Influence of PICC Ultrasound Guidance on Elbow Puncture and Catheterization and Its Complications: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LI Quanlei ¹ ,  YAN Meiqiong ² , ZHANG Xiaoju ³ , LU Zhenqi ³ , LIN Cen ¹

1. School of Nursing, Fudan University, Shanghai 200032, China;2. Department of Nursing, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China;3. Department of Nursing, Shanghai Cancer Center Affiliated to Fudan University, Shanghai 200032, China;

Corresponding author：

YAN Meiqiong, Email: mqyan_2012@163.com

Keywords：

PICC; Ultrasonography; Catheterization; Success rate of puncture; Complication; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20130147

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Objective 　To systematically evaluate the influence of PICC (peripherally inserted central catheter) ultrasound guidance on success rates and incidences of complications of elbow catheterization.
Methods 　The Cochrane Library (Issue 3, 2012), Library of JBI evidence-based nursing center, MEDLINE, EMbase, CBM, VIP, CNKI and WanFang Data were searched for relevant studies to influence on success rates of puncture and catheterization and complications from upper arm placement of PICC ultrasound guidance as well as conventional PICC placement from inception to March, 2012. The data were extracted according to the inclusion and exclusion criteria by two reviewers, the quality of included studies was also evaluated. Meta-analysis was conducted using RevMan 5.1, or only descriptive analysis was conducted instead.
Results 　Eleven randomized controlled trials, five clinical controlled trials and four cohort studies were included, involving 4 052 patients. The results of meta-analysis showed that, upper arm placement of PICC ultrasound guidance combined with modified Seldinger technique was associated with significantly higher one-time success rates of puncture and catheterization than conventional PICC placement below the elbow, with significant differences (OR=4.71, 95%CI 1.97 to 11.28, P=0.000 5; OR=8.63, 95%CI 1.92 to 38.82, P=0.005). Conventional elbow catheterization had a significantly higher incidence of phlebitis than catheterization on the elbow that under the guidance of PICC ultrasound and modified Seldinger technique (OR=0.13, 95%CI 0.08 to 0.21, P lt;0.000 01).
Conclusion 　Elbow catheterization under the guidance of PICC ultrasound combined with modified Seldinger technique has an obvious advantage in improving the success rates of puncture and catheterization and reducing the incidence of complications, compared with conventional elbow catheterization.

Citation： LI Quanlei,YAN Meiqiong,ZHANG Xiaoju,LU Zhenqi,LIN Cen. Influence of PICC Ultrasound Guidance on Elbow Puncture and Catheterization and Its Complications: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(7): 816-826. doi: 10.7507/1672-2531.20130147 Copy

