CN111790041A - Method for indwelling PICC catheter through internal jugular vein by double-tunnel technology - Google Patents

Abstract

The invention provides a method for indwelling a PICC catheter through an internal jugular vein by using a double-tunnel technology, which is used for indwelling the PICC catheter through the internal jugular vein by using the double-tunnel technology, wherein after the PICC catheter is successfully punctured through the internal jugular vein under the guidance of ultrasonic waves and is sent into the catheter to a preset length of the catheter, a subcutaneous tunnel with the length of 1cm is established at the same level of a puncture point by using a tunnel puncture needle, a longer subcutaneous tunnel is established from the outer side end of the tunnel to the position of 2 transverse fingers below the midline of a clavicle, the catheter passes through the two tunnels and penetrates out from a body surface outlet at the position of 2 transverse fingers below the midline of the clavicle, and then the catheter is trimmed. The method solves various difficult problems existing in the prior PICC catheter which is directly retained by the puncture of the internal jugular vein, has high operation quality, can reduce the complication of the patient with the catheter, improves the life quality, and has the obvious effects of reducing the physiological, psychological and economic burdens of the patient and the working strength of medical staff and improving the satisfaction degree of the patient.

Description

Method for indwelling PICC catheter through internal jugular vein by double-tunnel technology

Technical Field

The invention relates to a method for indwelling a PICC catheter through an internal jugular vein, in particular to a method for indwelling the PICC catheter through an internal jugular vein by using a double-tunnel technology.

Background

Central venous catheters (PICCs) placed by peripheral venipuncture have been widely used in chemotherapy, total parenteral nutrition and the like for tumor patients, and some tumor patients clinically have the following characteristics: after the bilateral breast cancer operation, the limbs are deficient, peripheral venous reflux disorder caused by axillary or subclavian masses, PICC is difficult to be reserved due to peripheral vascular access caused by peripheral venous thrombosis history and the like, and the indwelling catheter is directly punctured through internal jugular vein to become the preferred venous transfusion channel of the patients, but the PICC catheter body surface outlet reserved by the method is positioned at the neck, so that the privacy of the patients is easily exposed, the attractiveness is influenced, the body position and the activity of the patients are limited, the daily life of the patients is influenced, and due to the fact that the skin of the neck is loose, the sebaceous gland is excreased vigorously, the film is not firmly adhered, local skin allergy is easily caused, infection, catheter displacement, even accidental detachment and other various complications are caused, the unplanned extubation is caused, the pain of the patients is increased, the working strength of medical personnel is also increased.

Disclosure of Invention

The invention aims to solve the difficult problems existing in the PICC catheter indwelling through direct internal jugular vein puncture, and provides a method for indwelling the PICC catheter through internal jugular vein by using double-tunnel technology, which has high operation quality, can reduce the complications of patients with the catheter, improves the life quality, and can provide a long-term safe venous transfusion channel for the patients.

The invention comprises establishing double tunnels, and adopts the technical scheme that:

the specific operation steps are as follows:

step 1, determining a puncture point and a double-tunnel route: the patient takes out the pillow lying position, the puncture side shoulder is padded up, the head is deviated to the opposite side, the neck and the front chest wall of the side are fully exposed, the lower point of a triangular area formed by the clavicle and the sternocleidomastoid of the sternocleidomastoid is taken as a puncture point and marked, a marking line is drawn along the same horizontal side of the puncture point by 1cm, the outer side end of the marking line is taken as a point A, two transverse fingers below the central line of the front chest wall clavicle are taken as body surface outlets of a catheter and marked, the point A and the body surface outlets are connected by a marker pen, the puncture point → the point A is a subcutaneous tunnel 1, and the point A → the body surface outlet is a subcutaneous tunnel 2;

step 2, measuring the length of a preset pipe: the distance from the puncture point to the right sternoclavicular joint to the third rib is the catheter implantation length;

step 3, disinfecting and paving the towel: disinfecting the skin of 20cm above and below the puncture point, the point A and the triangular area of the body surface outlet by using 75% alcohol and 1% iodophor for 3 times respectively, and establishing a maximized sterile barrier;

step 4, local anesthesia: extracting 5ml of 2% lidocaine to perform local infiltration anesthesia along a subcutaneous tunnel route;

