经外周静脉穿刺中心静脉置管的应用进展和并发症

doi:10.3969/j.issn.1009-976X.2021.03.024

摘要/Abstract

摘要： 经外周静脉穿刺中心静脉置管（PICC）已成为一项成熟的技术,在癌症患者的长期输液、化疗和紧急救治中发挥了重要作用。尽管PICC导管的材料、类型和留置方法不断改进,但仍无法避免导管相关并发症发生,如感染、深静脉血栓形成,这些因素不仅与操作者和导管护理人员的经验水平有关,还与患者自身的免疫力和基础疾病有关。因此,在置管过程、导管位置、导管护理、和留置时间和患者的满意度都是从业人员重视的方面。本文旨在对PICC的应用、与静脉输液港（Port）比较、并发症等进展进行综述。

关键词: 经外周静脉穿刺中心静脉置管（PICC）, 静脉输液港并发症（Port）, 并发症, 进展

Abstract: Peripherally inserted central catheter（PICC） has become a mature technology and played important roles in long-term infusion, chemotherapy, and emergency treatment for cancer patients. Even though, the materials and types of the catheter and indwelling method for PICC were constantly improved, catheter-related complicationssuch as infection and deep vein thrombosis cannot be avoided.These are not only related to the experience level of the operator and catheter care staff, but also related to the patient′s own immunity and underlying diseases.Therefore, the catheter placement process, catheter location, catheter care, and indwelling time and patient satisfaction are all aspects that practitioners pay attention to. This article aims to review the progress of PICC application, comparison with intravenous port （Port）, and complications.

Key words: peripherally inserted central catheter （PICC）, totally implantable central venous access （Port）, complications, progress

中图分类号:

R608

吴贝贝. 经外周静脉穿刺中心静脉置管的应用进展和并发症[J]. 岭南现代临床外科, 2021, 21(03): 359-366.

WU Bei-bei. Progress of central venous catheterization via peripheral venipuncture and complications[J]. Lingnan Modern Clinics In Surgery, 2021, 21(03): 359-366.

