandizo cha mtsempha (IV).5 Kuonjezera apo, ngati malo a nsonga ya PICC azindikiridwa molakwika ndi X-ray pambuyo pa opaleshoni, ntchito za catheter ndi chifuwa X-ray ziyenera kubwerezedwa, zomwe zidzachititsa kuchedwa kwa chithandizo cha odwala ndi kugwiritsa ntchito nthawi yowonjezera, ndikuwonjezera ndalama.Kuonjezera apo, popeza kukhulupirika kwa kuvala kumasokonekera, zovuta zikhoza kuchitika, kuphatikizapo matenda okhudzana ndi catheter.6,7 Nthawi yowonjezera, mtengo, ndi kuwala kwa ma radiation omwe akukhudzidwa ndi kufufuza kwa radiological kwapangitsa kuti PICC ikhale yokhazikika m'zipatala.1
Njira ya ECG yopangira catheter yapakati (CVC) nsonga ya nsonga inanenedwa koyamba mu 1949. Kuyika kwa PICC 8 Intracavitary ECG-guided PICC kumapereka chitsimikizo cha nthawi yeniyeni ya nsonga panthawi yoika.Pali umboni wochuluka wosonyeza kuti kuyika nsonga ya PICC motsogozedwa ndi ECG kungakhale kolondola monga njira za X-ray.5,9-11 Kuwunika mwadongosolo kwa Walker kunawonetsa kuti malo ozikidwa pa ECG amatha kuthetsa kufunikira kwa X-ray pachifuwa cha postoperative, makamaka pakuyika mzere wa PICC.6 ECG motsogozedwa

Udindo wa nsonga ya PICC umamveketsedwa mu nthawi yeniyeni panthawi ya catheterization, popanda kusintha kwa postoperative kapena kuyikanso.PICC itha kugwiritsidwa ntchito atangoyiyika popanda kuchedwetsa chithandizo cha odwala.9
Muyezo wapano wa malo a nsonga ya PICC ndi gawo limodzi mwa magawo atatu a vena cava yapamwamba (SVC) ndi malo otsika a vena cava-atrial (CAJ).10,11 Pamene nsonga ya PICC ikuyandikira node ya sinus ku CAJ, P wave imayamba kukwera ndikufika pamtunda wake waukulu ku CAJ.Pamene ikudutsa mu atrium yoyenera, P wave imayamba kutembenuka, kusonyeza kuti PICC imayikidwa patali kwambiri.Malo abwino a nsonga ya PICC ndi pomwe ECG imawonetsa matalikidwe akulu kwambiri a P.Popeza kuika nsonga ya PICC pansi pa chitsogozo cha ECG kumaonedwa kuti ndi njira yotetezeka, yodalirika, komanso yobwereketsa, kodi ingagwiritsidwe ntchito kwa odwala omwe ali ndi matenda a atrial fibrillation (AF) opanda mafunde a P mu ECG?Gulu lathu lofufuza limachokera ku Affiliated Hospital of Qingdao University ndipo amaika pafupifupi 5,000 PICCs chaka chilichonse.Gulu lofufuza ladzipereka ku kafukufuku wa ma PICC.Pakufufuza kwathu, tidapeza kuti f wave ya odwala AF panthawi ya PICC nsonga yoyikanso ilinso ndi zosintha zina.Choncho gululo linafufuza izi.
Kafukufuku wamagulu omwe akuyembekezeka kuchitikira ku Affiliated Hospital of Qingdao University, chipatala chopititsa patsogolo maphunziro apamwamba omwe ali ndi mabedi oposa 3,600 kuyambira June 2015 mpaka May 2017. Dongosolo la kafukufuku linawunikiridwa ndikuvomerezedwa ndi Komiti Yoyang'anira Institutional Review ya Chipatala Chogwirizana cha Qingdao University ( nambala yovomerezeka QDFYLL201422).Odwala onse omwe adalembetsa adasaina chilolezo chodziwitsidwa.
Njira zophatikizira ndi izi: 1) Odwala omwe akusowa PICC, omwe ECG imasonyeza AF wave pamaso pa PICC kuyika;2) Kupitilira zaka 18;3) Odwala amatha kulekerera mayeso a X-ray.Njira zochotserako ndi izi: 1) Odwala omwe ali ndi matenda a maganizo kapena akhungu;2) Odwala omwe ali ndi pacemaker;3) Odwala omwe amagwiritsa ntchito mitundu ina iliyonse ya catheter 4) Odwala omwe amamwa mowa ndi iodophor.
