The Groshong Peripheral Inserted Central (PIC) Catheter: Initial Experience with Ultrasound-guided Insertion

十位上肢表淺靜脈打不上或病情嚴重無法躺平用開刀方式植入人工血管(port A)的患者，吾等嘗試以新引進4-Fr單管腔週邊植入式中央靜脈人工血管(peripheral inserted central catheter, PIC Catheter)代替。植入PIC catheter目的在於取得中長期（約三至六個月）中央靜脈留置管以便注射靜脈營養、化學抗癌藥物、抗生素或抽輸血用。我們以超音波導引下，由手肘處靜脈(basilic or brachial vein)植入至右心房及上腔靜脈交接處。值入成功率是100%。沒有發生任何併發症。因表淺靜脈已無法辨認，以超音波導引協助人工血管的植入不失為一個可靠又安全的方法。吾等認為如病人無法躺平或凝血時問延長而不能進行外科手術植入port A或Hickman catheter, PIC catheter是一種安全又好用的代替品。

關鍵字

靜脈，超音波；靜脈，介入性步驟；導管及導管置放，中央靜脈進入

並列摘要

We report our initial experience on the peripherally inserted central (PIC) catheters inserted under ultrasound guide to serve as alternative venous access devices for I.V. fluid and chemotherapy in a series of hematology/oncology patients who had difficult venous access by other means. Ten peripherally inserted central (PIC) catheters with a Groshong tip were inserted successfully in 8 oncology and 2 hematology patients (mean age 59.7 years, range 37 to 73 years) for mid to long-term venous access. These patients were unable to undergo implanted subcutaneous port placement because of disease status and had no visible peripheral vein for venous access by ordinary means. Catheters were inserted under image guidance (ultrasound and fluoroscopy) via the brachial vein or basilic vein in the non- dominant forearm. Catheter tips were placed at the junction of the superior vena cava and right atriuin. The externalized portion of the catheter was capped and sutured onto patient's skin at the forearm, and fixed like an ordinary intravenous line. PIC catheter insertion was successful in 100% of cases. One patient had a missed puncture which pierced the brachial artery. No immediate complication such as hematoma or nerve injury was noted. No phlebitis, venous thrombosis or infection was noted during this short-term follow up. These 4- French single lumen catheters were used for infusion of chemotherapeutic agents, fluid replacement, injection of antibiotics, and blood withdrawal as well as for total parenteral nutrition. The longest indwelling time was 58 days (average 34.8 days). Routine maintenance was done with 10c.c. of non-heparinized saline. Patient, nurse and physician acceptance of the PIC catheter was good especially for this group of patients with difficult venous access. PIC catheter insertion by an interventional radiologist has a high technical success rate and is safe. If the estimated use time of a venous access device is more than 1 week and less than 6 months, a PIC catheter is recommended. For venous access, they serve as an alternative to tunneled catheters, non-tunneled catheters and implanted subcutaneous ports because of ease of insertion, maintenance, and removal and low reported infection rate.

並列關鍵字

Veins, US ； Veins, interventional procedure ； Catheters and catheterization, central venous access

國際替代計量

The Groshong Peripheral Inserted Central (PIC) Catheter: Initial Experience with Ultrasound-guided Insertion

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