step 5, venipuncture: an operator is positioned at the head of a patient bed, a left-hand-held ultrasonic probe is arranged above an internal jugular vein, a right-hand-held micro puncture needle slowly enters along a puncture point at an angle of 15-30 degrees, and after puncture is successful, a guide wire is fed through the puncture needle, and the puncture needle is removed;

step 6, pipe conveying: taking a skin expanding knife to cling to the guide wire at a puncture point to open a transverse incision of 2mm, feeding the skin expanding knife into a tearable vascular sheath with a dilator along the guide wire, withdrawing the guide wire and the dilator, feeding the blood into the catheter to a preset length of the catheter through the tearable vascular sheath, removing the tearable vascular sheath, pumping back blood and flushing the catheter;

step 7, establishing double tunnels: establishment of the subcutaneous tunnel 1: taking a skin expanding knife to open a 2mm transverse incision at the point A, taking a subcutaneous tunnel puncture needle to penetrate into the skin from the point A and penetrate out from the puncture point, removing a supporting guide wire in a catheter, connecting the opening of the catheter with the front end of the subcutaneous tunnel puncture needle, then pulling the catheter out of the subcutaneous tunnel 1 from the point A, and simultaneously confirming the length of the catheter; establishment of the subcutaneous tunnel 2: a 2mm longitudinal incision is formed at the body surface outlet of the catheter by using a skin expanding knife, a subcutaneous tunnel puncture needle is taken to penetrate into the skin from the body surface outlet for 0.5-1 cm in depth, passes through a tunnel trend marking line and penetrates out from a point A, the opening of the catheter is connected with the front end of the subcutaneous tunnel puncture needle, and then the catheter is slowly pulled out from the body surface outlet through a subcutaneous tunnel 2;

step 8, trimming and fixing the catheter: trimming the catheter according to the catheter scale of +5cm at the body surface outlet, installing a connector and an infusion connector, punching and sealing the catheter, placing the catheter in an L shape, fixing a film, and smearing skin adhesive on the puncture point and the point A;

and 9, taking X-ray pictures, and removing the abnormal positions of the tip of the catheter to finish the operation.

The invention has the beneficial effects that: through the method, the body surface outlet of the PICC catheter indwelling in the internal jugular vein is transferred to the chest wall through the neck, the position is good in concealment, the privacy and attractive requirements of a patient can be met, the activity and the position of the patient are not limited, the influence on the daily life of the patient is not obvious, meanwhile, the skin at the position is flat, the secretion of sebaceous glands is low, the transparent dressing is stably pasted, a longer subcutaneous tunnel can play a role in fixing the catheter, the bacterial infection and the catheter detachment are not easy to cause, the whole operation is minimally invasive, the bleeding is slight, and the pain degree is light. The method solves various difficult problems existing in the prior PICC catheter which is directly retained by the puncture of the internal jugular vein, has high operation quality, can reduce the complication of the patient with the catheter, improves the life quality, and has the obvious effects of reducing the physiological, psychological and economic burdens of the patient and the working strength of medical staff and improving the satisfaction degree of the patient.

Detailed Description

Example 1

The specific operation steps are as follows:

step 1, determining a puncture point and a double-tunnel route: the patient takes out the pillow lying position, the puncture side shoulder is padded up, the head is deviated to the opposite side, the neck and the front chest wall of the side are fully exposed, the lower point of a triangular area formed by the clavicle and the sternocleidomastoid of the sternocleidomastoid is taken as a puncture point and marked, a marking line is drawn along the same horizontal side of the puncture point by 1cm, the outer side end of the marking line is taken as a point A, two transverse fingers below the central line of the front chest wall clavicle are taken as body surface outlets of a catheter and marked, the point A and the body surface outlets are connected by a marker pen, the puncture point → the point A is a subcutaneous tunnel 1, and the point A → the body surface outlet is a subcutaneous tunnel 2;

step 2, measuring the length of a preset pipe: the distance from the puncture point to the right sternoclavicular joint and then to the third rib is the catheter implantation length;

step 3, disinfecting and paving the towel: disinfecting the skin of 20cm above and below the puncture point, the point A and the triangular area of the body surface outlet by using 75% alcohol and 1% iodophor for 3 times respectively, and establishing a maximized sterile barrier;

step 4, local anesthesia: extracting 5ml of 2% lidocaine to perform local infiltration anesthesia along a subcutaneous tunnel route;

