Yufang Gao,1,* Yuxiu Liu,1,2,* Hui Zhang,1,* Fang Fang, 3 Lei Song4 1 Ofishin Gudanar da Asibiti, Asibitin Hade na Jami'ar Qingdao, Qingdao, Sin;2 Sashen Nursing na Jama'a, Makarantar Nursing, Weifang Medical University, Weifang;3 Sashen Nazarin Jiki, Asibitin Haɗin Kan Jami'ar Qingdao, Qingdao, Jamhuriyar Jama'ar Sin;4 Sashin kulawa mai zurfi, Asibitin da ke da alaƙa na Jami'ar Qingdao, Qingdao, Jamhuriyar Jama'ar Sin yana da mahimmanci don amfani da catheters.Hoton X-ray na ƙirji da aka yi bayan tiyata, waɗanda sune ayyukan “daidaitan gwal” da aka gane ta hanyar tukwici na PICC, na iya haifar da jinkiri mai yawa a cikin jiyya na IV ga marasa lafiya, farashi mai girma, da haifar da fallasa hasken radiation ga marasa lafiya da ma'aikata.Intracavitary electrocardiogram (IC-ECG) Jagorar PICC jeri yana ba da saƙon lokaci na gaske yayin aiwatar da shigarwa don tabbatar da cewa an yi amfani da shi sosai.Duk da haka, ga marasa lafiya tare da ECG na jikin jiki mara kyau, kamar marasa lafiya da ke da fibrillation (AF), ba a ba da rahoton aminci da daidaito na ECG ba.Makasudi: Don ƙayyade aminci da daidaiton fasahar IC-ECG a cikin tabbatar da matsayi na PICC na marasa lafiya AF.Marasa lafiya da hanyoyin: An gudanar da wani bincike na ƙungiyar a wani asibitin koyarwa da manyan asibitoci masu gadaje 3,600 a Qingdao, Jamhuriyar Jama'ar Sin.Binciken ya ɗauki manya marasa lafiya tare da AF wanda ke buƙatar jiko na PICC daga Yuni 2015 zuwa Mayu 2017. Ga kowane mai haƙuri na AF da aka haɗa, an yi amfani da ECG don gano matsayi na PICC a lokacin catheterization, kuma an yi haskoki na X don tabbatar da cewa matsayi mafi girma. shine "ma'aunin zinariya" bayan shigar da PICC.Kwatanta tasiri da daidaito na ECG-shiryarwar tukwici na tukwici da tabbatar da X-ray na kirji.Sakamako: Jimlar 118 PICCs an yi rajista a cikin marasa lafiya 118 masu fama da fibrillation (maza 58 da mata 60, masu shekaru 50-89).Babu wasu matsalolin da suka shafi catheterization.Lokacin da catheter ya shiga ƙananan 1/3 na maɗaukakin vena cava, girman girman f ɗin ya kai iyakarsa.Babu wani bambance-bambance na ƙididdiga tsakanin tabbatar da matakin tip na X-ray PICC da kuma IC-ECG PICC tip matsayi a cikin marasa lafiya na AF (χ2=1.31, P=0.232).Yin amfani da madaidaicin yanke na f canjin kalaman ≥ 0.5 cm, an lura cewa hankali shine 0.94, ƙayyadaddun ƙayyadaddun shine 0.71, ƙimar tsinkayar tabbatacce shine 0.98, kuma ƙimar tsinkaya mara kyau shine 0.42.Wurin da ke ƙarƙashin madaidaicin yanayin aiki mai karɓa shine 0.909 (95% CI: 0.810-1.000).Kammalawa: Fasahar jagorar ECG wata fasaha ce mai aminci da inganci wacce za a iya amfani da ita don tabbatar da matsayin PICC tip na marasa lafiya na AF, kuma yana iya kawar da buƙatar X-ray na ƙirji a cikin marasa lafiya na AF.Mahimman kalmomi: catheter na tsakiya na tsakiya, PICC, matsayi na tip, electrocardiogram, electrocardiogram, marasa lafiya tare da fibrillation
