Abstract
Purpose: To investigate the causes and the nursing interventions of vasovagal syncope (VVS) during ultrasound-guided Modified Seldinger Technique (MST) PICC catheterization. Methods: Clinical data (medical records, demographic data, diagnosis, local vascular compression situation, B-mode ultrasound-recorded catheter/vessel ratio and the occurrence time, symptoms and treatment of syncope) of 14 patients diagnosed as vasovagal syncope during ultrasound-guided PICC catheterization at three hospitals in Guangdong province from September 2018 to September 2019 were collected for this retrospective analysis. Results: There were 3091 cases of ultrasound-guided MST PICC catheterization in the venous catheter outpatient clinics of the 3 hospitals from September 2018 to October 2019 with 14 cases (0.45%) of intraoperative vasovagal syncope, all cancer patients (5 males, 9 females) with a mean age 45± 3.8. They all received PICC for the first time and were under mental stress during the operation. Among the 14 patients (2 mild, 7 moderate, 5 severe), 8 had multiple lymphadenectasis in the neck and clavicular areas of the catheterization side, which resulted in different degree of venous compression and difficulty in insertion; 5 had catheter/vessel ratio over 45%. 2 cases of VVS occurred when the patients were asked to turn their heads against shoulders on to the puncture side; 10 occurred when using B-mode ultrasound probe to examine the jugular vein; 2 occurred when pulling out the catheter sheath. Conclusion: The related factors of vasovagal syncope during ultrasound-guided PICC catheterization include overcompression and avulsion on blood vessels and mental stress. Therefore, it is recommended to implement psychological interventions before surgery, reduce compression and avulsion of the vascular access during catheterization, and improve practitioners’ abilities in vessel selection (vessels with a catheter/vessel ratio less than 45%) and catheterization skills to eliminate the incidence of vasovagal syncope during PICC catheterization.
Highlights
Central venous infusion technology has been widely applied in the treatment of severe, cancer or surgical patients [1] and peripherally inserted central catheter (PICC) has been widely used in clinical practice as well
There were 3091 cases of ultrasound-guided Modified Seldinger Technique (MST) PICC catheterization with 14 cases (0.45%), all cancer patients (5 males, 9 females) with a mean age 45± 3.8 years, all of which were under mental stress during the operation and received PICC catheterization for the first time
8 had multiple lymphadenectasis in the neck and clavicular areas of catheterization side, which resulted in different degree of venous compression and difficulty in insertion
Summary
Central venous infusion technology has been widely applied in the treatment of severe, cancer or surgical patients [1] and peripherally inserted central catheter (PICC) has been widely used in clinical practice as well. American Journal of Nursing Science 2020; 9(4): 239-243 rate of catheterization and increase patients’ satisfaction. There are many studies concerning PICC-related complications while few reports on the vasovagal syncope during ultrasound-guided PICC catheterization were found. Vasovagal syncope (VVS), a kind of nervous reflex syncope, is featured with low blood pressure, slow heart rate, dizziness, fatigue, cold sweat, pale complexion and some other symptoms. Questionnaire survey was carried out among certified PICC practitioners in the venous catheter outpatient clinics of the 3 hospitals, and the clinical data of patients with VVS during PICC catheterization from September 2018 to October 2019 were collected to discuss the symptoms and causes of that and put forward possible nursing interventions
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