step 5, venipuncture: an operator is positioned at the head of a patient bed, a left-hand-held ultrasonic probe is arranged above an internal jugular vein, a right-hand-held micro puncture needle slowly enters along a 15-degree angle of a puncture point, and after the puncture is successful, a guide wire is fed through the puncture needle, and the puncture needle is removed;

step 6, pipe conveying: taking a skin expanding knife to cling to the guide wire at a puncture point to open a transverse incision of 2mm, feeding the skin expanding knife into a tearable vascular sheath with a dilator along the guide wire, withdrawing the guide wire and the dilator, feeding the blood into the catheter to a preset length of the catheter through the tearable vascular sheath, removing the tearable vascular sheath, pumping back blood and flushing the catheter;

step 7, establishing double tunnels: establishment of the subcutaneous tunnel 1: taking a skin expanding knife to open a 2mm transverse incision at the point A, taking a subcutaneous tunnel puncture needle to penetrate into the skin from the point A and penetrate out from the puncture point, removing a supporting guide wire in a catheter, connecting the opening of the catheter with the front end of the subcutaneous tunnel puncture needle, then pulling the catheter out of the subcutaneous tunnel 1 from the point A, and simultaneously confirming the length of the catheter; establishment of the subcutaneous tunnel 2: a 2mm longitudinal incision is formed at the body surface outlet of the catheter by using a skin expanding knife, a subcutaneous tunnel puncture needle is taken to penetrate into the skin by the depth of 0.5cm from the body surface outlet, passes through a marking line along the tunnel trend and penetrates out from the point A, the opening of the catheter is connected with the front end of the subcutaneous tunnel puncture needle, and then the catheter is slowly pulled out from the body surface outlet through the subcutaneous tunnel 2;

step 8, trimming and fixing the catheter: trimming the catheter according to the catheter scale of +5cm at the body surface outlet, installing a connector and an infusion connector, punching and sealing the catheter, placing the catheter in an L shape, fixing a film, and smearing skin adhesive on the puncture point and the point A;

and 9, taking X-ray pictures, and removing the abnormal positions of the tip of the catheter to finish the operation.

Example 2

The specific operation steps are as follows:

step 1, determining a puncture point and a double-tunnel route: the patient takes out the pillow lying position, the puncture side shoulder is padded up, the head is deviated to the opposite side, the neck and the front chest wall of the side are fully exposed, the lower point of a triangular area formed by the clavicle and the sternocleidomastoid of the sternocleidomastoid is taken as a puncture point and marked, a marking line is drawn along the same horizontal side of the puncture point by 1cm, the outer side end of the marking line is taken as a point A, two transverse fingers below the central line of the front chest wall clavicle are taken as body surface outlets of a catheter and marked, the point A and the body surface outlets are connected by a marker pen, the puncture point → the point A is a subcutaneous tunnel 1, and the point A → the body surface outlet is a subcutaneous tunnel 2;

step 2, measuring the length of a preset pipe: the distance from the puncture point to the right sternoclavicular joint and then to the third rib is the catheter implantation length;

step 3, disinfecting and paving the towel: disinfecting the skin of 20cm above and below the puncture point, the point A and the triangular area of the body surface outlet by using 75% alcohol and 1% iodophor for 3 times respectively, and establishing a maximized sterile barrier;

step 4, local anesthesia: extracting 5ml of 2% lidocaine to perform local infiltration anesthesia along a subcutaneous tunnel route;

step 5, venipuncture: an operator is positioned at the head of a patient bed, the left-hand-held ultrasonic probe is arranged above an internal jugular vein, the right-hand-held micro puncture needle slowly enters along a 22-degree angle of a puncture point, and after the puncture is successful, the micro puncture needle is fed into a guide wire through the puncture needle, and the puncture needle is removed;

step 6, pipe conveying: taking a skin expanding knife to cling to the guide wire at a puncture point to open a transverse incision of 2mm, feeding the skin expanding knife into a tearable vascular sheath with a dilator along the guide wire, withdrawing the guide wire and the dilator, feeding the blood into the catheter to a preset length of the catheter through the tearable vascular sheath, removing the tearable vascular sheath, pumping back blood and flushing the catheter;