参考文献

[1] Tejedor SC, Tong D, Stein J, et al.Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the “idle central venous catheter”[J]. Infect Control Hosp Epidemiol, 2012, 33(1): 50-57.
[2] Periard D, Monney P, Waeber G, et al.Randomized controlled trial of peripherally inserted central catheters vs. peripheral catheters for middle duration in-hospital intravenous therapy[J]. J Thromb Haemost, 2008, 6(8): 1281-1288.
[3] Al-Asadi O, Almusarhed M, Eldeeb H.Predictive risk factors of venous thromboembolism (VTE) associated with peripherally inserted central catheters (PICC) in ambulant solid cancer patients: retrospective single centre cohort study[J]. Thromb J, 2019, 17: 2.
[4] Pu YL, Li ZS, Zhi XX, et al.Complications and Costs of Peripherally Inserted Central Venous Catheters Compared With Implantable Port Catheters for Cancer Patients: A Meta-analysis[J]. Cancer Nurs, 2020, 43(6): 455-467.
[5] Safety Committee of Japanese Society of Anesthesiologists. Practical guide for safe central venous catheterization and management 2017[J]. J Anesth, 2020, 34(2): 167-186.
[6] Schummer W, Koditz JA, Schelenz C, et al.Preprocedure ultrasound increases the success and safety of central venous catheterization[J]. Br J Anaesth, 2014, 113(1): 122-129.
[7] Troianos CA, Hartman GS, Glas KE, et al.Councils on Intraoperative Echocardiography and Vascular Ultrasound of the American Society of Echocardiography; Society of Cardiovascular Anesthesiologists. Special articles: guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists[J]. Anesth Analg, 2012, 114(1): 46-72.
[8] Perbet S, Pereira B, Grimaldi F, et al.Guidance and examination by ultrasound versus landmark and radiographic method for placement of subclavian central venous catheters: study protocol for a randomized controlled trial[J]. Trials, 2014, 15:175.
[9] Hatfield A, Bodenham A.Portable ultrasound for difficult central venous access[J]. Br J Anaesth, 1999, 82(6): 822-826.
[10] Brederlau J, Greim C, Schwemmer U, et al.Ultrasound-guided cannulation of the internal jugular vein in critically ill patients positioned in 30 degrees dorsal elevation[J]. Eur J Anaesthesiol, 2004, 21(9):684-687.
[11] Shiono M, Takahashi S, Takahashi M, et al.Current situation regarding central venous port implantation procedures and complications: a questionnaire-based survey of 11,693 implantations in Japan[J]. Int J Clin Oncol, 2016, 21(6): 1172-1182.
[12] Tippit D, Siegel E, Ochoa D, et al.Upper-extremity deep vein thrombosis in patients with breast cancer with chest versus arm central venous port catheters[J]. Breast Cancer (Auckl), 2018, 12: 1178223418771909.
[13] Tabatabaie O, Kasumova GG, Eskander MF, et al.Totally Implantable Venous Access Devices: a review of complications and management strategies[J]. Am J Clin Oncol, 2017, 40(1): 94-105.
[14] Merlicco D, Lombardi M, Fino MC.PICC-PORT: Valid indication to placement in patient with results of extensive skin burns of the neck and chest in oncology. The first case in the scientific literature[J]. Int J Surg Case Rep, 2020, 68: 63-66.
[15] Bertoglio S, Cafiero F, Meszaros P, et al.PICC-PORT totally implantable vascular access device in breast cancer patients undergoing chemotherapy[J]. J Vasc Access, 2020, 21(4): 460-466.
[16] Annetta MG, Ostroff M, Marche B, et al.Chest-to-arm tunneling: A novel technique for medium/long term venous access devices[J]. J Vasc Access, 2021, 19: 11297298211026825.
[17] Bayer O, Schummer C, Richter K, et al.Implication of the anatomy of the pericardial reflection on positioning of central venous catheters[J]. J Cardiothorac Vasc Anesth, 2006, 20(6): 777-780.
[18] Roldan CJ, Paniagua L.Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction[J]. West J Emerg Med, 2015, 16(5): 658-664.
[19] Oliver G, Jones M.ECG or X-ray as the ‘gold standard′ for establishing PICC-tip location?[J]. Br J Nurs, 2014, 23(Suppl 19): S10-16.
[20] Wirsing M, Schummer C, Neumann R, et al.Is traditional reading of the bedside chest radiograph appropriate to detect intraatrial central venous catheter position?[J]. Chest, 2008, 134(3): 527-533.
[21] Mansfield PF, Hohn DC, Fornage BD, et al.Complications and failures of subclavian-vein catheterization[J]. N Engl J Med, 1994, 331(26): 1735-1738.
[22] Connolly B, Amaral J, Walsh S, et al.Influence of arm movement on central tip location of peripherally inserted central catheters (PICCs)[J]. Pediatr Radiol, 2006, 36(8): 845-850.
[23] Gnannt R, Connolly BL, Parra DA, et al.Variables decreasing tip movement of peripherally inserted central catheters in pediatric patients[J]. Pediatr Radiol, 2016, 46(11): 1532-1538.
[24] Kleidon TM, Horowitz J, Rickard CM, et al.Peripherally Inserted Central Catheter Thrombosis After Placement via Electrocardiography vs Traditional Methods[J]. Am J Med, 2021, 134(2): e79-e88.
