Nontoxic separator and surgical expansion in the nursing application of central venous catheter
钝性分离器与手术扩皮在中心静脉置管中的护理应用

摘要

目的 探讨钝性分离器与手术扩皮在经外周插管的中心静脉置管（PICC）中的护理应用效果。方法选取本院2023年6月至2024年7月收治的68例行PICC中心静脉置管治疗的患者参与研究，根据奇偶数法将其随机分组为对照组（常规扩皮法置管，34例）和试验组（钝性分离器结合手术扩皮法置管，34例）。对比两组置管前5min、置管后即刻的血流动力学指标[舒张压（DBP）、收缩压（SBP）、心率（HR）]，并对比两组患者置管时、置管后第1、3d的疼痛程度（VAS），比较两组的一次性送鞘成功率和置管相关不良反应风险。结果 两组置管后即刻的DBP、SBP与HR水平较置管前5min均有提升，但对照组与置管前5min相比其组内对比结果显著（P＜0.05），试验组与置管前5min的组内对比结果无显著意义（P＞0.05），且试验组置管后即刻的血流动力学指标均低于对照组（P＜0.05）；试验组在置管时及置管后第1、3d的VAS评分均低于对照组（P＜0.05）；试验组一次性送鞘成功率比对照组更高，且置管相关不良反应（穿刺点出血、导管堵塞、静脉炎）发生率更低（P＜0.05）。结论 对行CVC治疗患者采用钝性分离器与手术扩皮法联合护理能有效稳定患者血流动力学指标，降低其疼痛度与不良反应风险，提高置管成功率，值得推广。

Abstract

Objective To explore the nursing application effects of blunt separator and surgical dilation in central venous catheterization (PICC) via peripheral cannulation.
Methods A total of 68 patients who underwent PICC central venous catheterization treatment from June 2023 to July 2024 were selected for this study. They were randomly divided into a control group (34 cases with conventional dilation catheterization) and an experimental group (34 cases with blunt separator combined with surgical dilation catheterization) using the odd-even method. The hemodynamic indicators [diastolic blood pressure (DBP), systolic blood pressure (SBP), heart rate (HR)] before 5 minutes and immediately after catheterization were compared between the two groups. The pain levels (VAS) at the time of catheterization, day 1, and day 3 post-catheterization were also compared. Additionally, the success rate of initial sheath insertion and the risk of catheter-related adverse reactions were evaluated.
Results The DBP, SBP, and HR levels immediately after catheterization were all higher than those 5 minutes before catheterization in both groups. However, the intra-group comparison results of the control group showed significant differences compared to 5 minutes before catheterization (P＜0.05), while the intra-group comparison results of the experimental group showed no significant difference compared to 5 minutes before catheterization (P＞0.05). Moreover, the hemodynamic indicators immediately after catheterization in the experimental group were lower than those in the control group (P＜0.05); the VAS scores at the time of catheterization and day 1 and day 3 post-catheterization in the experimental group were lower than those in the control group (P＜0.05); the success rate of initial sheath insertion in the experimental group was higher than that in the control group, and the incidence of catheter-related adverse reactions (bleeding at the puncture site, catheter blockage, phlebitis) was lower (P＜0.05).
Conclusion   The combined care of blunt separator and surgical skin expansion for patients undergoing CVC treatment can effectively stabilize the hemodynamic indicators of patients, reduce the risk of pain and adverse reactions, and improve the success rate of catheter placement, which is worth promoting.