Madaidaicin matsayi na gefen catheter na tsakiya (PICC) yana da mahimmanci don kauce wa rikice-rikice masu alaka da catheter kamar ƙaura, thrombosis venous, ko arrhythmia.1 PICC tip matsayi, X-ray kirji na baya, electrocardiogram (ECG), da wasu sun ruwaito sabbin fasahohi, irin su Sherlock 3CG® Tip Confirmation System (Bard Access Systems, Inc., Salt Lake City, UT, USA), wanda ke haɗa Magnetic. bibiya da fasahar tabbatar da tukwici na tushen ECG 2 da tsarin waya mai sarrafa wutar lantarki.3
X-ray na ƙirji ita ce hanyar da aka fi amfani da ita don tabbatar da matsayin tip ɗin PICC kuma ana ba da shawarar azaman ma'aunin gwal.4 Ɗaya daga cikin iyakancewar haskoki na X-ray shine tabbatarwa bayan tiyata na iya haifar da jiyya (IV).5 Bugu da ƙari, idan an gano matsayi na tip na PICC ba daidai ba ta hanyar X-ray bayan tiyata, aikin catheter da ray na kirji yana buƙatar sake maimaitawa, wanda zai haifar da jinkiri a cikin jiyya da ƙarin amfani da lokaci, da kuma ƙara farashi.Bugu da ƙari, tun lokacin da aka katse mutuncin suturar, matsalolin na iya faruwa, ciki har da cututtuka masu alaka da catheter.6,7 Ƙarin ƙarin lokaci, farashi, da kuma bayyanar radiation da ke cikin ƙima na rediyo sun haifar da PICCs waɗanda kawai za a iya sanya su a asibitoci.1
An fara ba da rahoton dabarar ECG don saka tip na tsakiyar venous catheter (CVC) a cikin 1949. 8 Intracavitary ECG-guided PICC jeri yana ba da tabbacin tip na ainihin lokacin lokacin sakawa.Akwai ƙara shaida cewa sakawa PICC jagorar ECG na iya zama daidai kamar hanyoyin X-ray.5,9-11 Bita na tsari na Walker ya nuna cewa matsayi na tushen ECG na iya kawar da buƙatar haskoki na kirji na baya, musamman a lokacin shigar da layin PICC.6 ECG
Matsayin tukwici na PICC yana fayyace cikin ainihin lokacin catheterization, ba tare da daidaitawa ba ko sakewa.Ana iya amfani da PICC nan da nan bayan sanyawa ba tare da jinkirta jinkirin haƙuri ba.9
Matsakaicin halin yanzu na wurin tukwici na PICC shine kashi ɗaya bisa uku na mafi girman vena cava (SVC) da madaidaicin vena cava-atrial junction (CAJ).10,11 Yayin da tip na PICC ke gabatowa kumburin sinus a CAJ, igiyar P ta fara tashi kuma ta kai iyakar girmanta a CAJ.Yayin da yake wucewa ta hanyar atrium na dama, igiyar P ta fara juyawa, yana nuna cewa an saka PICC da nisa.Madaidaicin matsayi na PICC shine matsayi inda ECG ke nuna girman P mafi girma.Tunda matsayi na tip na PICC a ƙarƙashin jagorancin ECG ana ɗaukar lafiya, abin dogara, kuma hanyar da za a iya sake sakewa, za a iya amfani da shi a cikin marasa lafiya tare da fibrillation (AF) ba tare da raƙuman P a cikin ECG ba?Ƙungiyar binciken mu ta fito ne daga Asibitin Haɗin gwiwa na Jami'ar Qingdao kuma tana saka kusan PICC 5,000 kowace shekara.Ƙungiyar binciken ta himmatu wajen nazarin PICCs.A yayin binciken mu, mun gano cewa f kalaman na marasa lafiya na AF yayin tsarin sakawa na PICC shima yana da wasu canje-canje a bayyane.Don haka tawagar ta binciki wannan.
An gudanar da wannan binciken na ƙungiyar da ke da alaƙa a Asibitin haɗin gwiwa na Jami'ar Qingdao, wani babban asibiti mai ba da shawara da fiye da gadaje 3,600 daga Yuni 2015 zuwa Mayu 2017. Kwamitin nazarin cibiyoyi na Cibiyar Nazarin Jami'ar Qingdao ya sake duba shirin binciken kuma ya amince da shi ( lambar yarda QDFYLL201422).Duk majinyatan da suka yi rajista sun sanya hannu a rubuce-rubucen izini.
