CN105476720B - Device and method for judging PICC (peripherally inserted Central catheter) ectopic position - Google Patents

Abstract

The invention belongs to the technical field of medical instruments and discloses a device and a method for judging PICC ectopic catheter placement. The method is to determine the position of the PICC catheter tip into the superior vena cava by detecting a continuous interruption in fluid instillation. The device comprises a singlechip, a photoelectric sensor for measuring the dropping speed of the liquid and a sound prompter for prompting according to a prompt signal sent by the singlechip; the I/O output end of the photoelectric sensor is electrically connected with the I/O input end of the singlechip, and the I/O output end of the singlechip is electrically connected with the I/O input end of the sound prompter; the method can conveniently and effectively judge PICC (peripherally inserted central catheter) catheter dislocation; the device has simple structure and convenient use.

Description

A device and method for judging the abnormal position of PICC catheter

technical field

The invention belongs to the technical field of medical devices, and in particular relates to a device and a method for judging the abnormal position of a PICC catheter.

Background technique

With the wide application of peripherally inserted central catheter (PICC) technology in clinic, more and more attention has been paid to its related complications. Catheter malposition is a common complication of PICC and the leading cause of unplanned extubation. Ectopia can occur during and after surgery. The occurrence of intraoperative ectopy is related to the catheterization method and individual blood vessel conditions. According to research reports, the incidence of intraoperative ectopy is 12.5% to 25%. At present, the conventional method for judging the abnormal position of the catheter is chest fluoroscopy or X-ray film. Usually, it is necessary to go to the relevant examination department after the catheter is placed, and then adjust it after the abnormal position is found. Increased infection probability, patient economic burden, nursing workload, and X-ray load also increased to varying degrees, and also reduced the success rate of first catheterization and patient satisfaction.

Amerasekera et al. reported that in adult patients, the incidence of catheter tip misplacement without X-ray imaging guidance was 6-10%. In pediatric patients, however, Fricke et al. found that only 14.2% of the initial PICCs were located at the central venous site. In order to improve the placement rate of the catheter tip, the most commonly used methods in foreign clinical practice are PICC placement under X-ray fluoroscopy, ultrasound technology to guide PICC placement, and cardiac ultrasound and other auxiliary technologies. However, most hospitals in China do not have the equipment. At the same time, the ultrasound machine cannot penetrate the bone and can only detect the subclavian vein, but cannot show the direction of all veins in the PICC. The occurrence of catheter ectopia cannot be completely judged.

According to the 2011 practice guidelines of the American Society of Infusion Nurses (INS), catheter ectopia can be divided into primary ectopia and secondary ectopia. Primary ectopy occurs during catheterization, and secondary ectopic can occur at any time during catheter indwelling. It is related to the change of intrathoracic pressure, the occurrence of congestive heart failure, the activities of upper limbs or neck, positive pressure ventilation, high-pressure injection or flushing technique, etc. Catheter ectopy can easily lead to complications such as phlebitis, catheter blockage, and venous thrombosis, and can also cause more serious complications such as arrhythmia, vascular perforation, cranial nerve damage, and cardiac tamponade, especially secondary ectopic catheters. Early asymptomatic, easy to be ignored. The INS guidelines state that a chest radiograph must be used to confirm catheter tip position after catheter insertion. How long it took to reposition the catheter tip during catheter indwelling was not specified. In clinical practice, regular chest X-rays are not routinely performed on patients with long-term catheters to confirm the position of the catheter tip. Repeated X-ray films will increase the economic burden and X-ray load of patients, and whether it is necessary is controversial. The detection of secondary heterotopia has gradually received attention.

Studies by Feng Bilong and others have shown that intracavitary ECG positioning technology can immediately detect catheter abnormality during catheterization and improve the accuracy of the head position. However, it requires corresponding equipment and has high technical requirements for the operator to correctly identify the ECG. At the same time, it connects the ECG electrodes to the guide wire of the PICC tube to obtain the intracavitary ECG signal. After successful PICC catheterization, the guide wire needs to be withdrawn after determining the position of the catheter tip. Therefore, this method is not suitable for the judgment of secondary ectopia.

Therefore, it is necessary to study a convenient and effective device and method for judging the abnormal position of PICC insertion.

Contents of the invention

The object of the present invention is to provide a device and a method for judging PICC indwelling in place, the device is simple in structure and easy to use; the method can conveniently and effectively judge PICC in place in place.

