背景:外周插入中心导管(PICC)的自发迁移是指PICC尖端在几天或几个月的PICC插入后,从上腔静脉(SVC)中令人满意的记录位置移入其相邻静脉,最常见于同侧颈内静脉。然而,在腹部手术后发生胃肠动力障碍的患者中,很少有报道检测到PICC尖端向奇静脉的迁移.我们在此报告2例自发性PICC错位进入奇静脉的病例,并讨论了这种情况的诱发因素和处理过程。
方法:两名女性胰腺疾病患者在腹部手术前在左肢插入PICC。手术后,1例患者患有胃轻瘫,另一个患有便秘。护士发现血液不能从PICC中抽出,而生理盐水可以通过PICC顺利注射。
方法:我们逐步确定了PICC尖端的位置,使用超声波,腔内心电图,胸部X光片,并确认PICC尖端迁移到奇静脉中。
方法:将患者从仰卧位置于半靠位,用推式暂停冲洗技术冲洗后,血液很容易从PICC中抽出。腔内心电图显示P升高,表明PICC尖端重新进入SVC并且位于SVC的较低1/3处。
结果:2例患者的PICC功能良好,在完成肠外营养支持后被移除。
结论:每次输注前评估PICC的功能至关重要。对于在左侧使用PICC进行腹部手术的患者,当他们有胃肠动力障碍合并PICC功能障碍时,应考虑PICC尖端自发迁移至奇静脉的可能性.
BACKGROUND: The spontaneous migration of the peripherally inserted central catheter (PICC) is the displacement of the PICC tip from a satisfactory documented position in the superior vena cava (SVC) into its adjacent veins after several days or months of PICC insertion, and most frequently occurs in the ipsilateral internal jugular vein. However, it is rarely reported to detect migration of PICC tip into the azygos vein in patients who suffered from gastrointestinal dysmotility after abdominal surgery. We report 2 cases of spontaneous malposition of PICC into the azygos vein here and discuss the predisposing factors and processing procedures of this condition.
METHODS: Two female patients with pancreatic disease were inserted PICCs on the left limbs before the abdominal surgery. After the surgery, 1 patient suffered from gastroparesis, and the other suffered from constipation. The nurses found that blood could not be aspirated from the PICCs while normal saline could be injected through the PICCs smoothly.
METHODS: We identified the position of the PICC tip step-by-step, using ultrasound, intracavitary electrocardiogram, and chest X-ray, and confirmed that the tip of the PICC migrated into the azygos vein.
METHODS: The patients were placed in the semi-reclining position from the supine position, and blood could be easily aspirated from the PICC after flushing with the push-pause flush technique. Intracavitary electrocardiogram displayed the elevated P, indicating that the PICC tip reentered the SVC and was at the lower 1/3 of SVC.
RESULTS: The PICCs of the 2 patients functioned well afterward and were removed after the parenteral nutrition support was completed.
CONCLUSIONS: It is critical to assess the function of the PICC before every time of infusion. For patients who undergo abdominal surgery with PICC on the left side, when they had gastrointestinal dysmotility combined with PICC dysfunction, the possibility of spontaneous migration of PICC tip into the azygos vein should be considered.