双PICC在儿童急性白血病中的应用及护理
Application and Nursing Care of Dual-Arm PICC in Childhood Acute Leukemia
DOI: 10.12677/ns.2025.1410234, PDF,   
作者: 黄丽芳, 陈 禧, 徐淑贞, 周 静, 张婷婷, 李智英：中山大学附属第一医院儿科，广东 广州
关键词: 急性白血病；儿童；双PICC；静脉治疗；护理；Acute Leukemia； Children； Dual-Arm PICC； Intravenous Therapy； Nursing
摘要: 目的：总结超声引导下经双上肢静脉同时留置PICC在儿童急性白血病中应用的护理经验。方法：回顾性分析2021年1月至2022年4月6例急性白血病患儿经超声引导下左右双臂同时留置PICC，建立静疗小组实施置管前后、置管维护和并发症的预防及护理。结果：患儿均置管成功，一针穿刺成功10例(83.3%)，导管留置期间出现静脉炎1例，导管相关性血栓1例，接触性皮炎1例，未发生导管堵塞，导管相关血流感染等并发症，积极处理并发症并成功保留导管，12例导管均使用到治疗结束拔管，导管平均留置天数(226 ± 117.9)天。结论：超声引导下经双上肢置入PICC并进行有效的管理，可为白血病患儿治疗提供长期安全的双静脉通路，满足复杂的治疗需求。
Abstract: Objective: To summarize the nursing experience of ultrasound-guided simultaneous dual-arm PICC placement via upper limb veins in children with acute leukemia. Methods: A retrospective analysis was performed on 6 children with acute leukemia who underwent ultrasound-guided simultaneous PICC placement in both arms between January 2021 and April 2022. An intravenous therapy team was established to manage pre- and post-insertion care, catheter maintenance, and the prevention and management of complications. Results: All catheters were successfully placed. First-attempt insertion success was achieved in 10 cases (83.3%). During the indwelling period, complications included one case of phlebitis, one case of catheter-related thrombosis, and one case of contact dermatitis. No catheter occlusion or catheter-related bloodstream infections occurred. Complications were managed actively, and all catheters were successfully retained. All 12 catheters were used until the end of treatment and then removed. The average catheter indwelling time was (226 ± 117.9) days. Conclusion: Ultrasound-guided dual-arm PICC insertion with effective management can provide long-term and safe dual venous access for children with leukemia, meeting complex treatment requirements.
文章引用：黄丽芳, 陈禧, 徐淑贞, 周静, 张婷婷, 李智英. 双PICC在儿童急性白血病中的应用及护理[J]. 护理学, 2025, 14(10): 1753-1758. https://doi.org/10.12677/ns.2025.1410234

参考文献

[1] Seth, R. and Singh, A. (2015) Leukemias in Children. The Indian Journal of Pediatrics, 82, 817-824. [Google Scholar] [CrossRef] [PubMed]
[2] Margolin, J.F., Rabin, K.R., Steuber, C.P. and Poplack, D.G. (2011) Acute Lymphoblastic Leukemia. In: Pizzo, P.A. and Poplack, D.G., Eds., Principles and Practice of Pediatric Oncology, Lippincott Williams & Wilkins, 518-565.
[3] Ullman, A.J., Bernstein, S.J., Brown, E., Aiyagari, R., Doellman, D., Faustino, E.V.S., et al. (2020) The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC. Pediatrics, 145, S269-S284. [Google Scholar] [CrossRef] [PubMed]
[4] 戴云鹏. 实用儿童血液病学[M]. 长春: 吉林科学技术出版社, 2018: 156-161.
[5] 张星霞, 胡艳杰, 李卡. 经外周静脉穿刺置入中心静脉导管留置时间研究现状[J]. 护理研究, 2021, 35(11): 1947-1950.
[6] 李瑞平, 武燕莹, 何肖华. 静疗小组在肿瘤晚期患者PICC置管中的应用[J]. 齐鲁护理杂志, 2020, 26(3): 88-91.
[7] 儿童静脉输液治疗临床实践循证指南[J]. 中国循证儿科杂志, 2021, 16(1): 1-42.
[8] Kim, I.J., Shim, D.J., Lee, J.H., Kim, E.T., Byeon, J.H., Lee, H.J., et al. (2018) Impact of Subcutaneous Tunnels on Peripherally Inserted Catheter Placement: A Multicenter Retrospective Study. European Radiology, 29, 2716-2723. [Google Scholar] [CrossRef] [PubMed]
[9] Sharp, R., Cummings, M., Fielder, A., Mikocka-Walus, A., Grech, C. and Esterman, A. (2015) The Catheter to Vein Ratio and Rates of Symptomatic Venous Thromboembolism in Patients with a Peripherally Inserted Central Catheter (PICC): A Prospective Cohort Study. International Journal of Nursing Studies, 52, 677-685. [Google Scholar] [CrossRef] [PubMed]
[10] 宋慧娟, 厉周. 植入式静脉输液港的应用与护理[J]. 中华护理杂志, 2004, 39(10): 785-786.
[11] 王凯蓉, 周英凤, 张晓菊, 陆箴琦, 王丽英, 薛嵋. PICC与输液港留置全程总成本的核算及比较研究[J]. 护理学杂志, 2021, 36(6): 49-53.
[12] 王丰松. 三种PICC穿刺部位对患者舒适度的影响[J]. 齐鲁护理杂志, 2015, 21(1): 33-34.
[13] Westergaard, B., Classen, V. and Walther‐Larsen, S. (2012) Peripherally Inserted Central Catheters in Infants and Children—Indications, Techniques, Complications and Clinical Recommendations. Acta Anaesthesiologica Scandinavica, 57, 278-287. [Google Scholar] [CrossRef] [PubMed]
[14] O’Callaghan, C., Sexton, M. and Wheeler, G. (2007) Music Therapy as a Non‐Pharmacological Anxiolytic for Paediatric Radiotherapy Patients. Australasian Radiology, 51, 159-162. [Google Scholar] [CrossRef] [PubMed]
[15] Leung, A., Heal, C., Perera, M. and Pretorius, C. (2015) A Systematic Review of Patient-Related Risk Factors for Catheter-Related Thrombosis. Journal of Thrombosis and Thrombolysis, 40, 363-373. [Google Scholar] [CrossRef] [PubMed]
[16] Gorski, L.A., Hadaway, L., Hagle, M.E., Broadhurst, D., Clare, S., Kleidon, T., et al. (2021) Infusion Therapy Standards of Practice, 8th Edition. Journal of Infusion Nursing, 44, S1-S224. [Google Scholar] [CrossRef] [PubMed]
[17] 贺成红, 宋应群, 巫素青, 张古方, 胡月. 粘胶祛除剂对PICC置管患者医用粘胶相关性皮肤损伤的影响[J]. 天津护理, 2019, 27(5): 596-595.
[18] 梅思娟, 段培蓓, 王晓庆, 杨丽华, 孙莉. PICC置管后患者局部皮肤发生接触性皮炎的危险因素分析[J]. 中华现代护理杂志, 2017, 23(23): 2997-3001.

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