In order to achieve the above object, the present invention adopts the following technical solutions to achieve.

Option One:

A device for judging the abnormal position of the PICC catheter, characterized in that: the liquid input end of the PICC catheter is connected with a precision infusion device; the device for judging the abnormal position of the PICC catheter includes a single-chip microcomputer for measuring precision infusion The photoelectric sensor of the time interval t between every two drops of liquid in the dripping glass of the device; the photoelectric sensor adopts a through-beam infrared sensor, and the through-beam infrared sensor includes a light emitter and a light receiver, and the light emitter and the light receiver are installed correspondingly Outside the two opposite sides of the drip leak of the precision infusion set, the installation height of the light emitter and the light receiver is below the position where the liquid drips out;

A time threshold T is preset in the single-chip microcomputer, and the single-chip microcomputer compares the time interval t with the time threshold T: when the time interval t is greater than the time threshold T, it is judged that the PICC is in place; otherwise, it is judged that the PICC is in place;

A sound prompter used to prompt the PICC tube placement in place according to the prompt signal sent by the single-chip microcomputer;

The I\O output terminal of the photoelectric sensor is electrically connected to the I\O input terminal of the single-chip microcomputer, and the I\O output terminal of the single-chip microcomputer is electrically connected to the I\O input terminal of the sound prompter.

Features and further improvements of the above-mentioned technical solution:

Further, the sound prompter is a buzzer prompter or a voice prompter.

Further, the output terminal of the single-chip microcomputer is also electrically connected to a display screen for displaying the time interval t between every two drops of liquid

Option II:

A method for judging the ectopic placement of the PICC catheter, based on the above-mentioned device for judging the ectopic placement of the PICC catheter, is characterized in that: the guide wire is retained after the PICC catheter is inserted, and the operation steps are as follows,

Step 1, installing the device for judging the misplacement of the PICC tube on the drip leak (1) of the precision infusion set, and adjusting the liquid dripping speed of the precision infusion set to a fixed value;

Step 2: When the patient is coughing, detect the change of the drop rate of the liquid:

If the continuity of fluid infusion is interrupted, judge the position of the tip of the PICC catheter into the superior vena cava;

If the drip rate is not affected, it is judged that the PICC catheter is abnormal.

Features and further improvements of the above-mentioned technical solution:

Further, the time threshold T is between 0.5 second and 1 second.

Further, if the interruption of liquid infusion is not obvious, withdraw more than half of the guide wire, and adjust the speed of liquid dripping, and then detect the change of liquid dripping speed when the patient is coughing again: if the continuity of liquid infusion is interrupted, then Determine the position of the tip of the PICC catheter into the superior vena cava; if the drip rate of the liquid is not affected, it is judged that the PICC catheter is abnormal.

Further, if the value of the time interval t minus the time threshold T is in the range of 0-0.2 seconds, it is judged that the interruption of liquid infusion is not obvious; when the time value of the time interval t minus the time threshold T is greater than 0.2 seconds, it is judged that If the continuity of liquid infusion is interrupted, it is judged that the PICC is placed in place; when the time interval t is less than or equal to the time threshold T, it is judged that the drip rate of the liquid is not affected, and it is judged that the PICC is not in place.

Further, after the liquid drip rate is not affected, the change of the liquid drip rate is detected when the patient's head is turned to the surgical side until the ear touches the shoulder. If the continuity of the liquid drip is interrupted, it is judged that the tip of the PICC catheter enters the internal jugular vein.

Further, after the liquid drip rate is not affected, the change of the liquid drip rate is detected when the patient’s limb on the operated side is adducted at 90 degrees from the position of the catheter and parallel to the body. If the continuity of the liquid drip is interrupted, the position of the tip of the PICC catheter is judged into the axillary vein.

The device and method for judging PICC intubation abnormality of the present invention judges whether PICC intubation is abnormal by detecting the influence of cough action on liquid drop rate. The method is convenient, effective and accurate; The judgment of heterotopia has good application value. The dripping speed of the liquid is judged by a photoelectric sensor and a single-chip microcomputer, which avoids human subjectivity, and the device has a simple structure and is convenient to use.

Description of drawings

Fig. 1 is a kind of structural schematic diagram of the device of judging PICC intubation misplacement of the present invention;

Fig. 2 is a kind of electrical structure schematic diagram of the device for judging PICC indubation abnormal position of the present invention;

In the figure: 1. Hourglass; 2. Light emitter; 3. Light receiver.

detailed description

The present invention will be described in detail below in conjunction with the accompanying drawings and specific embodiments.

