Elimination of PICC catheter refolding malposition by using the supporting guide wire / 中国实用护理杂志

ABSTRACT

Objective To explore the use of supporting guide wire to exclude the PICC catheter refolding malposition,and reduce the number of the catheter resetting and the average time of catheter resetting,while reducing the mechanicalness phlebitis and the incidence of symptomatic thrombosis. Methods A total of 3 513 patients who received PICC from September 2016 to August 2018 were enrolled. The patients were divided into control group (1 757 cases) and observation group (1 756 cases) by random number table method.The control group was treated with conventional B-ultrasound guided modified Sadinger technique PICC. After the observation group was finished on the basis of the control group, the support guide wire was partially withdrawn and re-sent, according to whether the guide wire was re-supplied or not, to determine whether the catheter has a partial fold in the body. The incidence of catheter refolding malposition, the number of reductions, the time of reduction, and the incidence of mechanicalness phlebitis and symptomatic thrombosis were compared between the two groups. Results The refolding malposition rate of the observation group and the control group were 0 and 3.47%(61/1 757), respectively. The difference was statistically significant (χ2=59.943, P＜0.01). Among the 74 patients in the observation group who underwent catheter resetting, 63 patients were reset≤1 times, 9 patients were reset twice, 2 patients were reset≥third;among the 61 patients in the control group who underwent catheter resetting, 24 patients were reset≤1 times, 6 patients were reset twice,31 patients were reset≥third,the number of the resetting in two groups were compared,the difference was statistically significant (χ2=42.712, P＜0.05). The average reset time of the observation group was (49.66 ± 25.45) s, and the average reset time of the control group was (610.41±206.23) s, the difference was statistically significant (t=18.636, P＜0.01).The incidence of mechanical phlebitis in the observation group and the control group were 1.31%(23/1 756) and 3.76%(66/1 757), respectively. The incidence of mechanical phlebitis in the two groups was statistically significant (χ2=20.241, P＜0.01). The incidence of symptomatic thrombosis in the observation group and the control group were 0.34% (6/1 756), 1.20% (21/1 757), respectively. The incidence of symptomatic thrombosis in the two groups was statistically significant (χ2=8.261, P＜0.05). Conclusions The use of the supportting guide wire to withdraw and re-feed during the catheterization process can effectively eliminate the PICC catheter refolding malposition, reduce the number of catheter reposition and the average reposition time, and reduce the incidence of mechanicalness phlebitis and symptomatic thrombosis. This method is simple and easy to use, it is worthy of clinical application.