OBJECTIVE: To explore the application value of blunt separation method in the modified sytinger technology peripherally inserted central catheter (PICC) catheterization in the hemopathic patients. METHODS: One hundred and twenty cases of the hemopathic diseases used modified sytinger technology PICC catheterization were selected from January 2016 to July 2017 in our Hospital, and randomly divided into blunt and routine group, each with 60 patients. For the routine group, the routine longitudinal method was used to expand the skin, for the blunt group the blunt separation method was used to expand the skin. RESULTS: At the time point of 24 h after the blunt catheterization, the bleeding volume and exudation rate in the blunt group were significantly lower than those in the rouline group (P<0.05). At the 1, 3, 5 d after catheterization, pain visual analogue score (VAS) showed that the scores of blunt group were significantly lower than those of the routine group (P<0.05). in expanding skin, the successful rate of catheterization once in blunt group and routine group were not significantly different (P>0.05). CONCLUSIONS Compared with the longitudinal method, the blunt separation method has considerable skin expansion and sheath feeding effect on the modified sytinger technology PICC catheterization for the hemopathic patients. This method can effectively reduce the patient's catheter trauma and percolation, and is helpful to relieve the patients' pain symptoms, worthing for further clinical promotion.
Catheterization, Central Venous ; Catheterization, Peripheral ; Humans

Catheterization, Central Venous ; Catheterization, Peripheral ; Humans ; Pleural Effusion

In thromboangiitis obliterans (Buerger's disease), little progress has been made in its treatment. Medical treatment is ineffective and bypass surgery is possible only in limited case. Nowadays, endovascular intervention is popular treatment option for Buerger's disease. Endovascular procedure is safe, technically feasible, and effective. Especially, in long occlusion lesion with distal channel, endovascular intervention can be an effective treatment option. Herein, we report a case of complete wound healing following the successful endovascular intervention in Buerger's disease patient with distal channel.
Catheterization, Peripheral ; Endovascular Procedures ; Humans ; Ischemia ; Thromboangiitis Obliterans* ; Wound Healing

OBJECTIVETo review the cannulation strategies and associated vascular complications of extracorporeal membrane oxygenation (ECMO) and to investigate the etiology and preventive procedures for those complications.

METHODSFrom January 2007 to December 2011, 34 patients (21 male and 13 female patients, aged from 23 to 66 years) underwent ECMO support through open approach, semi-Seldinger method or full Seldinger method of cannulation. Bleeding and limb ischemia related to the approach as major complications were retrospectively analyzed.

RESULTSThe ECMO duration were 2 to 21 days. Twenty-four patients (70.6%) successfully weaned from ECMO and 18 patients (52.9%) discharged. The venoarterial mode was used in 26 patients, and venovenous mode in 8 patients. Eight patients (30.8%, 6 for open approach and 2 for semi-seldinger) observed with limb ischemia, 2 of them required amputation, 1 had claudicatory sequela. Eleven and 6 patients suffered from bleeding and vessel injury respectively, all of them recovered by suitable treatment.

CONCLUSIONSThe proper size of cannula, optimal approch and position adjustment, accurate cannula placement and carefully attendance are the key points to decrease the cannulation related complications.

Amputation ; Catheterization, Peripheral ; Extracorporeal Membrane Oxygenation ; Humans ; Ischemia ; Retrospective Studies

OBJECTIVETo evaluate the feasibility and safety of the peripherally inserted central catheters (PICC) as a venous access for newborns who need a long-term venous transfusion.

METHODSSixty-five newborns receiving PICC and 80 newborns receiving peripheral intravenous catheters (PIV) from April 2006 to February 2008 were included in this study. A retrospective cohort study was used to compare the indwelling time of catheters, catheter-related mechanical complications, the incidence of sepsis, and the mortality between the two groups.

RESULTSThe indwelling time of catheters in the PICC and the PIV groups was 18.75+/-7.62 days (range:7-62 days) and 1.49+/-0.57 days (range: 30 minutes to 4 days) respectively. The indwelling time of catheters in the PICC group was significantly longer than that in the PIV group (<0.01). The incidence of catheter-related mechanical complications in the PICC group was significantly lower than that in the PIV group (27.7% vs 63.8%; <0.01). There were no significant differences in the incidence of sepsis and the mortality between the two groups.

