Background: Peripherally inserted central catheters (PICCs) are a better alternative to conventional central venous catheters (CVCs). However, PICCs are not widely used in several countries, including Japan, because of the difficulties involved in ultrasound-guided venipuncture and catheter placement under X-ray guidance.
Methods: Patients in whom indwelling PICCs were inserted by the standardized method developed in our department between 2015 and 2016 were enrolled. We analyzed the rate of successful placement of PICCs and the frequency/nature of complications associated with their placement. In all the patients enrolled in the present study, a 4-Fr single-lumen Groshong® catheter had been placed in the upper arm above the antecubital fossa. These catheters were inserted under ultrasound guidance and evaluated by X-ray.
Results: Successful placement was accomplished in 107 (92.2%) of the 116 attempts made to place a PICC. These 107 patients comprised 62 men and 45 women, with a mean age of 68±13 years. The major vessel of insertion was the basilic vein (97 patients; 91%). The median procedure time was 32 minutes (9-149 minutes). Complications included blood stream infection in three (2.8%) patients, phlebitis in three (2.8%) patients, and thrombotic line occlusion in two (1.9%) patients. The median indwelling period was 20 days (13-30 days).
Conclusion: We consider that placement of PICCs is uncomplicated, based on the short procedure time and relatively low rate of complications. Placement of PICCs using a standardized method should be widely adopted as a feasible alternative to CVC placement.
症例は60歳，女性．便秘を主訴に当院内科を受診し，下部消化管内視鏡検査で直腸Rbに粘膜下腫瘍を指摘された．内視鏡的に腫瘍生検を施行したが確定診断に至らず，CT・MRIの画像診断でも腫瘍の診断が困難であった．診断的治療目的に当科紹介され，経肛門的腫瘍切除を施行した．病理組織学検査ではCD34（－），c-kit（－），α-Actin（－），Desmin（－），S-100（＋）であり，悪性所見のない神経鞘腫であり断端は陰性であった．大腸原発の神経鞘腫は稀な疾患であり，一部に悪性例の報告もあるが，大部分は良性であり，自験例のように縮小手術で患者のQuality of life（QOL）を損なわずに根治できる疾患である．本邦報告例82例と合わせ，診断・治療について検討を行う．