Ma'auni na haɗawa sune kamar haka: 1) Marasa lafiya da ke buƙatar PICC, wanda ECG ya nuna alamar AF kafin shigar da PICC;2) Sama da shekaru 18;3) Marasa lafiya na iya jure wa gwajin X-ray.Sharuɗɗan keɓancewa sune kamar haka: 1) Marasa lafiya da cututtukan tunani ko fata;2) Marasa lafiya tare da na'urorin bugun zuciya;3) Marasa lafiya suna amfani da kowane nau'in catheters 4) Marasa lafiya masu rashin lafiyar barasa da iodophor.
An saka PICC a ƙarƙashin jagorar duban dan tayi ta kwararrun ma'aikatan jinya na PICC ƙarƙashin ingantattun yanayin rashin lafiya.Faransanci guda huɗu (Fr) guda-lumen distal silicone Bard Groshong® PICC (Bard Access Systems, Inc.) an yi amfani da su a cikin binciken.Ana amfani da Bard Site Rite 5 Ultrasound Machine Ultrasound System (Bard Access Systems, Inc.) don aunawa da kimanta jijiya masu dacewa a wurin shigarwa.Ana saka duk PICCs ta amfani da Groshong® NXT ClearVue ta hanyar ingantaccen fasahar Seldinger.Bayan shigar da bututu, kurkura duk PICC tare da 10 ml na saline na al'ada, kuma rufe ƙofar catheter tare da sutura bayan tsabtace fata.Bincika haskoki na ƙirji akai-akai don tabbatar da matsayin tip ɗin catheter.10
Bisa ga Ƙungiyar Ƙwararrun Ƙwararrun Jiko, wurin da aka ba da shawarar yana samuwa a cikin ƙananan uku na SVC kusa da ƙofar dama na atrium.11 Bisa ga rahotanni, kimanin 4 cm (95% CI: 3.8-4.3 cm) a ƙasa da carina a tip na CVC zai haifar da sanyawa kusa da CAJ.Matsakaicin tsayin SVC shine 7.1 cm.12 A cikin wannan binciken, mun yi amfani da hanyar X-ray a matsayin "ma'auni na zinariya" don tabbatar da matsayi na tip na PICC.A lokacin gwajin X-ray, duk marasa lafiya sun kasance a cikin tsaka-tsakin tsaka-tsakin tsaka-tsaki, tare da hannayensu kai tsaye zuwa jiki, kuma ba su yi numfashi da wuya ba don kauce wa yiwuwar ɓarna saboda matsayi ko ƙarfin numfashi.Muna amfani da carina azaman alamar yanayin jiki daga inda zamu auna tip ɗin PICC.A cikin bincikenmu, an kiyasta matsayi mafi kyau shine 1.6-4 cm a ƙasa da carina.12,13 X-ray bayanai an kimanta ta 2 masanan rediyo daban.Idan hukunce-hukuncen ba su dace ba, likitan rediyo na uku zai kara duba sakamakon X-ray kuma ya tabbatar da shawarar.
An samo ECG da ke ƙarƙashin binciken ta hanyar abin da ake kira "dabarun saline", wanda ke amfani da ginshiƙi na maganin salin da ke ƙunshe a cikin catheter a matsayin electrode na intraluminal.13 Braun® transducers da sauyawa don sauyawa daga yanayin ECG na jiki zuwa intracavity ECG (IC-ECG) tracking an yi amfani da su a cikin binciken.Na'urorin lantarki guda uku (hannun dama [RA], hannun hagu da ƙafar hagu) suna haɗe zuwa gubar II.Lokacin da tip na catheter ya shiga cikin SVC, haɗa catheter zuwa mai haɗawa na transducer, sa'an nan kuma ci gaba da ba da salin al'ada ta hanyar PICC.Electrocardiogram na marasa lafiya tare da fibrillation na atrial yana nuna f raƙuman ruwa maimakon raƙuman P.Tare da zurfafa tip na catheter, f taguwar kuma ta sami wani canji.Lokacin da catheter ya shiga cikin SVC, f wave ya zama mafi girma, kama da canjin P wave, wato, lokacin da catheter ya shiga cikin SVC, girman f wave yana karuwa a hankali.Lokacin da catheter ya shiga ƙananan 1/3 na SVC, f-wave amplitude ya kai matsakaicin darajarsa, kuma lokacin da catheter ya shiga dama atrium, f-wave amplitude yana raguwa.
Ga kowane shigar PICC, tattara bayanan masu zuwa: 1) Bayanan mara lafiya, gami da shekaru, jinsi, ganewar asali,
Lokacin aikawa: Dec-20-2021