Ms. Wu, 65 years old, underwent bilateral breast cancer surgery for bilateral breast cancer, and bilateral axillary lymph nodes were removed. Postoperative patients require chemotherapy, but due to lymphedema in both upper extremities, they cannot be injected intravenously into both upper extremities, and an indwelling PICC catheter (central venous catheter inserted through a peripheral vein) cannot be used for follow-up**.
The patient and his family were anxious, and many hospitals were consulted and the answer was that it could be injected through the jugular vein (neck) or femoral vein (thigh) or with "intravenous port implantation". Because patients need to undergo intravenous chemotherapy every 2 weeks, there is a high risk of long-term indwelling catheter infection in the neck and thigh root, and there are many inconveniences in daily lifeImplantable intravenous ports, on the other hand, are expensive and difficult for patients to accept.
After inquiring around, Ms. Wu learned that the Department of Interventional Medicine of the First People's Hospital of Xiangtan City could make a PICC catheter that was left at the collarbone, and the patient and his family immediately came to see her.
Luo Bingquan, deputy director of the Department of Interventional Medicine of the First People's Hospital of Xiangtan City, carefully checked the patient's condition, carefully evaluated the patient's CT and color ultrasound examinations, and informed the patient that he could do "double tunnel technique transjugular venous indwelling PICC catheterization" to open up a reliable intravenous infusion access for follow-up.
After obtaining the consent of the patient and his family, on December 15, Luo Bingquan, deputy director of the Department of Interventional Medicine of the First People's Hospital of Xiangtan City, and Chen Zhengxi, deputy chief physician of the Department of Interventional Medicine, successfully implanted a PICC catheter in the patient's right internal jugular vein using the double-tunnel technique, and the patient successfully completed the first intravenous chemotherapy after breast cancer surgery using the PICC catheter on the second day after surgery.
No incision after catheterization**.
X-rays after catheterization show that the catheter is in good position.
Popular science class.
Single tunnel: The internal jugular venous catheter forms a "V" arc with the tunnel catheter, and the catheter is easy to be discounted.
Double tunnel: The internal jugular intravenous catheter and the tunnel catheter form a "U" shaped arc, and the catheter is not easy to be discounted.
1. What are the indications for transjugular intrajugular indwelling PICC catheterization with double tunnel technique?
1) Patients who require long-term intravenous **;
2) patients lacking peripheral venous access;
3) Patients with contraindications to the cannulation of both upper limb veins and subclavian veins;
4) Patients who need to be infused with stimulant drugs, such as chemotherapy drugs;
5) Patients who require infusion of hyperosmolar or viscous fluids, such as parenteral nutrition;
6) Patients who need repeated blood transfusions or blood products, or repeated blood collection;
7) Patients in family beds.
2. What are the advantages of transjugular intrajugular indwelling PICC catheter with double tunnel technique?
1) Due to the wide lumen and straight passage of the internal jugular vein, compared with the axillary vein and subclavian vein, long-term indwelling catheters are less prone to catheter-related thrombotic events, vascular stenosis and other complications
2) The two tunnels of the double tunnel technique are both subcutaneous, the puncture point is only 2mm, the large blood vessels are not damaged, the bleeding is slight, and the subcutaneous tunnel is connected by two tunnels, and the amount of bleeding in the whole operation is small
3) The internal jugular venous catheter and the tunnel catheter form a "U" shaped arc instead of a "V" shaped arc, which avoids the shortcomings of catheter discount and ensures the smooth infusion
4) The body surface outlet of the catheter is migrated from the neck to the chest wall of the subclavian region through the double tunnel technology, which has good concealment and can be completely covered by clothing to meet the privacy and aesthetic needs of patients
5) The anterior chest wall of the subclavian area is flat, the sebaceous gland secretion is less, the transparent dressing fits closely with the first place, the activities of the head and shoulders and various daily life care have no impact on the dressing, the dressing is not easy to be moist and loose, the catheter is fixed securely, and the chance of bacterial infection and catheter prolapse is not increased
6) In a long subcutaneous tunnel, the catheter passes through the tunnel, and the contraction of the tissue and the wrapping of the connective tissue can fix the catheter, so the catheter is not easy to fall out.
Hunan Medical Chat Special Author: Xiangtan First People's Hospital Luo Bingquan Follow @Hunan Medical Chat to get more health science information!
Edit zs. Part of the *** network, invaded and deleted).
New Year's Day is healthy