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The Use of Peripherally Inserted Central Catheter (PICC) in Adut with Acute Leukemia
週邊植入式中央靜脈導管於成人急性白血病患者
摘要
急性白血病患者需要建立一條適當的靜脈輸液路徑，以往都是開刀植入大管徑 (6-8Fr)的Hickman catheter或是Port A catheter為主。我們嘗試著利用4Fr小管徑的週邊植入式中央靜脈導管來達成此目的。 連續41位急性白血病的新患者（20位男性、21位女性，平均年齡為47.9歲）參與研究，他們大多有全身性的感染及出血傾向（平血小板為48000/uL）。我們由左手肘處植入了44條中央脈導管在這些病人身上。由於在肉眼下看不到這些病人的手臂靜脈，導管的植入是在音波導引下進行，最後導管末放至上腔靜脈處。這些導管將作為抽血、靜脈輸液、給藥及化學治療。 放置週邊植入式中央靜脈導管的成功率為97.7%，置入導管的手肘部位無任何的皮下血腫發生。這44條導管放置在41位病人身上共3219天，平均每條導管放置73.2天。有18條導管發生併發症（佔40.9%），這些併發症包括4條導管有穿刺傷口的感染、2條導管引起靜脈炎、3條導管引起敗血病、4條導管發生阻塞、2條導管引起中央靜脈阻塞、發生放置導管的靜脈阻塞有1條導管、1條導管的導管接頭發生滲漏及此導管發生扭轉的現象、1條導管在日常照護時被意外拔除。這44條週邊植入式中央靜脈導管有33條(75%)曾經被作為化學治療的給藥途徑，平均使用1.9次的化療療程。 週邊植入式中央靜脈導管併剸症低於他人報告大管徑導管用於急性血癌患者的結果，而與國外利用週邊植入式中央靜脈導管於一般病人的結果相近。所以對於此高危險的患者不失為Hickman catheter及Port A catheter的另一種選擇。
並列摘要
The purpose of this study is to evaluate peripher-ally inserted central catheter (PICC) as a sole venous access device for management of patients with newly diagnosed leukemia. Forty-four PICCs (4-French, single lumen) were placed in 41 newly diagnosed acute leukemia patients mostly diagnosed with active systemic infection and bleeding tendency. Sonography-guided venipuncture using a 14-gauge needle sheath was performed because of no grossly visible forearm peripheral veins. PICC insertion sites were basilica vein in 14, brachial vein in 12, cephalic vein in 13, antecubital vein in one patient after failed antecubital approach. Catheter tips were placed at right atrium and supe-rior vena cava junction in all. The catheters were used for infusion of fluid, chemotherapeutic agents, No hematoma was encountered. The PICCs were used for a total 3219 catheter-days, with a mean indwelling time of 73.2 days (range 1-247 days). Complications occurred in 18 catheters (18 of 44,40.9%): puncture site infection in 4, phlebitis in 2, sepsis in 3, catheter clotting vein thrombosis in 1, catheter kinking and hub leakage in 1, and acci-dental removal by nursing personnel in 1. Induction chemotherapy was accomplish ed in 75% of PICCs (33 of 44), with an average of 1.9 courses (range 1~5 courses). PICC is safe and useful as an interim cemtral venous access device for management of critically ill, newly diagnosed adult acute leukemia atients com-plicated with active infection and bleeding tendency.