颈内静脉置管在血液透析临时性血管通路中的临床应用

目的观察双腔颈内静脉置管作为临时性血液透析血管通路的临床应用,总结临床应用经验。方法回顾分析我科2005—2008年154例终末期肾脏病患者采用局麻下selding技术行颈内静脉置管术建立临时血透血管通路的临床资料,观察置管相关并发症。结果实施临时性颈内静脉置管术154例,其中149例患者穿刺插管成功。穿刺成功率为96.75%;静脉置管留置时间为1～1.5个月,应用良好;感染发生率为4%,感染发生时间多在颈内静脉置管术后3周,常见病原菌依次为：金黄色葡萄球菌（4例）、枯草杆菌（1例）、鲍氏不动杆菌（1例）,其中1例患者并发真菌感染,给予拔管。血栓形成5例,发生率为3.36%。局部渗血、血肿形成7例,发生率为4.7%。结论颈内静脉穿刺插管术是一项安全、有效、方便的深静脉置管技术,对于需要临时留置导管者,是一项很好的选择。

Clinical application of temporary internal jugular vein catheters to hemodialysis patients

Objective To observe the application of temporary internal jugular vein catheters to hemodialysis patients,and summarize the clinical application experience.Methods Temporary vascular access with non-cuffed dual lumen cather was established in 154 patients who had been in end-stage renal failure from 2005 to 2008.Placement of catheter was carried out under local anesthesia with application of seldinger technique by route of internal jugular vein.The catheter related complications were observed.Results The placement of the dual lumen catheters was successful in 149 patients,and 6 episodes of catheter related infection were observed during the observation.The pathogenic bacteria were as below： staphylococcus aureus（4 cases）,bacillus subtilis（1 case）,and acinetobacter baumanil（1 case）.The catheter was removed in 1 case for fungal infection.The thrombosis was found in 5 cases（3.36%） and hematoma in 7 cases（4.7%）.Conclusion Non-cuffed dual cavity catheter is a safe,effective and convenient technique.For the patients who need temporary vascular access,the temperary internal jugular vein catheter is a good choice.