The relationship between the tip position of an indwelling venous catheter and the subcutaneous edema
The relationship between the tip position of an indwelling venous catheter and the subcutaneous edema
复制标题
DOI：
10.5582/bst.2015.01114
复制
发表时间：
2015-12-01
影响因子：
5.5
通讯作者：
Sanada, Hiromi
中科院分区：
文献类型：
--
作者：
Murayama, Ryoko;Takahashi, Toshiaki;Sanada, Hiromi
本观察性研究的目的是利用超声图像阐明留置静脉导管的尖端位置与皮下水肿的关系。数据是在日本东京一所大学医院的内科病房中拔除导管之前获得的。在拔管前对154例患者的200根外周静脉导管(PIVCs)进行了观察。我们分析了来自150名患者的194个PIVC的数据。43.8%的超声图像可见皮下水肿者。单因素分析显示，插入部位、PIVC尖端与血管壁的接触、刺激性药物的存在为Logistic回归分析的自变量。刺激性药物和PIVC针尖接触均与皮下水肿有关[调整优势比(OR)=2.68，95%可信区间(CI)=1.14~6.33；OR=2.01，95%CI=1.04~3.88]。据我们所知，这是第一次使用超声同时观察PIVC尖端位置和皮下水肿的研究。用超声观察PIVC可能是了解这些机制的有用方法。医护人员应选择合适的静脉和留置导管，避免PIVC尖端与管壁接触。需要进一步研究皮下水肿、导管放置和血栓形成之间的因果关系。此外，还需要进一步发展护理技能和医疗器械，以减少机械应力。
The present observational study aimed to clarify the relationship between the tip position of an indwelling venous catheter and the subcutaneous edema using ultrasonography images. Data were obtained before catheter removal in a medical ward of a university hospital in Tokyo, Japan. Two hundred peripheral intravenous catheters (PIVCs) from 154 patients were observed just before removal. We analyzed data for 194 PIVCs from 150 patients. Subcutaneous edema was observed in 43.8% of ultrasonography images. According to the univariate analysis, insertion site, PIVC tip contact with the vessel wall, and irritant drug's presence were selected as independent variables for logistic regression analysis. Both irritant drug and PIVC tip contact were associated with the presence of subcutaneous edema [adjusted odds ratio (OR) = 2.68, 95% confidence interval (CI) = 1.14-6.33; and OR = 2.01, 95% CI = 1.04-3.88, respectively]. To the best of our knowledge, this is the first study to use ultrasonography to simultaneously observe PIVC tip position and subcutaneous edema. Using ultrasonography to observe PIVC may be a useful method to understand these mechanisms. Medical staff should select an appropriate vein and indwelling catheter to avoid contact of PIVC tip with the vessel wall. Further studies exploring the causality of the relationship between subcutaneous edema, catheter placement, and thrombus formation is required. In addition, further development of nursing skills and medical devices to reduce mechanical stress is required.