PICC imayikidwa motsogozedwa ndi ultrasound ndi anamwino aluso a PICC pansi pamikhalidwe ya aseptic.Zinayi za French (Fr) single-lumen distal valved silicone Bard Groshong® PICC (Bard Access Systems, Inc.) zinagwiritsidwa ntchito pophunzira.The Bard Site Rite 5 Ultrasound Machine Ultrasound System (Bard Access Systems, Inc.) imagwiritsidwa ntchito poyesa ndi kuyesa mitsempha yoyenera pa malo oyikapo.Ma PICC onse amayikidwa pogwiritsa ntchito Groshong® NXT ClearVue kudzera muukadaulo wotsogola wa Seldinger.Mukalowetsa chubu, yambani PICC yonse ndi 10 ml ya saline wamba, ndikuphimba pakhomo la catheter ndi kuvala pambuyo pothira tizilombo toyambitsa matenda.Yang'anani pachifuwa X-ray nthawi zonse kuti mutsimikizire pomwe nsonga ya catheter ilipo.10
Malinga ndi Association of Infusion Nurses, malo omwe akulimbikitsidwa ali m'munsi mwa atatu a SVC pafupi ndi khomo la atrium yakumanja.11 Malingana ndi malipoti, pafupifupi 4 cm (95% CI: 3.8-4.3 cm) pansi pa carina pa nsonga ya CVC idzapangitsa kuti ikhale pafupi ndi CAJ.Kutalika kwapakati kwa SVC ndi 7.1 cm.12 Mu phunziro ili, tinagwiritsa ntchito njira ya X-ray ngati "golide" wotsimikizira malo a nsonga ya PICC.Pa X-ray kufufuza, odwala onse anali mu ndale supine udindo, ndi manja awo molunjika kwa thupi, ndipo sanali kupuma mwakhama kupewa zotheka nsonga dislocation chifukwa kaimidwe kapena amphamvu inhalation.Timagwiritsa ntchito carina ngati chizindikiro cha anatomical momwe tingayesere nsonga ya PICC.Mu phunziro lathu, malo abwino kwambiri akuti ndi 1.6-4 masentimita pansi pa carina.Deta ya 12,13 X-ray idawunikidwa ndi 2 radiologists mosiyana.Ngati zigamulo sizikugwirizana, radiologist yachitatu idzayang'ananso zotsatira za X-ray ndikutsimikizira chisankho.
ECG yomwe ikugwiritsidwa ntchito inapezedwa kudzera mu njira yotchedwa "saline njira", yomwe imagwiritsa ntchito gawo la saline solution yomwe ili mu catheter monga intraluminal electrode.Ma transducers a 13 Braun® ndi kusintha kwa kusintha kuchokera ku thupi la ECG kufufuza kwa intracavity ECG (IC-ECG) kufufuza) anagwiritsidwa ntchito pofufuza.Ma electrodes atatu (mkono wamanja [RA], mkono wakumanzere ndi mwendo wakumanzere) amalumikizidwa ndi kutsogolera II.Pamene nsonga ya catheter ilowa mu SVC, gwirizanitsani catheter ndi cholumikizira cha transducer, ndiyeno mosalekeza perekani saline wamba kudzera mu PICC.Electrocardiogram ya odwala omwe ali ndi atrial fibrillation imasonyeza f mafunde m'malo mwa mafunde a P.Ndi kuzama kwa nsonga ya catheter, f wave yasinthanso.Pamene catheter ilowa mu SVC, f wave imakhala yokwera, yofanana ndi kusintha kwa P wave, ndiko kuti, pamene catheter imalowa mu SVC, kukula kwa f wave kumawonjezeka pang'onopang'ono.Pamene catheter imalowa m'munsi mwa 1/3 ya SVC, f-wave amplitude imafika pamtengo wapatali, ndipo pamene catheter imalowa mu atrium yoyenera, f-wave amplitude imachepa.
Pakuyika kulikonse kwa PICC, sonkhanitsani izi: 1) Zambiri za odwala, kuphatikiza zaka, jenda, matenda, matenda,未标题-1


Nthawi yotumiza: Dec-20-2021