静脉输液港植入与管理多学科专家共识(2023版)
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Multidisciplinary expert consensus on implantation and management of venous infusion port (2023 edition)
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    摘要:

    完全植入式静脉给药装置(TIVAD)又称静脉输液港,是一种新兴的中心静脉输液通路装置,主要应用于肿瘤化疗、肠外营养支持,近年来的应用证实该技术可靠有效。目前国内对该技术的应用主要集中于大型医疗机构,不同地区植入手术和维护存在较大差异,造成实际应用效果差异较大、相关并发症的发生率高、患者满意度差别大。专家组集合了在静脉输液港工作方面具有丰富经验的来自不同专业的多位专家,结合最新研究结果,充分讨论制定了《静脉输液港植入与管理多学科专家共识(2023版)》,适用于从事静脉输液港工作的医护人员,内容涵盖了静脉输液港的植入和维护全部流程,目标是减少植入和使用的并发症,提高使用静脉输液港患者的安全性和满意度。

    Abstract:

    The totally implantable venous access device (TIVAD), also known as venous infusion port, is an emerging intravenous access device primarily used for chemotherapy and parenteral nutrition support. Its reliability and effectiveness have been confirmed by recent applications. Currently, the utilization of this technology in domestic settings is mainly concentrated in large medical institutions. However, there are significant differences in implantation surgery and maintenance practices among different regions, resulting in variations in actual outcomes, high incidence of related complications, and differences in patient satisfaction. The expert group, consisting of experienced professionals from various disciplines involved in TIVAD work, has collaborated and extensively discussed the latest research findings and then developed the Multidisciplinary expert consensus on implantation and management of venous infusion port (2023 edition). This consensus applies to healthcare professionals engaged in TIVAD work and covers the entire process of implantation and maintenance of the venous infusion port. The goal is to reduce complications associated with implantation and usage and improve the safety and satisfaction of patients using a TIVAD.

    表 1 GRADE证据质量分级标准及推荐标准Table 1 GRADE evidence quality grading criteria and recommendation standards
    图1 胸壁港植入 A:胸壁经颈静脉输液港术前标记,标记锁骨、胸锁乳突肌胸骨头、锁骨头,标记穿刺点和囊袋位置;B:超声引导下后入路穿刺颈内静脉置入导丝;C:按术前标记制作囊袋;D:经导丝置入可撕脱鞘管;E:经撕脱鞘置入导管;F:使用隧道器将导管自颈部切口引导至囊袋;G:连接港体,置入囊袋;H:缝合手术切口;I:无损伤针穿刺并封管Fig.1 Implantation of chest wall infusion port A: Preoperative marking of the chest wall infusion port via jugular vein, the collarbone clavicular head of the sternocleidomastoid muscle, and jugular notch as well as the puncture site and pocket location; B: Ultrasound-guided posterior approach puncture for placement of the guidewire in the internal jugular vein; C: Creating the pocket according to the preoperative markings; D: Placement of a peel-away sheath through the guidewire; E: Insertion of the catheter through the peel-away sheath; F: Using a tunneling device to guide the catheter from the neck incision to the pocket; G: Connecting the port body and placing it in the pocket; H: Closure of the surgical incision; I: Needle puncture and locking the catheter
    图2 上臂港植入 A:术前标记囊袋及目标血管穿刺位置;B:超声引导下穿刺目标静脉;C:置入导管后,于目标囊袋位置切开;D:粘合手术切口Fig.2 Implantation of upper arm infusion port A: Preoperative marking of the pocket and the target vessel puncture site; B: Ultrasound-guided puncture of the target vein; C: After inserting the catheter, an incision is made at the location of the target pocket; D: Closure of the surgical incision with adhesive strips
    图3 开放直视经头静脉胸壁港植入 A:超声下定位头静脉;B:游离头静脉;C:经头静脉直视下送入导管Fig.3 Implantation of chest wall infusion port via cephalic vein under direct visualization by open surgery A: Ultrasound-guided localization of the jugular vein; B: Mobilization of the cephalic vein; C: Insertion of the catheter through direct visualization of the cephalic vein
    图4 X线作为导管尖端定位 A:X线下解剖定位,理想导管位置位于气管隆突下方至腔房交界之间;B:X线引导下调整导管长度Fig.4 X-ray positioning of the catheter tip A: Anatomical positioning under X-ray guidance, with the ideal catheter position located between the suprasternal notch and the atrial junction; B: Adjustment of catheter length under X-ray guidance
    图5 腔内心电定位 A:通过导丝建立腔内心电图,导管深度不同,心电图将产生不同变化,P波最高点对应导管进入腔房交界;B:通过盐水建立腔内心电图;C:通过导丝建立腔内心电图Fig.5 intracavitary electrocardiographic localization A: Establishing intracavitary ECG by using a guidewire, and different catheter depths resulting in different ECG changes, with the highest point of the P wave corresponding to the catheter entering the atrial junction; B: Establishing intracavitary ECG using saline; C: Establishing intracavitary ECG by using a guidewire
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刘鹏,吴巍巍.静脉输液港植入与管理多学科专家共识(2023版)[J].中国普通外科杂志,2023,32(6):799-814.
DOI:10.7659/j. issn.1005-6947.2023.06.001

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  • 收稿日期:2023-03-04
  • 最后修改日期:2023-03-31
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  • 在线发布日期: 2023-07-07