A Clinical Study on Two Extracorporeal Measurements of Catheter PICC

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A Clinical Study on Two Extracorporeal Measurements of Catheter PICC

  1. 1. A Clinical Study on Two Extracorporeal Measurements of Catheter PICC fC CC Tangdu Hospital The Fourth Military Medical University Hospital, Xi’an, Shaanxi, China He Hua, Liu Li, Qi Juan, Zhang Aihuan, Wang Rui Department of Hematology
  2. 2. The Issue• To explore the optimal extracorporeal measurement of correct length for PICC • Due to safety and simplification of maintenance, PICC has been generally applied to clinical trials • During clinical practice, we found that the traditional extracorporeal measurement of PICC showed deeper insertion than its actual length • The traditional method was more often than not into the heart, even leading to such severe complication such as arrhythmia
  3. 3. The Intervention• Traditional method • New method Body position: Body position: • The patients were asked to take • The patients were made to take a supine position with the arm a supine position with the arm abducted to a 90 degree angle g g abducted to a 90 degree angle g g Extracorporeal measurement: Extracorporeal measurement: • Measuring the distance in the • Measuring the distance in the right upper limb from the right upper limb (left arm) from puncture point along the arm the puncture point, along the to the right sternoclavicular joint arm close to the skin, to the (in the left upper limb from the right sternoclavicular joint and p puncture p point to the left then vertically back to the upper y pp sternoclavicular joint and then to edge of the third rib the right sternoclavicular joint) and then vertically back to the point between the third rib and the fourth rib
  4. 4. Patients Criteria• Inclusion criteria –FFrequency of chemotherapy b i accepted t t t th f h th being t d to treat the malignant tumor – Thrombin functioning must be normally – PLT>30×109/L• Exclusion criteria – Predetermined point of intubation is under inflection or injury – Presence of superior vena cava syndrome – PICC cannot reach the predetermined depth
  5. 5. ResultsFactors Observed group Control groupStudy period 2009.01‐2010.03 2007.10‐2008.12n 100 90Age (years) 1.5‐75 3‐70Gender Female 58 51 Male  42 39Vein of intravenous injection j Basilica vein  51 46 Median vein 31 30  Cephalic vein 18 14Extracorporeal measurement Traditional method New methodEvaluation Index Determine the position of PICC by X‐ray
  6. 6. Results• Rate of PICC catheterization in the superior vena cava Group p n Superior vena cava  p Catheter ectopic p Observed group 100 94(94%) 6(6%) Control group Control group 90 76(84.4%) 76(84 4%) 14(15.6%) 14(15 6%) p <0.05• Position of PICC ectopic of two gro ps t o groups Group n heart Other places Observed group 6 0 6 Control group 14 8 6 p=0.04189
  7. 7. Discussions• Study of Yuan et. al. showed that if the catheter is too long, it can insert to right atrium and cause chest tightness, palpitations and even g g ,p p symptoms of arrhythmia and myocardial damage• If the catheter is short and does not reach the superior vena cava, it easily causes chemical phlebitis• The accuracy of the length of vitro measurement is very important• The length difference between measurement of body surface and the patient’s vessels in the body• We found that the measurement is related to the ectopic heart, but not concerned with jugular vein or axillary vein or other parts
  8. 8. Greatest Learnings• We move the end point up to the upper edge of the third rib when measuring the insertion length of PICC catheter• It can improve the success rate of inserting the catheter into the upper venous cavity. Especially, it can safely keep the catheter from reaching the heart• This extracorporeal measurement is more precise than traditional method

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