護理人員執行超音波導引周邊置入中心靜脈導管之發展

Development of Nurse-Driven Ultrasound Guidance for Inserting Peripheral Central Catheter

鄭如芬(Ju-Fen Cheng) ； 周佩君(Pei-Chun Chou)

《腫瘤護理雜誌》 13卷1期 (2013/06) Pp. 41-50

https://doi.org/10.6880/TJON.201306_13(1).05

摘要

周邊置入中心靜脈導管（peripherally inserted central catheter, PICC）為癌症及急重症單位病人常見的靜脈導管，廣泛使用於長期抗生素治療、腸外營養、刺激性／起泡性藥物的血管通路，甚至作為中心靜脈壓監測之用。國內外相關研究已證實PICC有許多優於其他中心靜脈導管之處，而且具有減少穿刺、病人滿意度高、及成本低等特性。超音波機器輔助PICC置放技術更使得管路置放的成功率提高至九成以上。在國外，經過專業的訓練後，護理人員亦能執行超音波輔助之PICC置放，且成本較低、病人等候排程時間較短。在護理專業層面，PICC置放技術的進展，更可擴展護理專業及獨特性。本文將介紹護理人員運用超音波導引之PICC置放，並深入探討PICC的管理與培訓機制。

關鍵字

周邊中心靜脈導管 ； 超音波導引 ； 化學治療

並列摘要

Peripherally inserted central catheter (PICC) is a common venous access in patients with chemotherapy and critical/emergent disease. The use of PICC has been diversely expanded to the long-term antibiotic delivery, parenteral nutrition, delivery of irritant/vesicant medications to establish vascular access in patients with difficult venous anatomies, and even central venous pressure monitoring. Domestic and abroad studies have proved that PICC has several advantages in comparison with other central venous access. The use of PICC effectively reduced needle punctures, improved patient satisfaction, and were cost-effective. An important addition to the PICC service armamentarium was portable ultrasound (US) to improve the success rate of bedside PICC placement more than 90%. After specialized training, US-guided PICC placement by nurses can reduce the costs and patients' waiting time. The development of PICC insertion techniques promoted the specialty and advanced practice nursing roles. This article described the use of the US guidance in the placement of PICC, as well as reviewed the practice management and training mechanisms to incorporate the use of US into clinical practice.

並列關鍵字

peripherally inserted central catheter ； PICC ； ultrasound guidance ； chemotherapy