With reference to Fig. 1, Fig. 2, it is a kind of structural schematic diagram of judging the device of PICC catheter ectopia of the present invention; The liquid input end of PICC catheter is connected with precision infusion set; This device for judging PICC ectopic placement includes single-chip microcomputer , a photoelectric sensor used to measure the time interval t between every two drops of liquid in drip 1 of a precision infusion set. The light receiver 3 is correspondingly installed on two opposite sides of the drip glass 1 of the precision infusion set, and the installation height of the light projector 2 and the light receiver 3 is below the position where the liquid drips out. When in use, the height of the liquid level in the drop glass 1 is controlled to be lower than the height of the light emitter 2 and the light receiver 3 .

A time threshold T is preset in the single-chip microcomputer, and the single-chip microcomputer compares the time interval t with the time threshold T: when the time interval t is greater than the time threshold T, it is judged that the PICC tube is in place; otherwise, it is judged that the PICC tube is not in place. The voice prompter is used to prompt the PICC tube to be placed in place according to the prompt signal sent by the single-chip microcomputer.

The I/O output end of the photoelectric sensor is electrically connected to the I/O input end of the single-chip microcomputer, and the I/O output end of the single-chip microcomputer is electrically connected to the I/O input end of the sound prompter.

The sound prompter is a buzzer prompter or a voice prompter, so that medical staff can be better warned.

The output end of the single-chip microcomputer is also electrically connected with a display screen for displaying the time interval t between every two drops of liquid, which is convenient for medical personnel to detect.

The through-beam infrared photoelectric sensor has the advantages of non-contact measurement, fast response, little influence from the environment, and high measurement accuracy. It is a sensitive characteristic that can be used to measure small displacements by using its sensitivity to the blackness of the object's surface. After the light beam of a certain intensity emitted from the infrared emitting tube of the light source reaches the measuring surface, according to the different blackness and surface finish of the object surface, part of the light is scattered and reflected to the infrared sensitive receiving tube and transformed into proportional to the light intensity received by the receiving tube. electrical signal. The through-beam photoelectric sensor is divided into two parts: the light emitter 2 and the light receiver 3. The optical axes of the two coincide on the same straight line. When working, the light projector 2 emits modulated light, which is received by the light receiver 3 and becomes an electrical signal. When the measured object enters the detection area, the light is blocked, and the light receiver 3 has no light to receive. The output state of the sensor changes. The output pulse is changed into high and low level through pulse shaping and A/D conversion, and finally input to the external interrupt of the single-chip microcomputer. The single-chip microcomputer judges the presence or absence of droplets and counts the droplets according to the change of high and low levels; each water drop generates such an irregular negative pulse, and the number of pulses corresponds to the number of water droplets; When the time interval t is timed, when the time interval t is greater than the time threshold T, the single-chip microcomputer sends a prompt signal to the sound prompter, and the sound prompter emits a buzzer after receiving the alarm signal.

The drop speed of the liquid is accurately calculated by a photoelectric sensor and a single-chip microcomputer, which avoids human subjectivity, and the device has a simple structure and is convenient to use.

The method of judging the abnormal position of the PICC catheter by using the device is to judge the position of the tip of the PICC catheter into the superior vena cava by detecting the continuous interruption of the infusion of the liquid.

Nurses who have obtained the catheterization qualification routinely insert the PICC catheter into the patient's body and keep the guide wire. Insert an empty syringe into the liquid input end of the PICC catheter, withdraw the syringe, and after seeing the blood return in the PICC catheter, use the pulse method to flush the PICC catheter, which can prevent the PICC catheter from being blocked; pull out the syringe, and connect the liquid output end of the precision infusion set to the PICC catheter Adjust the liquid drop speed to a fixed value. The specific method for judging the misplaced placement of the PICC catheter includes the following steps:

Step 1: Install the above-mentioned device for judging the misplacement of the PICC tube on the dripper 1 of the precision infusion set, and adjust the liquid dripping speed of the precision infusion set to a fixed value;

Step 2: When the patient is coughing, detect the change of the drop rate of the liquid:

If the continuity of fluid infusion is interrupted, judge the position of the tip of the PICC catheter into the superior vena cava;

If the drip rate is not affected, it is judged that the PICC catheter is abnormal.

The above-mentioned time threshold T is between 0.5 second and 1 second.