step 7, establishing double tunnels: establishment of the subcutaneous tunnel 1: taking a skin expanding knife to open a 2mm transverse incision at the point A, taking a subcutaneous tunnel puncture needle to penetrate into the skin from the point A and penetrate out from the puncture point, removing a supporting guide wire in a catheter, connecting the opening of the catheter with the front end of the subcutaneous tunnel puncture needle, then pulling the catheter out of the subcutaneous tunnel 1 from the point A, and simultaneously confirming the length of the catheter; establishment of the subcutaneous tunnel 2: a 2mm longitudinal incision is formed at the body surface outlet of the catheter by using a skin expanding knife, a subcutaneous tunnel puncture needle is taken to penetrate into the skin by the depth of 0.8cm from the body surface outlet, passes through a marking line along the tunnel trend and penetrates out from the point A, the opening of the catheter is connected with the front end of the subcutaneous tunnel puncture needle, and then the catheter is slowly pulled out from the body surface outlet through the subcutaneous tunnel 2;

step 8, trimming and fixing the catheter: trimming the catheter according to the catheter scale of +5cm at the body surface outlet, installing a connector and an infusion connector, punching and sealing the catheter, placing the catheter in an L shape, fixing a film, and smearing skin adhesive on the puncture point and the point A;

and 9, taking X-ray pictures, and removing the abnormal positions of the tip of the catheter to finish the operation.

Example 3

The specific operation steps are as follows:

step 1, determining a puncture point and a double-tunnel route: the patient takes out the pillow lying position, the puncture side shoulder is padded up, the head is deviated to the opposite side, the neck and the front chest wall of the side are fully exposed, the lower point of a triangular area formed by the clavicle and the sternocleidomastoid of the sternocleidomastoid is taken as a puncture point and marked, a marking line is drawn along the same horizontal side of the puncture point by 1cm, the outer side end of the marking line is taken as a point A, two transverse fingers below the central line of the front chest wall clavicle are taken as body surface outlets of a catheter and marked, the point A and the body surface outlets are connected by a marker pen, the puncture point → the point A is a subcutaneous tunnel 1, and the point A → the body surface outlet is a subcutaneous tunnel 2;

step 2, measuring the length of a preset pipe: the distance from the puncture point to the right sternoclavicular joint and then to the third rib is the catheter implantation length;

step 3, disinfecting and paving the towel: disinfecting the skin of 20cm above and below the puncture point, the point A and the triangular area of the body surface outlet by using 75% alcohol and 1% iodophor for 3 times respectively, and establishing a maximized sterile barrier;

step 4, local anesthesia: extracting 5ml of 2% lidocaine to perform local infiltration anesthesia along a subcutaneous tunnel route;

step 5, venipuncture: an operator is positioned at the head of a patient bed, a left-hand-held ultrasonic probe is arranged above an internal jugular vein, a right-hand-held micro puncture needle slowly enters along a 30-degree angle of a puncture point, and after the puncture is successful, a guide wire is fed through the puncture needle, and the puncture needle is removed;

step 6, pipe conveying: taking a skin expanding knife to cling to the guide wire at a puncture point to open a transverse incision of 2mm, feeding the skin expanding knife into a tearable vascular sheath with a dilator along the guide wire, withdrawing the guide wire and the dilator, feeding the blood into the catheter to a preset length of the catheter through the tearable vascular sheath, removing the tearable vascular sheath, pumping back blood and flushing the catheter;

step 7, establishing double tunnels: establishment of the subcutaneous tunnel 1: taking a skin expanding knife to open a 2mm transverse incision at the point A, taking a subcutaneous tunnel puncture needle to penetrate into the skin from the point A and penetrate out from the puncture point, removing a supporting guide wire in a catheter, connecting the opening of the catheter with the front end of the subcutaneous tunnel puncture needle, then pulling the catheter out of the subcutaneous tunnel 1 from the point A, and simultaneously confirming the length of the catheter; establishment of the subcutaneous tunnel 2: a 2mm longitudinal incision is formed at the body surface outlet of the catheter by using a skin expanding knife, a subcutaneous tunnel puncture needle is taken to penetrate into the subcutaneous region by the depth of 1cm from the body surface outlet, passes through a marking line along the tunnel trend and penetrates out from the point A, the opening of the catheter is connected with the front end of the subcutaneous tunnel puncture needle, and then the catheter is slowly pulled out from the body surface outlet through the subcutaneous tunnel 2;

step 8, trimming and fixing the catheter: trimming the catheter according to the catheter scale of +5cm at the body surface outlet, installing a connector and an infusion connector, punching and sealing the catheter, placing the catheter in an L shape, fixing a film, and smearing skin adhesive on the puncture point and the point A;

and 9, taking X-ray pictures, and removing the abnormal positions of the tip of the catheter to finish the operation.