CONCLUSIONSThe application of PICC can cause a decrease in the number of venous puncture. PICC is a safe and effective venous access in newborns.

Catheterization, Central Venous ; adverse effects ; Catheterization, Peripheral ; adverse effects ; Humans ; Infant, Newborn ; Sepsis ; etiology ; Time Factors

OBJECTIVETo study the efficiency of electrocardiogram (ECG) monitor for positioning the catheter tip in the placement of peripherally inserted central catheter (PICC) in neonates.

METHODSA total of 160 neonates who were admitted to the neonatal intensive care unit (NICU) from January 2015 to December 2017 and underwent the PICC placement via the veins of upper extremity were enrolled. They were randomly divided into an observation group and a control group, with 80 neonates in each group. The neonates in the control group were given body surface measurement and postoperative X-ray localization, while those in the observation group were given body surface measurement, ECG localization, and postoperative X-ray localization. The two groups were compared in terms of general information, one-time success rate of PICC placement, and time spent on PICC placement.

RESULTSThere were no significant differences between the two groups in sex composition, gestational age, age in days at the time of PICC placement, disease type, and site of puncture (P>0.05). Compared with the control group, the observation group had a significantly higher one-time success rate of PICC placement (95% vs 79%; P<0.05) and a significantly shorter time spent on PICC placement (P<0.05). Localization under an ECG monitor during PICC placement had a sensitivity of 97% and a specificity of 100%.

CONCLUSIONSDuring the PICC placement in neonates, the use of ECG monitor to determine the position of catheter tip can improve the one-time success rate of placement and reduce the time spent on placement.

Catheterization, Central Venous ; instrumentation ; Catheterization, Peripheral ; methods ; Catheters, Indwelling ; Electrocardiography ; instrumentation ; Female ; Humans ; Infant, Newborn ; Male

OBJECTIVE: To investigate the effect of placement of peripherally inserted central catheter (PICC) via the upper versus lower extremity veins in neonates through a Meta analysis. METHODS: CNKI, Wanfang Data, VIP Data, CBMdisc, PubMed, Web of Knowledge, Embase, Medline, Cochrane Library and Google Scholar were searched for control studies on the effect of PICC placement via the upper versus lower extremity veins in neonates. RevMan 5.3 was used to perform a Meta analysis of the studies which met the inclusion criteria. RESULTS: A total of 18 studies were included, among which there were 8 randomized controlled trials and 10 cohort studies, with 4 890 subjects in total. Compared with those undergoing PICC placement via the upper extremity veins, the neonates undergoing PICC placement via the lower extremity veins had significantly lower incidence rates of complications (RR=0.83, 95%CI: 0.75-0.92, P<0.05), catheter-related infections (RR=0.77, 95%CI: 0.60-0.99, P<0.05), catheter malposition (RR=0.28, 95%CI: 0.18-0.42, P<0.05), extravasation of the infusate (RR=0.52, 95%CI: 0.40-0.70, P<0.05), and unplanned extubation (RR=0.82, 95%CI: 0.69-0.98, P<0.05). They also had a significantly higher first-attempt success rate of puncture (RR=1.17, 95%CI: 1.05-1.30, P<0.05) and a significantly shorter PICC indwelling time (MD=-0.93, 95%CI: -1.26-0.60, P<0.05). CONCLUSIONS The above evidence shows that PICC placement via the lower extremity veins has a better effect than PICC placement via the upper extremity veins in neonates.
Catheterization, Central Venous ; Catheterization, Peripheral ; Cohort Studies ; Humans ; Infant, Newborn ; Lower Extremity ; Retrospective Studies