Under normal circumstances, it can be detected that there is an obvious pause in the infusion of the liquid. The speed of the infusion of the liquid is uniform, and the length of the pause in the middle is consistent. At the end of the patient's cough, the continuity of the infusion of the liquid is interrupted, that is, the length of the pause is prolonged. Make the rate of liquid dripping uneven.

If the interruption of liquid infusion is not obvious, withdraw more than half of the guide wire and speed up the liquid drip rate. Once again, when the patient is coughing, detect the change of liquid drip rate: if the continuity of liquid infusion is interrupted, judge the PICC catheter The tip position enters the superior vena cava; if the drip rate of the liquid is not affected, it is judged that the PICC catheter is abnormal.

If the value of the time interval t minus the time threshold T is in the range of 0-0.2 seconds, it is judged that the interruption of liquid infusion is not obvious; when the time value of the time interval t minus the time threshold T is greater than 0.2 seconds, it is judged as a liquid drop Note that if the continuity is interrupted, it is judged that the PICC is placed in place; when the time interval t is less than or equal to the time threshold T, it is judged that the dripping speed of the liquid is not affected, and the PICC is judged to be abnormal.

After the liquid drip rate is not affected, the change of the liquid drip rate is detected when the patient's head is turned to the surgical side until the ear touches the shoulder. If the continuity of the liquid drip is interrupted, it is judged that the tip of the PICC catheter enters the internal jugular vein.

After the liquid drip rate is not affected, when the patient’s limb on the operated side is adducted at 90 degrees from the position of the catheter and parallel to the body, the change of the liquid drip rate is detected. If the continuity of the liquid drip is interrupted, it is judged that the tip of the PICC catheter enters the axillary vein .

From the basilic vein and other peripheral veins to the front of the superior vena cava belongs to the extrathoracic system, and from the superior vena cava to the right atrium belongs to the internal thoracic system. The tip of the PICC catheter is located in the superior vena cava (SVC), and drugs are infused along the thoracic circulatory system. Respiratory exercise can change the thoracic pressure. Because the internal thoracic system is affected by the change of respiration thoracic pressure, the pressure and blood flow will change significantly; it shows that the blood flow toward the heart gradually increases during the inspiratory phase, and reaches the peak at the end of inspiratory. The flow velocity in the expiratory phase gradually slows down to the minimum at the end of expiration; while the blood flow velocity of the centrifugal direction wave slows down in the inspiratory phase and reaches the minimum at the end of inspiratory phase, and vice versa in the expiratory phase. Since the SVC is located in the upper middle mediastinum, its shape and hemodynamics are affected by both the cardiac cycle and the respiratory cycle, and the changes in blood flow velocity and direction reflect the pressure cycle of the right heart caused by the combined mechanical activities of the heart and lungs. According to the principles of fluid mechanics, the velocity and direction of SVC blood flow are determined by the instantaneous pressure difference between the SVC and the right atrium. If the pressure difference is large, the flow rate will be fast, and if the pressure difference is small, the opposite will occur. Blood flow; when inhaling, the volume of the thoracic cavity increases, and the negative pressure value of the thoracic cavity further increases, which further expands the large veins in the thoracic cavity and the right atrium, and further reduces the pressure, which is conducive to the return of blood from the peripheral veins to the right atrium. The opposite is true for gas. Especially when the patient coughs, the pressure in the pleural cavity will increase sharply, resulting in a rapid increase in the pressure in the right atrium of the superior vena cava, which is not conducive to the return of blood from the peripheral veins to the right atrium, and even produces a centrifugal blood flow, which is harmful to liquid droplets. Note that there is a noticeable impact. In this study, the detection of respiratory movement has no obvious effect on the liquid drop rate, but the coughing action has a significant impact on the liquid drop rate, and a significant pause in the liquid drip can be detected at the end of the cough.

However, the lumen of the extrathoracic system is not affected by changes in pleural pressure during coughing. When the tip of the catheter is located in the extrathoracic system, that is, when it is located in a vein other than the superior vena cava, the lumen will not change due to changes in pleural pressure, and the drip rate of the fluid will not change accordingly. Therefore, in patients with PICC catheterization, the chest pressure can be changed instantaneously by coughing, and the internal pressure of the superior vena cava and right atrium can be changed to detect the infusion rate of the fluid and determine the position of the catheter tip.

