摘要
探讨1例左手上臂静脉PICC导管患者拔管过程中遇到的困难和解决方法。患者PICC导管通过DSA血管造影和超声检查排除静脉炎和血栓形成，经静脉输液专家会诊考虑是纤维蛋白形成，包裹住导管前端，使拔管回缩现象严重。考虑通过松懈皮下组织的方式进行治疗，即使用针头剥离穿刺点周围组织，并联合静滴654-2的治疗方式，成功拔管。一月后随访患者左上肢穿刺部位愈合良好，肢体功能正常。总结对于纤维蛋白鞘包裹或者血管壁粘附PICC导管患者，可以考虑局麻下借助针头等小的利器对穿刺点进行松解，患者预后良好。
关键词： PICC；拔管困难；纤维蛋白鞘；血管痉挛
Abstract
To explore the difficulties and solutions encountered in extubation of PICC catheter in a patient with left upper arm vein. The PICC catheter of the patient was ruled out by DSA angiography and ultrasound examination for phlebitis and thrombosis. After consultation with intravenous infusion experts, it was considered to be fibrin formation, which wrapped the front end of the catheter and made the extubation retraction serious. Treatment by loosening the subcutaneous tissue was considered, that is, the use of a needle to peel off the tissue around the puncture point, combined with intravenous drops of 654-2, and successful extubation. One month later, the puncture site of the left upper limb healed well and the limb function was normal. Conclusion For patients with fibrin sheath or vascular wall adhesion to PICC catheter, the needle and other small sharp instruments can be used to release the puncture point under local anesthesia, and the prognosis of patients is good.
Key words： PICC. Difficulty in extubation; Fibrin sheath; vasospasm
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