OBJECTIVES: To study the efficiency of electrocardiogram (ECG) monitor for positioning the catheter tip in the placement of peripherally inserted central venous catheterization (PICC) via lower extremity veins in neonates. METHODS: A total of 120 neonates who were admitted to the neonatal intensive care unit from January 2020 to January 2022 and received PICC via lower extremity veins were enrolled and divided into a control group and an observation group using a random number table (n=60 each). The neonates in the control group were given body surface measurement and postoperative chest X-ray localization, and those in the observation group were given body surface measurement, ECG-guided positioning, and postoperative chest X-ray localization. The two groups were compared in terms of general information, one-time success rate of PICC placement, and time spent on PICC placement, and the efficiency of ECG-guided positioning was evaluated. RESULTS: Compared with the control group, the observation group had a higher one-time success rate of PICC placement (92% vs 75%; P<0.05) and a shorter time spent on PICC placement [(26.5±3.0) min vs (31.8±2.8) min; P<0.05]. ECG-guided positioning had a sensitivity of 90.9% and a specificity of 100% in the PICC placement via lower extremity veins in neonates. CONCLUSIONS ECG monitor helps to determine the position of catheter tip in the PICC placement via lower extremity veins in neonates and can improve the one-time success rate of PICC placement and reduce the time spent on PICC placement, with a good positioning efficiency.
Infant, Newborn ; Humans ; Catheterization, Peripheral ; Catheterization, Central Venous ; Electrocardiography ; Lower Extremity ; Catheters ; Central Venous Catheters

OBJECTIVE: To analyze the specificity and sensitivity of the modified microbubble test in identifying the peripherally inserted central venous catheters (PICC) tip based on the chest X-ray location as the "gold standard", and to find out an accurate and noninvasive PICC tip positioning method that can save time and cost. METHODS: Convenient sampling method was conducted. The patients under PICC guided by ultrasound in intensive care unit (ICU) or PICC clinic of the First Affiliated Hospital of Nanchang University from August 2017 to February 2018 were enrolled. All patients were followed up by ultrasound guided PICC catheter placement, modified microbubble test and chest X-ray localization. The relationship between the density of microbubbles in modified microbubble test and the location of PICC tip in chest X-ray localization was analyzed. Using chest X-ray localization as the "gold standard", the diagnostic evaluation indexes such as specificity and sensitivity of PICC tip identification by modified microbubble test were calculated. RESULTS: A total of 120 patients were enrolled during the study period, excluding those who refused to participate in the study, unclear right atrial ultrasound, conscious intolerance, unclear chest X-ray, and finally 108 patients completed the modified microbubble test and chest X-ray tip localization. According to the chest X-ray localization results of 108 patients, 69 patients (63.9%) were in ideal locations, 33 (30.6%) were in dissatisfactory position, and 6 (5.5%) were in malposition. There was no significant difference in gender, age, tube placement, depth of catheterization, placement of catheterization room, and catheterization among the three groups. In the modified microbubble test, there were 74 patients (68.5%) with grade I microbubble, 25 (23.2%) with grade II microbubble, and 9 (8.3%) with grade III microbubble. There was a correlation between microbubble density and the tip position of the catheter, showing a moderate intensity correlation, and the contingency coefficient was 0.662. The sensitivity of the modified microbubble test for PICC tip positioning was 95.7% (66/69), the specificity was 89.7% (35/39), the rate of missed diagnosis was 4.4% (3/69), the misdiagnosis rate was 10.3% (4/39), the positive predictive value was 94.3% (66/70), the negative predictive value was 92.1% (35/38), and the Youden index was 0.85. The consistency between the two methods was good, and the Kappa value was 0.86. CONCLUSIONS Compared with the chest X-ray localization method, the modified microbubble test method has high sensitivity and specificity in identifying PICC in the position, and the operation is simple, noninvasive, with less time and low cost. The modified microbubble test can be used as a screening test for PICC tip position, especially in ICU. When there are technical limitations or suspicious patient, further chest X-ray is necessary.
Catheterization, Central Venous ; Catheterization, Peripheral ; Central Venous Catheters ; Humans ; Microbubbles ; Ultrasonography

Peripherally inserted central catheter (PICC) has been widely used in the neonatal intensive care unit (NICU) in recent years, but there are potential risks for complications related to PICC. Based on the current evidence in China and overseas, the operation and management guidelines for PICC in neonates were developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) in order to help the NICU staff to regulate the operation and management of PICC.
Catheterization, Central Venous/adverse effects* ; Catheterization, Peripheral/adverse effects* ; Catheters ; China ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal