Background
Placement of central venous catheter PERIPHERALLY INSERTED CENTRAL CATHETER (PICC) via peripheral venipuncture is an effective medical catheterization. Is widely applied to long-term chemotherapy, parenteral nutrition infusion and the like, and has the advantages of small wound, long retention time, convenience, safety and the like. The catheter tip is positioned at a proper position, which is a precondition for reducing infusion related complications and ensuring the safe use of the catheter. The starting position of the cannula is usually chosen from the great vein, the median elbow vein, the head vein. The three types of vein are smaller in vessel diameter than the great vein, so that if the great vein is used as a starting point, a smaller puncture needle and catheter are needed, and inconvenience is brought to the operation. The vessel diameter of the head vein is similar to that of the noble vein, but the turning angle at the crossing of the tail end of the head vein and the axillary vein is too large, so that the resistance is too large, and the dislocation is extremely easy to generate. Thus, the advantage of having a vein as the origin is significant.
Currently, there are two main approaches to PICC catheterization. Method 1: PICC intubates earlier, later uses X-ray film to judge whether the pipe is located target and does not have the ectopic, if have the ectopic repetition this process. This approach often requires repeated cannulas to succeed, causing significant trauma to the patient. Method 2: b ultrasonic assists the starting point puncture, then the PICC intubate is moved behind according to body surface measurement pipe length, finally adopt B ultrasonic to judge whether the pipe is located target point and does not have the ectopic, if have the ectopic repeat this process. The method can greatly reduce the number of repeated intubation, but the intubation repetition rate is still high, the occurrence of complications such as mechanical phlebitis, catheter-related blood flow infection and the like is increased, and the pain of patients is increased.
Therefore, it is necessary to invent PICC catheterization technique with low catheterization repetition rate.
Disclosure of Invention
The invention aims to solve the technical bottleneck. Therefore, the invention provides an auxiliary positioning standard model of PICC under the real-time guidance of B ultrasonic. With this method, a cannula repetition rate of about 1% has made a significant improvement over methods 1 (cannula repetition rate of about 67%) and 2 (cannula repetition rate of about 35%).
Preferably, an auxiliary positioning standard model of PICC under the real-time guidance of B ultrasonic, the standard model mainly comprises 9 auxiliary positioning targets, 1 main path and 1 target, the standard model needs to use B ultrasonic for real-time positioning guidance, and the standard model is used for auxiliary positioning in PICC; the 1 target point of the standard model is the tail third of the superior vena cava, the 1 main paths are the basilic vein, the axillary vein, the subclavian vein, the left brachiocephalic vein, the superior vena cava and the right atrium, and the 9 auxiliary positioning targets are respectively
Auxiliary positioning target point 1: the junction of the axillary vein and the anterior brachial vein,
Auxiliary positioning target point 2: the junction of the axillary vein and the posterior brachial vein,
Auxiliary positioning target 3: the junction of the axillary vein and the lateral thoracic vein,
Auxiliary positioning target 4: the junction of the axillary vein and the head vein,
Auxiliary positioning target point 5: the intersection of the subclavian vein with the suprascapular vein,
Auxiliary positioning target point 6: the junction of the subclavian vein and the external jugular vein,
Auxiliary positioning target 7: the intersection of the left brachiocephalic vein and the internal jugular vein,
Auxiliary positioning target point 8: the intersection of the left brachiocephalic vein and the hypothyroid vein,
Auxiliary positioning target 9: the junction of the superior vena cava tip with the right atrium inlet.
Preferably, an auxiliary positioning standard model of PICC under B ultrasonic real-time guidance, the standard model is used for auxiliary positioning in PICC, and the method comprises the following steps:
B ultrasonic imaging is carried out in advance in the advancing direction of the catheter, and the relative position of the catheter and the intravenous tube of the patient is adjusted by rotating the catheter according to the relative position of the auxiliary target point and the advancing head end of the catheter so as to cause no ectopic position in the advancing process of the advancing head end of the catheter.
Preferably, the relative position of the catheter and the patient's vein is adjusted by rotating the catheter, said relative position comprising the proximal vein wall of the auxiliary target point, the distal vein wall of the auxiliary target point.
Preferably, the rotating catheter is operated with the aim of: by rotating the catheter, the advancing head end of the catheter is moved from the proximal vein wall end of the auxiliary target point to the distal vein wall end of the auxiliary target point, so that the aim that the advancing head end of the catheter is far away from the intersection point of the vein and the vein is fulfilled, and the catheter is effectively prevented from generating dislocation.
Compared with the prior art, the invention has the following beneficial effects:
The standard model established by the invention is applied to PICC operation, so that the repetition rate of intubation is greatly reduced to about 1% from 67% or 35% reported by most hospitals at present, and substantial progress is achieved.
Detailed Description
In order to make the technical solutions of the present invention more apparent to those skilled in the art, the following examples will be presented. It should be noted that the following examples do not limit the scope of the invention.
The starting materials, reagents or apparatus used in the following examples are all available from conventional commercial sources or may be obtained by methods known in the art unless otherwise specified.
Example 1:
Under the real-time guidance of B ultrasonic, the PICC is performed by using the auxiliary positioning standard model disclosed in the patent application, B ultrasonic imaging is performed in advance in the advancing direction of the catheter, and the relative position of the catheter and the intravenous tube of the patient is adjusted by rotating the catheter according to the relative position of the auxiliary target point and the advancing head end of the catheter so as to cause no ectopic in the advancing process of the advancing head end of the catheter. The preparation process, the disinfection process and the puncture process belong to the conventional standard process of medical science and are operated by adopting the general standard specification. Under the real-time guidance of the ultrasonic B, the advancing head end of the catheter is about to pass through the auxiliary positioning target point 1, the catheter is attached to the vein wall (the proximal side wall of the auxiliary positioning target point 1) to advance, so that the advancing catheter is very easy to generate dislocation and enter an unknown blood vessel, the advancing head end of the catheter is attached to the vein wall (the distal side wall of the auxiliary positioning target point 1) to advance by adopting a method of rotating the catheter, and the advancing head end of the catheter is far away from the intersection between the vein walls, so that the catheter smoothly passes through the auxiliary positioning target point 1.
Under the real-time guidance of the B ultrasonic, the advancing head end of the catheter is about to pass through the auxiliary positioning target point 2, and the catheter is attached to the vein wall (the distal tube wall of the auxiliary positioning target point 2), and the advancing head end of the catheter is far away from the intersection between the vein tubes, so that the catheter smoothly passes through the auxiliary positioning target point 2.
Under the real-time guidance of the ultrasonic B, the advancing head end of the catheter is about to pass through the auxiliary positioning target point 3, the catheter is attached to the vein wall (the proximal side wall of the auxiliary positioning target point 3) to advance, so that the advancing catheter is very easy to generate dislocation and enter an unknown blood vessel, the advancing head end of the catheter is attached to the vein wall (the distal side wall of the auxiliary positioning target point 3) to advance by adopting a method of rotating the catheter, and the advancing head end of the catheter is far away from the intersection between the vein tubes, so that the catheter smoothly passes through the auxiliary positioning target point 3.
Under the real-time guidance of the ultrasonic B, the advancing head end of the catheter is about to pass through the auxiliary positioning target point 4, the catheter is attached to the vein wall (the proximal side wall of the auxiliary positioning target point 4) to advance, so that the advancing catheter is very easy to generate dislocation and enter an unknown blood vessel, the advancing head end of the catheter is attached to the vein wall (the distal side wall of the auxiliary positioning target point 4) to advance by adopting a method of rotating the catheter, and the advancing head end of the catheter is far away from the intersection between the vein tubes, so that the catheter smoothly passes through the auxiliary positioning target point 4.
Under the real-time guidance of the B ultrasonic, the advancing head end of the catheter is about to pass through the auxiliary positioning target point 5, and the catheter is attached to the vein wall (the distal tube wall of the auxiliary positioning target point 5), and the advancing head end of the catheter is far away from the intersection between the vein tubes, so that the catheter smoothly passes through the auxiliary positioning target point 5.
Under the real-time guidance of the B ultrasonic, the advancing head end of the catheter is about to pass through the auxiliary positioning target point 6, and the catheter is attached to the wall of a vein (the distal wall of the auxiliary positioning target point 6), and the advancing head end of the catheter is far away from the intersection between the vein, so that the catheter smoothly passes through the auxiliary positioning target point 6.
Under the real-time guidance of the B ultrasonic, the advancing head end of the catheter is about to pass through the auxiliary positioning target point 7, and the catheter is attached to the vein wall (the distal tube wall of the auxiliary positioning target point 7), and the advancing head end of the catheter is far away from the intersection between the vein tubes, so that the catheter smoothly passes through the auxiliary positioning target point 7.
