| Background More and more PICCs (Peripherally Inserted Central Catheters) have been widely used in clinical patients because of long-term indwelling catheters. Complications associated with PICC have been the focus of clinical research. The literature retrieval found the research about PICC care was more in the prevention of complications, but the research of inserted length and tip position were relatively few. Especially the research is less how to choose reasonable tips landmark of PICC to determine the optimal location. So it has the same important significance to pay more attention to inserted length and tips position of PICC in reducing the complications associated with PICC.Objective To explore the clinical application of thoracic vertebrae and carina as radiographic tips landmark of PICC; To evaluate the relation between the optimal inserted length and the heigh in adult patients with PICCs, and investigate the tips position. It will provide scientific evidence for clinical PICC special nurses; To analysis the correlation between the optimal inserted length and the measurement length, in order to make out a more accurate method of the length of PICCs placement.Methods The research consisted of two parts, adopting retrospective study method. A epidemiology quasi-experiment design was conducted among the convenient sample of liver transplantation adult patients with PICCs aged above20years from August2008to October2011hospitalized in the transplant research institute of the Chinese people’s armed police force general hospital.Part one:the clinical data of200adult patients were invested. The three groups are divided into according to height of patients:A150-160cm, B161-170cm, C171-180cm. Two experienced X-Ray technicians worked above5years analysized the tips position by Anteroposterior (AP) chest radiograph (CXR),with thoracic vertebrae as PICC location landmark. We input the collected data into the computer, and analyzed the optimal inserted length and tips position of200adult patients by SPSS12.0statistic software, we made some compares among three groups, including between the left and right arm in the same group. We compared the optimal inserted length on the left and right arm with two-sample t-test; we compared the tip position with chi-square test and Fisher probabilities in2×2table, bilateral inspection level a=0.05.Part two:The clinical data of patients in the same period were Collected. The body surface measure length (X) of181patients with PICCs were surveyed. According to the different puncture position,181cases were divided into six groups:basilic vein,cephalic vein,median cabital vein on the the right and on the left. Two experienced X-Ray technicians worked above5years measured the optimal inserted depth (Y)by Anteroposterior (AP) chest radiograph (CXR) with carina as PICC location landmark on the day of PICCs to be inserted. We input the collected data into the computer, and analyzed the relation between the optimal inserted depth and the body surface measure length (X) of181patients by SPSS12.0statistic software with Pearson correlation analysis and regression analysis.Results Part one:Among the200patients, male patients:160(80%); female patients:40(20%). age:22～80, average age:51.84±10.49. The optimal inserted lengthth: group A:left45.60±2.68cm, right43.20±1.75cm; group B: left48.44±1.98cm, right45.18±2.75cm; group C:left50.95±2.72cm, right47.90±1.65cm.The tips position of PICC among the three groups is no difference (p>0.05); there is no difference on the left and right tip position In the same group (p>0.05). Incidence of malpositioning was more on the right (9.1%) than on the left (4.9%). Incidence of high position in group A (10%) was less than group B (23.7%) and group C (17.8%); Incidence of low position in group A (13.3%) was more than group B (10%) and group C (5.5%). Incidence of malpositioning in group B (2.5%) was the least. Incidence of malpositioning in group C (10%) was the most, more than group A (6.7%) and group B (2.5%); Incidence of low position in group A (5.5%) was the least.Part two:Among the200patients, male patients:145(80.1%), female patients:36(19.9%). age:22～80, average age:51.33±10.24. The body surface inserted length of six groups:38～58cm, average length:47.13±3.45cm. The optimal inserted length:41～53cm, average length:49.67±2.85cm. Regression equation:right basilic vein:Y=-3.402+1.148X; right cephalic vein:Y=18.892+0.658X; right median cabital vein:Y=25.424+0.503X; left basilic vein:Y=12.687+0.785X; left cephalic vein:Y=28.018+0.457X; left median cabital:Y=16.580+0.707X. Incidence of malpositioning in group right cephalic vein (20%) was the most. Incidence of malpositioning in group basilic vein (4.2%) was the least, less than group cephalic vein (13.5%) and group median cabital (7.9%). Incidence of malpositioning in group cephalic vein (13.5%) was the most.Conclusions Part one:The inserted length of the optimal position is related to the height of the patients with PICC. The tips position in different height patients is no difference, as well as on the left and right. Incidence of malpositioning is more in right-sided catheters. Incidence of malpositioning was the least in medium level height group. Incidence of low position was the most in low height group, and incidence of high position was the least Incidence of low position was the least in high height group, and incidence of malpositioning was the most. Patients are supposed to turn their heads in the right once the intubation of PICC is carried out on the right side, which could prevent internal jugular vein and brachiocephalic vein in one straight line.Part two:There is depth correlation between the body surface measurement length of PICC and the optimal inserted length. The correlation of basilic vein on the right is the best. The regression equations have certain clinical significance through the clinical small sample test of30patients, and needs to be further tested and calibrated by expanded sample size. Incidence of malpositioning was the most on the right cephalic vein. Incidence of malpositioning was the the least in the basilic vein, and the most in the cephalic vein. To choose peripherally inserted vein, basilic vein should be choose first, second median cabital vein, third cephalic vein. Patients are supposed to turn their heads in the right once the intubation of PICC is carried out on the right side, which could prevent internal jugular vein and brachiocephalic vein in one straight line. |
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