In the present invention, combined with coughing action, the chest pressure can be changed indirectly and quickly, the internal pressure of the superior vena cava can be changed, and the liquid drop speed can be changed. After the catheter is inserted during the catheterization process, the liquid drop speed at the end of the cough can be detected by instructing the patient to cough. Whether there is a significant pause, judge whether the catheter is in place, and adjust the position of the catheter accordingly to improve the success rate of one-time catheterization.

A total of 252 patients were selected as research subjects. Inclusion criteria: ①Patients who can guide and cooperate to complete coughing movements; ②Patients with disturbance of consciousness with cough reflex; ③Participate in this study voluntarily after informed consent; Exclusion criteria: ①Patients with profound disturbance of consciousness and no cough Emission; ②Patients with obvious chest pain and unable to complete the coughing action. A total of 252 patients who underwent PICC catheterization in our department were selected, including 135 males and 117 females, aged 47 to 81 years; 75 cases of lung cancer and 177 cases of esophageal cancer. During the catheterization process, after the predetermined scale of the catheter was fully inserted, 217 patients experienced a stoppage of liquid infusion at the end of coughing, accounting for 81.11%, and 35 patients did not. Among the 35 patients, 18 cases had head tilting to the operation side to affect the liquid drip rate, accounting for 7.14%; 15 cases had the upper limb adduction movement on the operation side to affect the liquid drop rate, accounting for 5.95%, suspected ectopic axillary vein and internal jugular vein. The above-mentioned 35 patients, after re-transmission of the catheter, finally reached the judgment standard of the catheter into the superior vena cava - the stop of liquid infusion at the end of coughing. X-rays were used to confirm the position of the tip of the catheter after catheterization in 252 patients. In 251 cases, it was the lower 1/3 segment of the superior vena cava, and in 1 case, it entered the right atrium. The success rate of catheterization for the first time was 100%. The correct rate of detecting whether the tip of the catheter enters the superior vena cava is 100%. The detection method of the effect of coughing action on the drip rate can effectively detect the abnormal position of the catheter during the catheterization process, and adjust it in time, avoiding the secondary adjustment of the catheter, and largely ensuring the success rate of the first catheterization.

252 cases of patients affected by the speed of liquid dripping

This method is also applicable to the judgment of the position of the PICC three-chamber valve catheter.

The faster the drip rate, the more pronounced the pause in fluid drip at the end of the cough. However, caution should be exercised for patients with cardiopulmonary insufficiency and other patients who need to control the drip rate.

Although the embodiments of the present invention have been described above in conjunction with the accompanying drawings, the present invention is not limited to the above-mentioned specific embodiments and application fields, and the above-mentioned specific embodiments are only illustrative, instructive, and not restrictive . Under the enlightenment of the description, those skilled in the art can also make many forms without departing from the protection scope of the claims of the present invention, and these all belong to the protection of the present invention.

Claims (3)

1. a kind of be used to judge that PICC puts the device of pipe dystopy, it is characterised in that：The fluid input port of PICC conduits is connected with essence Close transfusion device；This is used to judge that PICC puts the device of pipe dystopy including single-chip microcomputer, in the water clock (1) for measuring precision infusion set Every two drop of liquid between time interval t photoelectric sensor；The photoelectric sensor uses correlation infrared sensor, described Correlation infrared sensor includes light projector (2) and light-receiving device (3), and the light projector (2) and light-receiving device (3) correspondence are arranged on essence Outside the two relative side of the water clock (1) of close transfusion device, the setting height(from bottom) of the light projector (2) and light-receiving device (3) is oozed in liquid The lower section of position；

Time threshold T is preset with the single-chip microcomputer, time interval t is compared by single-chip microcomputer with time threshold T：When between the time When t is more than time threshold T, judge that PICC puts pipe in place；Otherwise, judge that PICC puts pipe dystopy；

Cue for being sent according to single-chip microcomputer carries out prompting PICC and puts the voice prompting device of pipe in place；

The I of the photoelectric sensor O output ends electrically connect the single-chip microcomputer I O inputs, the I of the single-chip microcomputer O outputs The I of the end electrical connection voice prompting device O inputs.

2. it is as claimed in claim 1 a kind of for judging that PICC puts the device of pipe dystopy, it is characterised in that：The auditory tone cues Device is buzzing prompting device or voice prompting device.

3. it is as claimed in claim 1 or 2 a kind of for judging that PICC puts the device of pipe dystopy, it is characterised in that：The monolithic The output end of machine is also electrically connected with the display screen for showing the time interval t between every two drop of liquid.