Under the real-time guidance of the ultrasonic B, the advancing head end of the catheter is about to pass through the auxiliary positioning target point 8, the catheter is attached to the vein wall (the proximal side wall of the auxiliary positioning target point 8) to advance, so that the advancing catheter is very easy to generate dislocation and enter an unknown blood vessel, the advancing head end of the catheter is attached to the vein wall (the distal side wall of the auxiliary positioning target point 8) to advance by adopting a method of rotating the catheter, and the advancing head end of the catheter is far away from the intersection between the vein tubes, so that the catheter smoothly passes through the auxiliary positioning target point 8.
After smoothly passing through the auxiliary positioning target point 8, the catheter advances to the head end to enter the superior vena cava. The auxiliary positioning target point 9 is a cut-off target point, namely the front end of the advancing catheter is forbidden to enter the auxiliary positioning target point 9. If the catheter enters the right atrium, immediate withdrawal of the catheter is required, otherwise irreversible damage to the patient may occur. Under the real-time guidance of the B ultrasonic, the leading end of the leading tube which is seen by the B ultrasonic image is close to the inlet of the right atrium, namely, the leading tube is stopped at the third position of the tail end of the superior vena cava, and the key part of PICC operation is successfully completed.
300 Clinical cases of the hospital are selected, wherein 100 clinical cases (recorded as group 1) are subjected to the method 1' PICC catheterization is firstly carried out, then X-ray radiography is used for judging whether the catheter is positioned at a target point and has no dislocation, and if the catheter is positioned at the target point, the process is repeated. Another 100 clinical cases (noted as group 2) were punctured with the aid of method 2"B over the auxiliary starting point, then the catheter length was estimated and PICC cannulated, finally the B-ultrasound was used to determine if the catheter was at the target site and not in place, and if in place the procedure was repeated.
Another 100 clinical cases (recorded as group 3) adopt a new technical method 'an auxiliary positioning standard model of PICC operation under the real-time guidance of B ultrasonic', which is proposed in the present patent application, recorded as method 3, and the specific method is that under the real-time guidance of B ultrasonic, the PICC operation is performed by using the auxiliary positioning standard model described in the present patent application, B ultrasonic imaging is performed in advance in the advancing direction of the catheter, and the relative position of the catheter and the intravenous vessel of the patient is adjusted by rotating the catheter according to the relative position of the auxiliary target point and the advancing head end of the catheter, so that no dislocation exists in the advancing process of the advancing head end of the catheter, and if there is an dislocation, the process is repeated. The results of the corresponding cannula repetition rates are shown in table 1.
Table 1 the new technical approach proposed in this patent application and the result analysis of the existing hospital clinical case control group
| Grouping | Number of clinical cases/cases | Method of use | Cannula repetition Rate R/% |
| Group 1 | 100 | Method 1 | 67 |
| Group 2 | 100 | Method 2 | 35 |
| Group 3 | 100 | Method 3 (present patent application) | 1 |
Note that: cannula repetition rateWherein N: the number of clinical cases is the same as the number of clinical cases,
Km: number of cannulations performed by the mth patient prior to successful PICC catheterization.
Method 1: and judging whether the catheter is positioned at a target point or not by using PICC intubation and then using X-ray radiography, and repeating the process if the catheter is positioned at the target point.
Method 2: and (3) performing B-ultrasonic assisted starting point puncture, then estimating the using length of the catheter and performing PICC intubation, and finally judging whether the catheter is positioned at a target point or not by using B-ultrasonic, and repeating the process if the catheter is positioned at an abnormal position.
Method 3: under the 'B ultrasonic real-time guidance', the PICC technology is performed by using the auxiliary positioning standard model disclosed in the patent application, B ultrasonic imaging is performed in advance in the advancing direction of the catheter, and the relative position of the catheter and the intravenous tube of the patient is adjusted by rotating the catheter according to the relative position of the auxiliary target point and the advancing head end of the catheter so as to cause no dislocation in the advancing process of the advancing head end of the catheter, and if the dislocation exists, the process is repeated.
Analysis of results: as shown in table 1, the corresponding cannula repetition rate was 67% when method 1 was employed; if the method 2 is adopted, the corresponding intubation repetition rate is 35%; if the method 3 is adopted, the corresponding intubation repetition rate is 1%; thus, method 3 represents a substantial technical advance over methods 1 and 2.