2014贝朗BCP组靶向定位用心呵护——贝朗舒途坦PICC腔内心电定位技术介绍1导管头端定位技术的发展内容①②舒途坦ECG定位技术的优势③舒途坦导管的特点和带给临床的益处2导管头端定位技术的发展内容①②舒途坦ECG定位技术的优势③舒途坦导管的特点和带给临床的益处3PICC置入途径及头端位置静脉直径血流量头静脉6mm40ml/min贵要静脉8mm95ml/min腋静脉16mm333ml/min锁骨下静脉19mm800ml/min无名静脉19mm800ml/min上腔静脉20-30mm2000-2500ml/min肘正中静脉锁骨下静脉腋静脉①贵要静脉肱静脉③头静脉②肘正中静脉4上腔静脉下1/3段，靠近右心房交界处（需垂直悬于上腔静脉中）头端位于此处的好处：•血流量大，能确保药物迅速稀释而不造成血管损伤•并发症少，保障患者安全PICC导管头端最佳位置5上腔静脉的生理解剖上腔静脉(SVC)•长度5~11cm，平均7cm•宽度2~3cm6上腔静脉与右心房交界处在哪？上腔静脉与右心房交界处(CAJ)?7位于SVC中上段废管静脉血栓胸腔积液炎症导管移位回血堵管静脉壁腐蚀静脉穿孔PICC导管头端位置过浅与并发症的关系8头端位置过浅所致并发症的参考文献•SchwarzR,CoitD&GroegerJ.Transcutaneouslytunneledcentralvenouslinesincancerpatients:ananalysisofdevice-relatedmorbidityfactorsbasedonprospectivedatacollection.AnnalsofSurgicalOncology,2000,7(6):441–449.•CadmanA,LawranceJ,FitzsimmonsL,etal.Toclotornottoclot?Thatisthequestionincentralvenouscatheters.ClinicalRadiology,2004,59:349–355.•SivasubramaniamS&HiremathM.Centralvenouscatheters:Doweneedtoreviewpracticeonpositioning?JICS,2008,9(3):228-231.•FlectcherS&BodenhamA.Safeplacementofcentralvenouscatheters:whereshouldthetipofthecatheterlie?BritishJournalofAnaesthesia,2000,85(2):188-191.•FioravantiJ,BuzzardCJ,HarrisJP.Pericardialeffusionandtamponadeasaresultofpercutaneoussilasticcatheteruse.NeonatalNetwork,1998,17(5):39-42.•PuelV,CaudryM,LeMétayerP,etal.Superiorvenacavathrombosisrelatedtocathetermalpositionincancerchemotherapygiventhroughimplantedports.Cancer,1993,72(7):2248-2252.•KurekciE,KayeR&KoehlerM.Chylothoraxandchylopericardium:Acomplicationofacentralvenouscatheter.JournalofPediatrics,1998,132:1064–1066.9位于右心房心包填塞甚至死亡静脉血栓肺栓塞心律失常心肌穿孔心包积液心内膜炎心房血栓静脉血栓瓣膜损伤PICC导管头端位置过深与并发症的关系10头端位置过深所致并发症的参考文献•FuchsS,PollakA&GilonD.Centralvenouscathetermechanicalirritationoftherightatrialfreewall:acauseforthrombusformation.Cardiology,1999,91:169–172.•NadrooAM,LinJ,GreenRS,etal.Deathasacomplicationofperipherallyinsertedcentralcathetersinneonate.JournalofPediatrics,2001,138:599-601.•FioravantiJ,BuzzardCJ,HarrisJP.Pericardialeffusionandtamponadeasaresultofpercutaneoussilasticcatheteruse.NeonatalNetwork,1998,17(5):39-42.•NowlenTT,RosenthalGL,JohnsonGL,etal.Pericardialeffusionandtamponadeininfantswithcentralcatheters.Pediatrics,2002,110:137–142.•FlectcherS&BodenhamA.Safeplacementofcentralvenouscatheters:whereshouldthetipofthecatheterlie?EditorialII,BritishJournalofAnaesthesia,2000,85(2):188-191.•SivasubramaniamS&HiremathM.Centralvenouscatheters:Doweneedtoreviewpracticeonpositioning?JICS,2008,9(3):228-231.•GebhardR,SzmukP,PivalizzaE,etal.Theaccuracyofelectrocardiogram-controlledcentrallineplacement.AnesthAnalg,2007,104(1):65–70.•KalenV,MedigeTA,Rinskyla.Pericardinaltamponadesecondarytoperforationbycentralvenouscathetersinorthopaedicpatients.JBoneJointSurgAm,1991,73:1503-1506.•KowalskiC,KaufmanJ,RivitzM,etal.Migrationofcentralvenouscatheters:implicationsforinitialcathetertippositioning.JVIR,1997,8:443-447.•VeselyT.Ce...