And 7, taking the subcutaneous tunnel puncture needle, penetrating the subcutaneous tunnel puncture needle into the subcutaneous tissue by a depth of 0.5-1 cm from a body surface outlet, and determining the penetration depth according to the thickness of the subcutaneous tissue of the patient.

Claims (1)

1. A method for indwelling a PICC catheter through an internal jugular vein by using a double-tunnel technology comprises the steps of establishing double tunnels, and is characterized in that:

the specific operation steps are as follows:

step 1, determining a puncture point and a double-tunnel route: the patient takes out the pillow lying position, the puncture side shoulder is padded up, the head is deviated to the opposite side, the neck and the front chest wall of the side are fully exposed, the lower point of a triangular area formed by the clavicle and the sternocleidomastoid of the sternocleidomastoid is taken as a puncture point and marked, a marking line is drawn along the same horizontal side of the puncture point by 1cm, the outer side end of the marking line is taken as a point A, two transverse fingers below the central line of the front chest wall clavicle are taken as body surface outlets of a catheter and marked, the point A and the body surface outlets are connected by a marker pen, the puncture point → the point A is a subcutaneous tunnel 1, and the point A → the body surface outlet is a subcutaneous tunnel 2;

step 2, measuring the length of a preset pipe: the distance from the puncture point to the right sternoclavicular joint and then to the third rib is the catheter implantation length;

step 3, disinfecting and paving the towel: disinfecting the skin of 20cm above and below the puncture point, the point A and the triangular area of the body surface outlet by using 75% alcohol and 1% iodophor for 3 times respectively, and establishing a maximized sterile barrier;

step 4, local anesthesia: extracting 5ml of 2% lidocaine to perform local infiltration anesthesia along a subcutaneous tunnel route;

step 5, venipuncture: an operator is positioned at the head of a patient bed, a left-hand-held ultrasonic probe is arranged above an internal jugular vein, a right-hand-held micro puncture needle slowly enters along a puncture point at an angle of 15-30 degrees, and after puncture is successful, a guide wire is fed through the puncture needle, and the puncture needle is removed;

step 6, pipe conveying: taking a skin expanding knife to cling to the guide wire at a puncture point to open a transverse incision of 2mm, feeding the skin expanding knife into a tearable vascular sheath with a dilator along the guide wire, withdrawing the guide wire and the dilator, feeding the blood into the catheter to a preset length of the catheter through the tearable vascular sheath, removing the tearable vascular sheath, pumping back blood and flushing the catheter;

step 7, establishing double tunnels: establishment of the subcutaneous tunnel 1: taking a skin expanding knife to open a 2mm transverse incision at the point A, taking a subcutaneous tunnel puncture needle to penetrate into the skin from the point A and penetrate out from the puncture point, removing a supporting guide wire in a catheter, connecting the opening of the catheter with the front end of the subcutaneous tunnel puncture needle, then pulling the catheter out of the subcutaneous tunnel 1 from the point A, and simultaneously confirming the length of the catheter; establishment of the subcutaneous tunnel 2: a 2mm longitudinal incision is formed at the body surface outlet of the catheter by using a skin expanding knife, a subcutaneous tunnel puncture needle is taken to penetrate into the skin from the body surface outlet for 0.5-1 cm in depth, passes through a tunnel trend marking line and penetrates out from a point A, the opening of the catheter is connected with the front end of the subcutaneous tunnel puncture needle, and then the catheter is slowly pulled out from the body surface outlet through a subcutaneous tunnel 2;

step 8, trimming and fixing the catheter: trimming the catheter according to the catheter scale of +5cm at the body surface outlet, installing a connector and an infusion connector, punching and sealing the catheter, placing the catheter in an L shape, fixing a film, and smearing skin adhesive on the puncture point and the point A;

and 9, taking X-ray pictures, and removing the abnormal positions of the tip of the catheter to finish the operation.