[25] Roldan CJ, Paniagua L.Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction[J]. West J Emerg Med, 2015, 16(5): 658-664.
[26] Funaki B.Diagnostic and interventional radiology in central venous access[J]. Semin Roentgenol, 2002, 37(4): 343-353
[27] Furlong-Dillard J, Aljabari S, Hirshberg E.Diagnostic accuracy among trainees to safely confirm peripherally inserted central catheter (PICC) placement using bedside ultrasound[J]. Br J Nurs, 2020, 29(19): S20-S28.
[28] Gekle R, Dubensky L, Haddad S, et al.Saline Flush Test: Can Bedside Sonography Replace Conventional Radiography for Confirmation of Above-the-Diaphragm Central Venous Catheter Placement?[J]. J Ultrasound Med, 2015, 34(7): 1295-1299.
[29] Duran-Gehring PE, Guirgis FW, McKee KC, et al. The bubble study: ultrasound confirmation of central venous catheter placement[J]. Am J Emerg Med, 2015, 33(3): 315-319.
[30] Chu KS, Hsu JH, Wang SS, et al.Accurate central venous port-A catheter placement: intravenous electrocardiography and surface landmark techniques compared by using transesophageal echocardiography[J]. Anesth Analg, 2004, 98(4): 910-914.
[31] Smith B, Neuharth RM, Hendrix MA, McDonnall D, Michaels AD. Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters[J]. J Electrocardiol, 2010, 43(3): 274-278.
[32] Dale M, Higgins A, Carolan-Rees G.Sherlock 3CG(®) Tip Confirmation System for Placement of Peripherally Inserted Central Catheters: a NICE Medical Technology Guidance[J]. Appl Health Econ Health Policy, 2016, 14(1): 41-49.
[33] Yuan L, Li R, Meng A, et al.Superior success rate of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement in patients with cancer: a randomized open-label controlled multicenter study[J]. PLoS One, 2017, 12(3): e0171630.
[34] Liu G, Hou W, Zhou C, et al.Meta-analysis of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement[J]. J Vasc Access, 2019, 20(6): 577-582.
[35] Patel GS, Jain K, Kumar R, et al.Comparison of peripherally inserted central venous catheters (PICC) versus subcutaneously implanted port-chamber catheters by complication and cost for patients receiving chemotherapy for non-haematological malignancies[J]. Support Care Cancer, 2014, 22(1): 121-128
[36] Chopra V, Anand S, Hickner A, et al.Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis[J]. Lancet, 2013, 382(9889): 311-325
[37] Chopra V, Flanders SA, Saint S.The problem with peripherally inserted central catheters[J]. JAMA, 2012, 308(15): 1527-1528
[38] Jones D, Wismayer K, Bozas G, et al.The risk of venous thromboembolism associated with peripherally inserted central catheters in ambulant cancer patients[J]. Thromb J, 2017, 15: 25
[39] Chopra V, Flanders SA, Saint S, et al.The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method[J]. Ann Intern Med, 2015, 163(6 Suppl): S1-S40.
[40] Schiffer CA, Mangu PB, Wade JC, et al.Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline[J]. J Clin Oncol, 2013, 31(10): 1357-1370.
[41] Sousa B, Furlanetto J, Hutka M, et al.Central venous access in oncology: ESMO clinical practice guidelines[J]. Ann Oncol, 2015, 26(Suppl 5): v152-168.
[42] Taxbro K, Hammarskjöld F, Thelin B, et al.Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial[J]. Br J Anaesth, 2019, 122(6): 734-741.
[43] Wang K, Zhong J, Huang N, Zhou Y.Economic evaluation of peripherally inserted central catheter and other venous access devices: A scoping review[J]. J Vasc Access, 2020, 21(6): 826-837.
[44] Taxbro K, Hammarskjöld F, Juhlin D, et al.Cost analysis comparison between peripherally inserted central catheters and implanted chest ports in patients with cancer-A health economic evaluation of the PICCPORT trial[J]. Acta Anaesthesiol Scand, 2020, 64(3): 385-393.
[45] Taxbro K, Berg S, Hammarskjold F, et al.A prospective observational study on 249 subcutaneous central vein access ports in a Swedish county hospital[J]. Acta Oncol, 2013, 52(5): 893-901.
[46] Aw A, Carrier M, Koczerginski J, et al.Incidence and predictive factors of symptomatic thrombosis related to peripherally inserted central catheters in chemotherapy patients[J]. Thromb Res, 2012, 130(3): 323-326.
[47] Catalano O, de Lutio di Castelguidone E, Sandomenico C, et al. Central venous device-related thrombosis as imaged with MDCT in oncologic patients: prevalence and findings[J]. Acta Radiol, 2011, 52(2): 148-154.
[48] Nifong TP, McDevitt TJ. The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters[J]. Chest, 2011, 140(1): 48-53
[49] Chopra V, Anand S, Krein SL, et al.Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence[J]. Am J Med, 2012, 125(8): 733-741.
[50] Chopra V, O′Horo JC, Rogers MAM, et al. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis[J]. Infect Control Hosp Epidemiol, 2013, 34(9): 908-918.
[51] Hammarskjold F, Berg S, Hanberger H, Taxbro K.Low incidence of arterial catheter infections in a Swedish intensive care unit: risk factors for colonisation and infection[J]. J Hosp Infect, 2010, 76(2): 130-134.
[52] Hammarskjold F, Berg S, Hanberger H, et al.Sustained low incidence of central venous catheter-related infections over six years in a Swedish hospital with an active central venous catheter team[J]. Am J Infect Control, 2014, 42(2): 122-128.
[53] Wang GD, Wang HZ, Shen YF, et al.The Influence of Venous Characteristics on Peripherally Inserted Central Catheter-Related Symptomatic Venous Thrombosis in Cancer Patients[J]. Cancer Manag Res, 2020, 12: 11909-11920.
[54] Song L, Li X, Guo Y, et al.Malposition of peripherally inserted central catheter: experience from 3012 cancer patients[J]. Int J Nurs Pract. 2014, 20(4): 446-449.
[55] Gallieni M, Pittiruti M, Biffi R.Vascular access in oncology patients[J]. CA Cancer J Clin, 2008, 58(6): 323-346.
[56] Evans RS, Sharp JH, Linford LH, et al.Risk of symptomatic DVT associated with peripherally inserted central catheters[J]. Chest, 2010, 138(4): 803-810.
[57] Liu H, Yuan H, Wang Y, et al.Prediction of venous thromboembolism with machine learning techniques in young-middle-aged inpatients[J]. Sci Rep, 2021, 11(1): 12868.
[58] Grove JR, Pevec WC.Venous thrombosis related to peripherally inserted central catheters[J]. J Vasc Interv Radiol, 2000, 11(7): 837-840.
[59] Evans RS, Sharp JH, Linford LH, et al.Reduction of peripherally inserted central catheter-associated DVT[J]. Chest, 2013, 143(3): 627-633.
[60] Cotogni P, Pittiruti M.Focus on peripherally inserted central catheters in critically ill patients[J]. World J Crit Care Med, 2014, 3(4): 80-94.
[61] Lee AY, Levine MN, Butler G, et al.Incidence, risk factors, and outcomes of catheter-related thrombosis in adult patients with cancer[J]. J Clin Oncol, 2006, 24(9): 1404-1408.
[62] Kim K, Kim Y, Peck KR.Previous peripherally inserted central catheter (PICC) placement as a risk factor for PICC-associated bloodstream infections[J]. Am J Infect Control, 2020, 48(10): 1166-1170.
[63] Cheng YJ, Liu ZH, Yao FJ, et al.Current and former smoking and risk for venous thromboembolism: a systematic review and meta-analysis[J]. PLoS Med, 2013, 10(9):e1001515.
[64] Blom JW, Vanderschoot JP, Oostindiër MJ, et al.Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study[J]. J Thromb Haemost, 2006, 4(3):529-535.
[65] Karthaus M, Kretzschmar A, Kröning H, et al.Dalteparin for prevention of catheter-related complications in cancer patients with central venous catheters: final results of a double-blind, placebo-controlled phase III trial[J]. Ann Oncol, 2006, 17(2):289-296.
[66] Young AM, Billingham LJ, Begum G, et al.Warfarin thromboprophylaxis in cancer patients with central venous catheters (WARP): an open-label randomised trial[J]. Lancet, 2009, 373(9663):567-574.
[67] Lv S, Liu Y, Wei G, et al.The anticoagulants rivaroxaban and low molecular weight heparin prevent PICC-related upper extremity venous thrombosis in cancer patients[J]. Medicine (Baltimore), 2019, 98(47):e17894.
[68] Akl EA, Ramly EP, Kahale LA, et al. Anticoagulation for people with cancer and central venous catheters [J]. Cochrane Database Syst Rev, 2014,10: CD006468.
[69] Kahale LA, Tsolakian IG, Hakoum MB, et al. Anticoagulation for people with cancer and central venous catheters [J]. Cochrane Database Syst Rev, 2018, 6(6):CD006468.
[70] Lyman GH, Carrier M, Ay C, et al.American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer[J]. Blood Adv, 2021, 5(4): 927-974.
[71] Safdar N, Maki DG.Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients[J]. Chest, 2005, 128(2): 489-495.
[72] Gahlot R, Nigam C, Kumar V, et al.Catheter-related bloodstream infections[J]. Int J Crit Illn Inj Sci, 2014, 4(2): 162-167.
[73] McGee DC, Gould MK. Preventing complications of central venous catheterization[J]. N Engl J Med, 2003, 348(12): 1123-1133.
[74] Cobb DK, High KP, Sawyer RG, et al.A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters[J]. N Engl J Med, 1992, 327(15): 1062-1068.
[75] Park S, Moon S, Pai H, Kim B.Appropriate duration of peripherally inserted central catheter maintenance to prevent central line-associated bloodstream infection[J]. PLoS One, 2020, 15(6): e0234966.
[76] He K, Wan Y, Xian S.Risk analysis on infection caused by peripherally inserted central catheter for bone tumor patients[J]. J Cancer Res Ther, 2018, 14(1):90-93.
[77] Ullman AJ, August D, Kleidon T, et al.Peripherally Inserted Central catheter iNnovation to reduce Infections and Clots (the PICNIC trial): a randomised controlled trial protocol[J]. BMJ Open, 2021, 11(4): e042475.