Recently, under the guidance of head nurse Lin Weifen, the head of the static therapy group, He Yuxia and Huang Dongli, nurses in the catheter outpatient department of Guangxi Nationalities Hospital, successfully placed a PICC catheter for a pacemaker patient in the neurology department. A new “life channel” was built for the patient, which is the first case of successful intubation of a pacemaker patient in the hospital.
Pre-cannulation chest radiograph
PICC is an Peripheral veins such as the precious vein, median cubital vein, and cephalic vein are punctured and placed, and the tip of the catheter is located at the lower third of the patient’s superior vena cava or the central venous catheter at the junction of the superior vena cava and the right atrium. A permanent cardiac pacemaker generally consists of two or a single electrode and a pulse generator. The electrodes are implanted through the subclavian vein to the right atrium or ventricle, and are placed in the same side of the PICC. Entry paths overlap. Therefore, the limb ipsilateral to the pacemaker should not be selected for PICC puncture, otherwise it will seriously affect the venous blood flow velocity and increase the risk of venous thromboembolism (VTE). The patient Gan was diagnosed with acute cerebral infarction. After the implantation of the cardiac pacemaker, he is currently in critical condition. There are many underlying diseases, which may aggravate the condition or even threaten life at any time. The peripheral vascular condition of the patient is very Poor, it is difficult to open the infusion access in the first area of neurology. The patient was seriously ill, and a deep venous access was urgently needed to solve the problem of intravenous medication. The first area of the neurology department applied for a consultation and invited the catheter clinic to help solve the problem.
ECG changes
The catheter outpatient team has a The pacemaker installation path, treatment plan, treatment time, and nature of medication were comprehensively evaluated, and the PICC catheter was the best choice. However, the patient’s pacemaker approach was the left subclavian vein, so the left upper limb was not suitable for puncture, so it was decided to place a PICC catheter in the right upper limb. During the catheter placement process, the catheter outpatient team closely monitored the patient’s ECG changes. Specialist nurse He Yuxia used a needle tunnel puncture under the guidance of ultrasound, and used non-invasive skin expansion technology to expand the skin. When inserting the catheter, the catheter delivery action is gentle and slow to avoid damage to the pacemaker lead, and the intracavity electrolocation technique is used to observe the changes of the P wave. Combined with the in vitro measurement, the catheter tip is accurately placed into the superior vena cava. The position of the catheter tip was determined to be at the ideal level of the T6 vertebral body, and the positional relationship between the catheter and the electrode lead was clearly seen, and the three-way valve PICC was successfully placed.
Post-cannulation chest radiograph
Carrying a pacemaker The patient is not an absolute contraindication to PICC catheterization, nor is it a contraindication to intracavitary electrolocation technology. my country has entered an aging society, and the number of patients with pacemakers has increased, but it is difficult for patients with pacemakers to have PICC catheterization. Therefore, patients with cardiac pacemakers should be comprehensively evaluated before catheterization, and closely observed during catheterization. The patient’s condition and electrocardiogram changes, the catheterization nurse should have skilled catheterization technology to provide a guarantee for the patient to safely place the PICC catheter. This successful catheter placement case is a new breakthrough in the PICC catheter placement technology of Guangxi Nationalities Hospital, and it also demonstrates that the hospital has reached a higher level in the field of static therapy technology. (He Yuxia)