Coding tree interviewees.

A liquid-based perinatal life support system (PLS) for extremely premature infants (born before 28 week of gestational age) envisions a connection between the infant’s native umbilical cord and an artificial placenta system through cannulation. This system mimics a natural mothers’ womb to achieve better organ maturations. The objective of this study is to gain insight into the clinical focus points of umbilical cord cannulation and how cannulation should be addressed in extremely premature infants during the transfer from the uterus to an in-utero simulating liquid-based PLS system. We performed an explorative qualitative study. Twelve medical specialists with knowledge of vessel cannulation participated. We collected data through twelve interviews and two focus group discussions. Data were analyzed using inductive content and constant comparison analysis via open and axial coding. Results were derived on the following topics: (1) cannulation technique, (2) cannula fixation, (3) local and systemic anticoagulation, and (4) vasospasm. A side-entry technique is preferred as this may decrease wall damage, stabilizes the vessel better and ensures continuous blood flow. Sutures, especially via an automatic microsurgery instrument, are favored above glue, stents, or balloons as these may be firmer and faster. Medication possibilities for both vasospasm and anticoagulation should function locally since there were uncertainties regarding the systemic effects. According to the findings of this research, the needed umbilical cord cannulation method should include minimal wall damage, improved vascular stability, blood flow maintenance, a strong fixation connection, and local anticoagulation effect.针对胎龄不足28周的极早早产儿的液态基围生期生命支持系统（PLS），旨在通过插管实现患儿自体脐带与人工胎盘系统的连接。该系统模拟母体子宫环境，以促进器官更好地发育成熟。本研究旨在明确脐带插管的临床关注要点，以及极早早产儿从子宫转运至模拟子宫内环境的液态基PLS系统过程中，脐带插管的处理方案。本研究为探索性质性研究，招募12名具备血管插管操作经验的医学专科医师参与。研究通过12次访谈与2次焦点小组讨论采集数据，并采用归纳式内容分析法与持续比较分析法，通过开放式编码与主轴编码完成数据分析。研究结果围绕以下4个主题展开：(1) 插管技术；(2) 导管固定；(3) 局部与全身抗凝；(4) 血管痉挛。侧入式插管技术为首选方案，因其可减轻血管壁损伤、更好地稳定血管并保障血流持续通畅。相较于医用胶、支架或球囊，缝合固定（尤其是借助自动显微手术器械完成的缝合）更受青睐，因其固定效果更稳固且操作更快捷。鉴于全身用药存在不确定性，针对血管痉挛与抗凝治疗的可用给药方式应优先采用局部给药。基于本研究结果，理想的脐带插管方案应具备以下特征：最小化血管壁损伤、提升血管稳定性、维持血流通畅、实现牢固的固定连接，以及具备局部抗凝效果。