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

Abstract

<p><strong>Objective</strong> To systematically evaluate the influence of PICC (peripherally inserted central catheter) ultrasound guidance on success rates and incidences of complications of elbow catheterization.<br><strong>Methods</strong> 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.<br><strong>Results</strong> 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).<br><strong>Conclusion</strong> 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.<br></p>

目的系統評價PICC超聲引導下肘上置管對穿刺置管成功率、并發癥發生率的影響。方法計算機檢索The Cochrane Library (2012年第3期）、JBI循證護理中心圖書館、MEDLINE、EMbase、CBM、VIP、CNKI和WanFang Data,收集所有關于PICC超聲引導下肘上置管和常規肘下置管對穿刺置管成功率、并發癥發生率影響的隨機對照試驗、臨床對照試驗和隊列研究。檢索時限均為從建庫至2012年3月。由2名研究員按照納入和排除標準篩選文獻、提取資料、評價質量,然后采用RevMan 5.1軟件進行Meta分析或僅行描述性分析。結果共納入11個隨機對照試驗、5個臨床對照試驗、4個隊列研究,4 052例患者。Meta分析結果顯示:超聲引導下結合改良賽丁格技術肘上置管的一次穿刺成功率、置管成功率均較常規肘下置管高,其差異均有統計學意義[OR=4.71,95%CI（1.97,11.28）,P=0.000 5;OR=8.63,95%CI（1.92,38.82）,P=0.005]。常規肘下置管的靜脈炎發生率較超聲引導下肘上置管高,其差異有統計學意義[OR=0.13,95%CI（0.08,0.21）,P＜0.000 01]。結論 PICC超聲引導下結合改良賽丁格技術肘上置管較常規肘下置管在提高穿刺置管成功率和降低并發癥發生率方面具有明顯優勢。