1.	于跃, 郝强. 经外周静脉置入中心静脉导管末端定位的研究进展. 第二军医大学学报, 2008, 29(10): 1244-1247.
2.	李新萍. 外周导入中心静脉置管的护理进展. 护士进修杂志, 2002, 17(11): 859-861.
3.	马珊, 马容莉, 林静. 超声引导和改良塞丁格技术置入PICC的研究进展. 护理学杂志, 2010, 25(9): 89-91.
4.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). [cited 2012 Jan 5]. Available from: URL: http://www.cochrane-handbook.org.
5.	Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in Meta-analysis. [cited 2012 Jan 11]. Available from: URL: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
6.	胡雁, 李晓玲. 循证护理的理论与实践. 上海: 复旦大学出版社, 2007: 30-40, 49, 74-78.
7.	方建华, 杨红萍, 杨琛, 等. 超声引导下经浅静脉PICC置管的临床应用价值.心脑血管病防治, 2011, 11(1): 38-40.
8.	黄爱梅, 朱敏. PICC不同置管部位的选择对置管后并发症发生率的影响. 中国医药指南, 2011, 9(17): 264-265.
9.	马姗, 马容莉, 林静, 等. 静脉穿刺外周中心静脉置管感染的预防. 中国消毒学杂志, 2011, 28(2): 235-236.
10.	陶莲德, 张莉, 袁志平, 等. 超声引导下改良经肘上外周穿刺置入中心静脉导管的效果观察. 西部医学, 2011, 23(7): 1362-1363.
11.	章洁, 马珊, 林静. 2种不同穿刺方法对高龄患者PICC置管并发症的影响. 现代中西医结合杂志, 2011, 20(26): 3330-3331.
12.	张晓菊, 陆箴琦, 戴宏琴, 等. 超声导引结合改良塞丁格技术行上臂PICC置入与盲穿置管的比较. 中华护理杂志, 2011, 46(1): 42-45.
13.	郑雪艳, 华茂, 潘亚萍. 彩超引导行上臂PICC穿刺的护理研究. 包头医学院学报, 2011, 27(5): 57-58.
14.	周薇, 刘丽兰, 何佩仪, 等. 超声引导下经外周置入中心静脉导管的效果观察. 护理学报, 2011, 18(1B): 53-55.
15.	方建华, 杨红萍, 许亮, 等. 超声引导下浅静脉PICC置管的临床评价. 中国现代医生, 2010, 48(27): 66-67.
16.	付阿丹. 不同部位置入PICC导管后并发机械性静脉炎的观察. 护理研究, 2010, 24(5B): 1246.
17.	田庆, 严云丽, 左杰. 血管超声引导下运用MST技术行PICC置管效果观察. 齐鲁护理杂志, 2010, 16(11): 56-57.
18.	万永慧, 谭飞, 陈芊, 等. 改良Seldinger技术应用于血管超声引导下上臂置入PICC的效果. 解放军护理杂志, 2010, 27(19):1507-1508.
19.	王东平, 陈立萍, 王萍, 等. 彩超引导联合改良塞丁格尔技术在PICC置管中的应用价值. 实用临床医药杂志, 2010, 14(11): 84-85.
20.	王建意. B超引导与传统PICC置管技术的对比研究. 齐鲁护理杂志, 2010, 16(10): 123-124.
21.	郭敏, 李静, 余晋涛, 等. 超声引导下经肘上外周穿刺置入中心静脉导管的效果观察. 现代临床护理, 2009, 8(11): 22-24.
22.	胡君娥, 龚兰, 唐运香, 等. 彩色多普勒血流显像技术引导下行PICC30例. 护理学杂志, 2007, 22(5): 39-40.
23.	黄石群, 胡敏芝, 梁艳芳, 等. PICC穿刺部位对并发症发生率的影响. 右江医学, 2007, 35(4): 401-402.
24.	郭丽娟, 张鸿雁, 赵晓玉, 等. 经外周静脉留置中心静脉导管穿刺部位的改进. 护理学杂志, 2006, 21(12): 37-38.
25.	Stokowski G, Steele D, Wilson D. The use of ultrasound to improve practice and reduce complication rates in peripherally inserted central catheter insertions: final report of investigation. J Infus Nurs, 2009, 32(3): 145-155.
26.	Polak JF, Anderson D, Hagspiel K, et al. Peripherally inserted central venous catheters: factors affecting patient satisfaction. Am J Roentgenol, 1998, 170(6): 1609-1611.
27.	沈峰平, 李红梅, 陈燕, 等. B超引导下PICC置管的护理. 解放军护理杂志, 2008, 25(21): 64.
28.	Nifong TP, Mcdevitt TJ. The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters. Chest, 2011, 140(1): 48-53.
29.	Johnson MA, Mckenzie L, Tussey S, et al. Portable ultrasound: A cost-effective process improvement tool for PICC placement. Nurs Manage, 2009, 40(1): 47-50.
30.	李昌娣. 彩色超声引导下运用改良塞丁格技术行经外周中心静脉置管术的临床应用及护理. 临床合理用药杂志, 2011, 4(20): 115-116.
31.	刘志敏, 王春燕, 刘纯一. 超声引导下改良Seldinger技术置入PICC导管的临床分析. 护士进修杂志, 2011, 26(21): 1983-1984.
32.	范育英, 胡雯, 黄蔚华. 106例超声引导下结合微插管鞘行PICC置管术的临床效果. 当代护士, 2010, (12): 114-115.
33.	王建荣. 输液治疗护理实践指南与实施细则. 北京: 人民军医出版社, 2009: 48.
34.	Abdullah BJ, Mohammad N, Sangkar JV, et al. Incidence of upper limb venous thrombosis associated with peripherally inserted central catheters (PICC). Br J Radiol, 2005, 78(931): 596-600.
35.	Gonsalves CF, Eschelman DJ, Sullivan KL, et al. Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement. Cardiovasc Intervent Radiol, 2003, 26(2): 123-127.
36.	Hughes ME. PICC-Related Thrombosis: Pathophysiology, Incidence,Morbidity and the Effect of Ultrasound-Guided Placement Technique on Occurrence in Cancer Patients. JAVA, 2011, 16(1): 8-18.
37.	Butler PJ, Sood S, Mojibian H, et al. Previous PICC placement may be associated with catheter-related infections in hemodialysis patients. Cardiovasc Intervent Radiol, 2011, 34(1): 120-123.
38.	Nichols I, Humphrey JP. The efficacy of upper arm placement of peripherally inserted central catheters using bedside ultrasound and microintroducer technique. J Infus Nurs, 2008, 31(3): 165-176.
39.	Larue GD. Efficacy of ultrasonography in peripheral venous cannulation. J Intraven Nurs, 2000, 23(1): 29-34.
40.	Bourgeois FC, Lamagna P, Chiang VW. Peripherally inserted central catheters. Pediatr Emerg Care, 2011, 27(6): 556-561, 562-563.
41.	李玉彬, 胡一波. 头静脉与贵要静脉的应用解剖和PICC置管. 医学理论与实践, 2011, 24(24): 3027-3029.
42.	单志桂, 杨新玲, 姚亚妮. 如何运用系统评价结果进行临床实践. 中国循证医学杂志, 2012, 12(3): 357-359.

