目的 构建PICC继发性异位管理方案并评价其在极低出生体重儿中的应用效果。方法 对极低出生体重儿PICC继发性异位相关证据进行系统检索和质量评价，拟定方案初稿。2024年5月—6月采用德尔菲法对15名专家进行2轮函询，确定最终方案。选取2024年7月—10月河南省某三级甲等医院新生儿重症监护病房收治的经上肢置入PICC导管的极低出生体重儿为研究对象，2024年9月—10月收治的患儿为试验组，2024年7月—8月收治的患儿为对照组。试验组实施超声联合关节量角器的PICC继发性异位管理方案，对照组采用常规筛查及护理，评价两组的应用效果。结果 2轮专家函询问卷回收率分别为88.24%和100%，权威系数为0.91。最终形成的方案包括8个干预时机，6个方面的干预内容。试验组PICC继发性异位发生率为17.07%，PICC继发性异位拔管率为2.44%；对照组PICC继发性异位发生率为39.47%，PICC继发性异位拔管率为18.42%，差异均具有统计学意义（P<0.05）。结论 应用PICC继发性异位管理方案可降低极低出生体重儿PICC继发性异位发生率和拔管率，为临床PICC继发性异位管理提供参考。

Objective To construct a secondary ectopic management program for PICC and to evaluate its application effects in very low birth weight infants. Methods A systematic search and quality evaluation of the evidence related to secondary ectopia of PICC in very low birth weight infants were conducted，and the first draft of the protocol was prepared. From May to June 2024，the Delphi method was used to conduct two rounds of expert consultation with 15 experts to determine the final program. Very low birth weight infants with PICC catheters inserted through the upper limbs who were admitted to the neonatal intensive care unit of a tertiary hospital in Henan Province from July to October 2024 were selected as the study subjects. The children enrolled form July to August 2024 were the control group，and the children enrolled from September to October 2024 were the observation group. The control group was treated with routine screening and nursing，and the observation group was given a management program for PICC secondary ectopic with ultrasound combined with arthroprotractor as the intervention method，and its application effect in the management of PICC in very low birth weight infants was evaluated. Results The questionnaire recovery rates were 88.24% and 100%，respectively，and the expert authority coefficient was 0.91. The final intervention program comprised eight intervention timing and six aspects of intervention content. The incidence of secondary ectopia of PICC in the control group was 39.47%，and the extubation rate of secondary ectopia PICC was 18.42%. The incidence of secondary ectopia of PICC in the observation group was 17.07%，and the extubation rate was 2.44%. The differences between the two groups were statistically significant（P<0.05）. Conclusion The application of PICC secondary ectopic management program can reduce the incidence and extubation rate of PICC secondary ectopia in very low birth weight infants，and provide a reference for the clinical management of PICC secondary ectopia.