| Objective To assess the clinical effects of two kinds of PICC placements, compare their complications rates and differences of medical expenses, then evaluate the two methods using costs-effects analysis, to provide academic supports and evidences for seeking for more economic, convenient and efficient PICC catheter placement.Methods To select randomly319cases who needed PICC placements by willingness from May,2009to April,2011,175cases were assigned into the control group with the old technique of inserting PICCs and144cases were assigned into the experimental group with the improved Seldinger to insert PICCs by ultrasound guidance. The effects of placement, including success rates of puncturing and inserting, the position and the vein of inserting PICCs, pain degree, practice duration, local tissue injury, amount of bleeding in24-hour following catheter placement, and other complications during mid-operation and post-operation, the complications rates within the periods of inserting PICCs and being with the catheter as well as the cost effectiveness were evaluated using health economic indicators.Results1.The average puncturing time using improved Seldinger by ultrasound guidance was35.35+23.19min and the average length of inserting PICC was25.07+3.48cm; but the average puncturing time using traditional trocar was28.1+6.57min and the average length of inserting PICC was45.52+4.53cm. Seventy-eight percent of venous implanted pathways were available for the basilic vein in control group as against98%in experimental group.21percent of vein puncture points located in the place of chelidon in control group as against99%in experimental group, statistic differences were shown between them (p=0.000<0.01), and there was no statistic difference regarding the arm circumference and the site of tube end (p>0.05).2.99.6percent success rates of PICC placement in experimental group, which was higher than85%success rates of that in control group.94.6percent success rates of puncturing in experimental group as against75.4%in control group,95.8%success rates of primary inserting PICC in experimental group as against91.4%in control group. Significant differences were seen in the success rates of puncturing and inserting once as well as numbers of failure (p<0.01). The amount of bleeding in operating time was2.41+1.40ml,24-hr-amount of bleeding was0.11+0.08ml in experimental group as against3.26+1.79ml amounts of bleeding in operating time and0.29+0.66ml amounts of bleeding for24-hr; and per capita pain scores were2.79+1.91in experimental group as against5.16+1.44per capita scores in control group; there were statistic differences between them (p<0.01). 3. The complications rates in experimental group after inserting were apparently lower than that in control group, and statistic differences were seen in the local tissue injury, phlebitis, the accident of pulling the catheter out, the catheter displaced rates and infection occurrence rates (p<0.01). No statistic differences were seen in the incidence of the upper arm thrombosis and swelling (p>0.05). There was conspicuous differences in the rate of non-planned pulling the catheter out,11.4%in experimental group and1.4%in control group (p<0.01).4.The average medical expenses for PICC in experimental group were more than that in control group during the time of inserting PICC and second-half-year of that, yet the expenditure in the experimental group to tackle the complications was prominently lower than that in the control group, which showed statistic difference respectively (p<0.01). The consume fee of medical resource in control group were￥57’332, asagainst￥19’499in experimental group, which showed the statistic differences (p<0.01).5.A matter of patients’comfortable sense assessment,76.6%reported comfort and above that in experimental group as against44.7%in control group, and the statistic difference was seen (p<0.01).6.98.6percent patients attained to intended purpose of PICC placement in experimental group as against88.6%in control group, there was remarkable difference (p<0.01). Conclusions1.The improved Seldinger of inserting PICC by ultrasound guidance with reduced more complications is safer, more accurate and practical than traditional trocar technique of inserting PICC, and the former has clinically fruitful prospects.2.Compared the former with the latter, the former makes the patients more comfortable with favorable cost effectiveness, and it is appropriate for spreading across in clinic. |
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