1. 于跃, 郝强. 经外周静脉置入中心静脉导管末端定位的研究进展. 第二军医大学学报, 2008, 29(10): 1244-1247.
2. 李新萍. 外周导入中心静脉置管的护理进展. 护士进修杂志, 2002, 17(11): 859-861.
3. 马珊, 马容莉, 林静. 超声引导和改良塞丁格技术置入PICC的研究进展. 护理学杂志, 2010, 25(9): 89-91.
4. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). [cited 2012 Jan 5]. Available from: URL: http://www.cochrane-handbook.org.
5. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in Meta-analysis. [cited 2012 Jan 11]. Available from: URL: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
6. 胡雁, 李晓玲. 循证护理的理论与实践. 上海: 复旦大学出版社, 2007: 30-40, 49, 74-78.
7. 方建华, 杨红萍, 杨琛, 等. 超声引导下经浅静脉PICC置管的临床应用价值.心脑血管病防治, 2011, 11(1): 38-40.
8. 黄爱梅, 朱敏. PICC不同置管部位的选择对置管后并发症发生率的影响. 中国医药指南, 2011, 9(17): 264-265.
9. 马姗, 马容莉, 林静, 等. 静脉穿刺外周中心静脉置管感染的预防. 中国消毒学杂志, 2011, 28(2): 235-236.
10. 陶莲德, 张莉, 袁志平, 等. 超声引导下改良经肘上外周穿刺置入中心静脉导管的效果观察. 西部医学, 2011, 23(7): 1362-1363.
11. 章洁, 马珊, 林静. 2种不同穿刺方法对高龄患者PICC置管并发症的影响. 现代中西医结合杂志, 2011, 20(26): 3330-3331.
12. 张晓菊, 陆箴琦, 戴宏琴, 等. 超声导引结合改良塞丁格技术行上臂PICC置入与盲穿置管的比较. 中华护理杂志, 2011, 46(1): 42-45.
13. 郑雪艳, 华茂, 潘亚萍. 彩超引导行上臂PICC穿刺的护理研究. 包头医学院学报, 2011, 27(5): 57-58.
14. 周薇, 刘丽兰, 何佩仪, 等. 超声引导下经外周置入中心静脉导管的效果观察. 护理学报, 2011, 18(1B): 53-55.
15. 方建华, 杨红萍, 许亮, 等. 超声引导下浅静脉PICC置管的临床评价. 中国现代医生, 2010, 48(27): 66-67.
16. 付阿丹. 不同部位置入PICC导管后并发机械性静脉炎的观察. 护理研究, 2010, 24(5B): 1246.
17. 田庆, 严云丽, 左杰. 血管超声引导下运用MST技术行PICC置管效果观察. 齐鲁护理杂志, 2010, 16(11): 56-57.
18. 万永慧, 谭飞, 陈芊, 等. 改良Seldinger技术应用于血管超声引导下上臂置入PICC的效果. 解放军护理杂志, 2010, 27(19):1507-1508.
19. 王东平, 陈立萍, 王萍, 等. 彩超引导联合改良塞丁格尔技术在PICC置管中的应用价值. 实用临床医药杂志, 2010, 14(11): 84-85.
20. 王建意. B超引导与传统PICC置管技术的对比研究. 齐鲁护理杂志, 2010, 16(10): 123-124.
21. 郭敏, 李静, 余晋涛, 等. 超声引导下经肘上外周穿刺置入中心静脉导管的效果观察. 现代临床护理, 2009, 8(11): 22-24.
22. 胡君娥, 龚兰, 唐运香, 等. 彩色多普勒血流显像技术引导下行PICC30例. 护理学杂志, 2007, 22(5): 39-40.
23. 黄石群, 胡敏芝, 梁艳芳, 等. PICC穿刺部位对并发症发生率的影响. 右江医学, 2007, 35(4): 401-402.
24. 郭丽娟, 张鸿雁, 赵晓玉, 等. 经外周静脉留置中心静脉导管穿刺部位的改进. 护理学杂志, 2006, 21(12): 37-38.
25. Stokowski G, Steele D, Wilson D. The use of ultrasound to improve practice and reduce complication rates in peripherally inserted central catheter insertions: final report of investigation. J Infus Nurs, 2009, 32(3): 145-155.
26. Polak JF, Anderson D, Hagspiel K, et al. Peripherally inserted central venous catheters: factors affecting patient satisfaction. Am J Roentgenol, 1998, 170(6): 1609-1611.
