关键词: 经外周穿刺中心静脉置管（PICC）, 困难静脉通路（DIVA）, 心脏移植

Abstract: Objective To investigate the reasons for the difficulty in delivery of a high-pressure-resistant dual-chamber PICC in patients after heart transplantation, and to provide corresponding countermeasures to improve the success rate of delivery. Methods A retrospective analysis of the causes and countermeasures of difficulty in delivery of a high-pressure PICC after heart transplantation. Results Five of 23 patients with catheterization after heart transplantation had difficulty in delivery. Among them, two cases of difficulty in delivery were caused by stenosis and malformation caused by venous scars, one case was abnormal vein anatomy, and left brachiocephalic vein was cut during transplantation; one case was due to positional factors or catheter factors or hemodynamic factors; one case was not found for specific reasons. Conclusion In the case of difficult tube delivery in post-transplant cardiac patients, in addition to considering the patient's venous condition, body position placement, and the material of the catheter itself, the hemodynamic changes in the postoperative patient should not be ignored. In order to reduce the occurrence of difficult tube delivery, pre-tubing venous assessment should be done adequately to exclude malformations and stenosis. Therefore, it is particularly important to know the patient's trauma history, surgical history, intraoperative conditions, and to review previous CT findings.

Key words: peripherally inserted central catheter（PICC）, difficult intravenous access（DIVA）, heart transplantation