1例异体移植患者PICC药物性堵管成功再通的案例分析

Case Analysis of Successful Revascularization of a PICC Occluded by Medication in an Allogeneic Transplant Patient

摘要: 目的：分享1例白血病移植患者因序贯输注复合磷酸氢钾与葡萄糖酸钙在PICC管路内形成不溶性磷酸钙沉淀导致堵管，并采用1.1%枸橼酸钠溶使得管路再通的护理经验。方法：患者中年女性，确诊急性髓系白血病1年余，为行异基因造血干细胞移植于2025年9月28日入仓。11月5日22:00护士巡视时发现液体滴注不畅，使用预充式导管冲洗器10 mL (舒来喜)冲管时推注阻力大，回抽无回血，初步判断为PICC血栓性堵管。立即采取以下措施：① 停止输液，关闭管路夹；评估确认患者生命体征平稳，无胸痛、肢体肿胀及呼吸困难等不适。② 使用注射器连接PICC接口尝试回抽无回血，且未能抽出管腔内液体。③ 运用三通负压抽吸原理，将溶管药物(1.1%枸橼酸钠溶液)借助负压“吸入”PICC导管，并静置留置。结果：历经约11小时(至11月6日9:00)，PICC管路恢复通畅，液体滴注顺畅，回抽可见回血，推注无阻力。导管功能成功恢复，全程未发生任何相关并发症。结论：本案例成功证实，对于因磷酸钙沉淀物导致的PICC非血栓性堵管，采用1.1%枸橼酸钠溶液进行溶解是一项安全、有效且操作简便的疏通方法。

Abstract: Objective: To share a case where a leukemia patient developed insoluble calcium phosphate precipitation within the catheter after receiving sequential infusions of compound phosphoric acid potassium and calcium gluconate, resulting in PICC catheter blockage. The successful re-introduction using 1.1% citrate sodium solution was also described in this report. Method: A middle-aged female patient diagnosed with acute myeloid leukemia over a year ago was admitted to the transplant unit on September 28, 2025, for allogeneic hematopoietic stem cell transplantation. On November 5th at 22:00, during the nurse’s rounds, it was discovered that the intravenous infusion was not flowing smoothly. When using the catheter flushing device for flushing, there was obvious resistance during the injection process, and no return blood was observed during the suction. The initial diagnosis was thrombotic blockage of the PICC pipeline. Please take the following immediate measures: ① Stop the infusion and close the tube clamp. After assessing and confirming that the patient’s vital signs are stable and there are no symptoms such as chest pain, limb swelling or breathing difficulties, proceed with the operation. ② Connect the syringe to the PICC interface and attempt the aspiration operation. However, no return blood was observed, and no liquid was extracted from the lumen. ③ Utilize the three-way negative pressure aspiration principle. Use negative pressure to draw the dissolved drug (1.1% citrate sodium solution) into the PICC catheter and keep it in that position for retention. Result: After approximately 11 hours (until 9:00 on November 6th), the PICC tube was restored to normal patency, the fluid infusion was smooth, and blood return could be observed upon aspiration, with no resistance during injection. The function of the catheter was successfully restored, and no related complications occurred throughout the process. Conclusion: This case has successfully demonstrated that using a 1.1% citrate sodium solution for dissolving PICC non-thrombotic blockages caused by calcium phosphate deposits is a safe, effective and simple method for unblocking the catheter.