27. 沈峰平, 李红梅, 陈燕, 等. B超引导下PICC置管的护理. 解放军护理杂志, 2008, 25(21): 64.
28. Nifong TP, Mcdevitt TJ. The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters. Chest, 2011, 140(1): 48-53.
29. Johnson MA, Mckenzie L, Tussey S, et al. Portable ultrasound: A cost-effective process improvement tool for PICC placement. Nurs Manage, 2009, 40(1): 47-50.
30. 李昌娣. 彩色超声引导下运用改良塞丁格技术行经外周中心静脉置管术的临床应用及护理. 临床合理用药杂志, 2011, 4(20): 115-116.
31. 刘志敏, 王春燕, 刘纯一. 超声引导下改良Seldinger技术置入PICC导管的临床分析. 护士进修杂志, 2011, 26(21): 1983-1984.
32. 范育英, 胡雯, 黄蔚华. 106例超声引导下结合微插管鞘行PICC置管术的临床效果. 当代护士, 2010, (12): 114-115.
33. 王建荣. 输液治疗护理实践指南与实施细则. 北京: 人民军医出版社, 2009: 48.
34. Abdullah BJ, Mohammad N, Sangkar JV, et al. Incidence of upper limb venous thrombosis associated with peripherally inserted central catheters (PICC). Br J Radiol, 2005, 78(931): 596-600.
35. Gonsalves CF, Eschelman DJ, Sullivan KL, et al. Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement. Cardiovasc Intervent Radiol, 2003, 26(2): 123-127.
36. Hughes ME. PICC-Related Thrombosis: Pathophysiology, Incidence,Morbidity and the Effect of Ultrasound-Guided Placement Technique on Occurrence in Cancer Patients. JAVA, 2011, 16(1): 8-18.
37. Butler PJ, Sood S, Mojibian H, et al. Previous PICC placement may be associated with catheter-related infections in hemodialysis patients. Cardiovasc Intervent Radiol, 2011, 34(1): 120-123.
38. Nichols I, Humphrey JP. The efficacy of upper arm placement of peripherally inserted central catheters using bedside ultrasound and microintroducer technique. J Infus Nurs, 2008, 31(3): 165-176.
39. Larue GD. Efficacy of ultrasonography in peripheral venous cannulation. J Intraven Nurs, 2000, 23(1): 29-34.
40. Bourgeois FC, Lamagna P, Chiang VW. Peripherally inserted central catheters. Pediatr Emerg Care, 2011, 27(6): 556-561, 562-563.
41. 李玉彬, 胡一波. 头静脉与贵要静脉的应用解剖和PICC置管. 医学理论与实践, 2011, 24(24): 3027-3029.
42. 单志桂, 杨新玲, 姚亚妮. 如何运用系统评价结果进行临床实践. 中国循证医学杂志, 2012, 12(3): 357-359.

Chinese Journal of Evidence-Based Medicine

Influence of PICC Ultrasound Guidance on Elbow Puncture and Catheterization and Its Complications: A Systematic Review

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