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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates.
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Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates.

机译：上肢位置的变化会导致新生儿外周插入的中心导管迁移。

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OBJECTIVE: The migration of peripherally inserted central catheters (PICCs) from the superior or inferior vena cava into the right atrium can pose a significant risk of lethal pericardial effusion and tamponade secondary to myocardial perforation. Arm movement has been reported to cause displacement of the catheter tip toward the heart and lead to ventricular tachycardia in adults. The objective of this study was to investigate whether adduction or abduction at the shoulder and flexion or extension at the elbow affect the position of PICCs placed via upper limb veins. We also hypothesized that arm movements can be used to reposition malpositioned catheters. METHODS: A total of 280 radiographs of 60 neonates with PICCs inserted via upper limb veins from July 2000 through June 2001 were reviewed. Differences in catheter tip position as a result of abduction versus adduction at the shoulder, flexion versus extension at the elbow, and combination changes in arm posture were determined by measurements in paired radiographs. Correction of malpositioned catheters was attempted in 10 patients by using arm movements without any alterations at the site of insertion. RESULTS: Arm movements were associated with significant displacement of catheters. Catheters that were placed via the basilic or axillary vein migrated toward the heart with adduction of the arm, whereas those that were placed via the cephalic vein moved away from the heart with adduction. Flexion of the elbow displaced catheters that were placed in the basilic or cephalic vein below the elbow toward the heart but did not have any effect on catheters that were placed via the axillary vein. For catheters that were placed in the basilic vein, simultaneous shoulder adduction and elbow flexion caused the greatest movement toward the heart (15.11 +/- 1.22 mm). We were able to reposition correctly inappropriately placed catheters in 9 of 10 patients by using arm movements. CONCLUSIONS: Arm movements significantly affect the position of the tip of the PICCs. Prevention of catheter migration into the right atrium requires radiographic determination of vein of insertion and monitoring of catheter tip position with upper extremity in position of maximum inward movement of catheter for that vein. Arm movements can be used to correct the malpositioned catheters.
机译：目的：外围插入的中央导管（PICCs）从上腔静脉或下腔静脉迁移至右心房可能会导致致命的心包积液和继发于心肌穿孔的填塞物。据报道，手臂运动会导致成人导管尖端向心脏移位，并导致室性心动过速。这项研究的目的是调查在肩膀上的内收或外展以及肘部的屈曲或伸展是否影响通过上肢静脉放置的PICC的位置。我们还假设手臂运动可用于重新定位错位的导管。方法：回顾了2000年7月至2001年6月通过上肢静脉插入PICC的60例新生儿的280张X线照片。通过在成对的X线照片中进行测量，可以确定由于在肩上外展与内收，肘部在屈曲与伸展以及手臂姿势的组合变化而导致的导管尖端位置的差异。尝试通过手臂移动在插入部位没有任何改变的方式对10例患者的导管位置错误进行纠正。结果：手臂运动与导管的明显移位相关。通过手臂内收而通过基底静脉或腋静脉放置的导管会向心脏迁移，而通过头内静脉所放置的导管会通过内收而远离心脏。放置在肘部下方的基底或头静脉中朝向心脏的肘部弯曲导管的弯曲，但对通过腋静脉放置的导管没有任何影响。对于放置在基底静脉中的导管，同时肩关节内收和肘部弯曲引起向心脏的最大运动（15.11 +/- 1.22 mm）。通过手臂移动，我们能够在10名患者中的9名患者中正确放置了放置不当的导管。结论：手臂的运动会显着影响PICCs尖端的位置。预防导管向右心房迁移需要射线照相术确定插入静脉并监测导管尖端位置，上肢处于该静脉的最大导管向内运动的位置。手臂运动可用于纠正导管位置错误的情况。

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