Application Effect Of Ultrasound Probe Internal Jugular Vein Occlusion Combined With ECG Positioning In PICC Catheterization In Neurologically Critical Patients

Objective:The purpose of this study was to investigate the effect of ultrasound probe internal jugular vein occlusion method combined with ECG positioning on PICC catheterization in patients with severe neurological disease who established artificial airway in catheterization operation time,artificial airway balloon pressure,airway secretion pepsin content,The application effect of the success rate of first catheterization,catheter tip placement rate,and related complications after catheterization.Methods:This study was conducted in the neurosurgery ICU of a tertiary hospital in Changchun from December 2020 to December 2021.A total of 120 patients who met the inclusion criteria and required PICC catheterization due to treatment were recruited and randomly divided into groups according to the random number table method,with 60 patients in each group.The intervention group used ultrasound probe internal jugular vein occlusion method combined with ECG positioning for PICC catheterization,while the control group used conventional head tilt method combined with X-ray positioning for PICC catheterization.The general data and related outcome indicators of the patients were collected and recorded before,during and after the catheterization operation.In this study,IBM SPSS Statistics 24.0 software was used for statistical analysis of the data.The measurement data conforming to the normal distribution were described by the mean and standard deviation,and the non-normal distribution measurement data were described by the median and quartile.The count data uses frequency and composition ratio to describe the results.The t-test was used to compare the quantitative data between two independent samples in accordance with the normal distribution,and the non-parametric rank-sum test was used for the non-normal distribution.The chi-square test was used to compare the count data of two independent samples between groups.Repeated measures ANOVA was used for repeated measures data.A P<0.05 difference was considered to be statistically significant.Results:1.The general information of the study subjects included age,gender,type of medical insurance,type of disease,artificial airway,Glasgow Coma Score（GCS）,implanted lumen,implanted blood vessel,implanted site,implanted length.There was no statistical difference in the general data of the two groups of patients（P>0.05）,and they were comparable.2.Changes of artificial airway balloon pressure in two groups of patients at different time points(P_d1<0.001,P_d2=0.001,P_d3=0.022)and differences of pepsin content in airway secretions before and after intubation（P<0.001）are statistically significant.There were statistically significant differences between the two groups in the success rate of the first catheterization（P=0.004）,the catheter tip placement rate（P=0.025）,and the degree of bleeding at the puncture point on the 7th day after catheterization（P<0.001）.3.There were no statistical difference among the operation time of catheterization（P=0.384）,the balloon pressure（P=0.303）,the degree of bleeding at the puncture point on the 2nd day after catheterization（P=0.092）,and the phlebitis within 7 days（P=1.000）,catheter blockage（P=1.000）between the two groups.Conclusion:Compared with the conventional head tilt method combined with X-ray positioning for PICC catheterization,the catheterization method of ultrasound probe internal jugular vein occlusion method combined with ECG positioning can reduce the degree of change in artificial airway balloon pressure during catheterization,and reduce the risk of increased pepsin content in airway secretions reduces the risk of aspiration due to postural changes in neurologically critical patients with artificial airway established during intubation.In addition,the success rate of the first catheter placement and the placement rate of the catheter tip are improved,the accuracy of catheter placement is increased,and the degree of bleeding at the puncture point on the 7th day after catheter placement can be reduced.However,no clear advantages were found in terms of catheterization time,balloon pressure values,degree of puncture site oozing on the 2nd day after catheterization,phlebitis within 7 days,and catheter blockage.In general,the catheterization method of ultrasound probe internal jugular vein occlusion method combined with ECG positioning can enhance the safety and effectiveness of catheterization,especially for patients with severe neurological disease who are difficult to cooperate with conventional head tilt position.The scientific catheter placement method is recommended to be applied in clinical PICC placement.