股静脉穿刺中心静脉置管72例分析

目的 分析股静脉穿刺中心静脉置管的适用范围及优缺点；方法 对72例行股静脉穿刺中心静脉置管的危重患者的相关临床资料进行总结，分析其优缺点及并发症发生情况；结果 穿刺成功70例，成功率97％。穿刺误入股动脉4例，发生巨大血肿1例，小血肿1例，导管无法置入1例，置管后穿刺点渗血不止1例，无神经损伤、穿刺点感染等并发症发生；结论 股静脉穿刺中心静脉置管因其本身技术上的缺陷在临床上日趋少用，但对颈部及胸部外伤、颈部手术、头颈部烧伤、气管切开等危重患者在无法行颈内静脉穿刺时仍可采用。     

股静脉穿刺置管方法的改进

由于头颈部手术、颈部淋巴结清扫术或伴有上腔静脉压迫综合征者常不宜行颈部的中心静脉穿刺置管，为不失时机确保治疗有效地进行，行经皮股静脉置管治疗有重要意义。而传统的股静脉穿刺置管法通常采用高位穿刺，误穿动脉、穿刺失败的发生率较高，且输液的通畅与否与体位关系很大。2002年以来，我科试用低位股静脉穿刺置管法，成功率高，且不易出现淤斑、血肿等并发症。现对2种穿刺置管法进行比较，报告如下。     

股静脉穿刺置管临床并发症发生及处理分析

目的探讨双腔股静脉穿刺置管术患者临床并发症的发生情况及处理方法,总结以后穿刺及对并发症的处理经验。方法以2008年9月～2011年9月我科243例因各种原因需行血液净化治疗而建立临时双腔股静脉穿刺置管术的患者为研究对象,分析其临床并发症的发生情况及处理方法。结果 243例双腔股静脉置管患者中,置管成功者239例(98.4%),置管失败者4例(1.6%)。置管术后至2周内出现导管不通畅或导管完全阻塞16例(6.5%);导管相关性菌血症10例(4.1%);留置导管周围渗血9例(3.7%),留置导管滑脱4例(1.6%),局部血肿形成3例(1.2%),术侧下肢肿胀3例(1.2%),动静脉瘘1例(0.4%)。结论股静脉穿刺留置导管作为肾内科常规治疗手段,具有穿刺置管成功率高,操作技术相对简单,风险小,能保证足够血流量的优点。在急慢性肾衰竭、中毒及内外科其他多种危急重症的抢救、治疗中有重要的应用价值。     

股静脉穿刺置管在神经内科的应用

为了更好地配合医生临床用药输液治疗,我科对昏迷、躁动及长期输液末梢血管不充盈的患者,采取了股静脉穿刺置管。     

低位进路法股静脉穿刺置管100例

1995-02/1999-02我们在急危重症患抢救中采用低位进路法行股静脉穿刺置管输液或监测中心静脉压(CVP)100例,取得满意效果,现报道如下。     

经下肢外周静脉穿刺至股静脉置管化疗的探讨

目的 探讨经下肢外周静脉穿刺至股静脉置管在化疗中的应用效果.方法 将25例需经下肢静脉穿刺化疗的患者随机分成研究组和对照组.研究组15例采用经下肢外周静脉穿刺至股静脉置管的方法给药,对照组10例采用头皮针或浅静脉留置针的方法给药.比较2组患者化疗静脉炎的发生率.结果 研究组化疗静脉炎的发生率显著低于对照组(P＜0.01),差异有统计学意义.结论 在下肢化疗的患者建议予股静脉置管,以降低化疗期间静脉炎的发生率,减轻患者的痛苦,提高其生活质量及生存意义.     

经股静脉穿刺置管监测中心静脉压31例应用体会

目的 探讨经股静脉穿刺监测中心静脉压(cvp)在重症抢救中的应用价值. 方法 对经股静脉穿刺置管的31例(下称股穿组)重症患者进行总结,观察监测cvp时血流搏动反应时间,搏动幅度情况,并对两组穿刺成功率、并发症发生率作对比. 结果 测CVP回血时间股穿组2～5S,颈穿组1～3 S;搏动幅度两组无差异;搏动衰减时间股穿组平均7d,颈穿组平均10d.穿刺成功率及并发症发生率股穿组明显优于颈穿组.结论 股静脉穿刺置管监测CVP 可达临床应用要求,且手术简便、风险低、并发症少.有临床应用价值.     

新生儿股静脉穿刺误入膀胱1例

<正>股静脉穿刺是新生儿静脉采血的主要途径之一,在新生儿临床护理工作中较常使用。现将笔者所在科在股静脉穿刺中误入膀胱1例报告如下。1病例介绍患儿,男,出生1d,体重3.1kg,身长53cm,患新生儿吸入性肺炎,以新生儿缺氧缺血性脑病收治入院。因病情需     

Psoas abscess as a complication of subclavian venous catheterization

A 76 year old woman developed a psoas abscess from vascular seeding of an infected subclavian venous catheter. The presentation was insidious and diagnosis delayed. Despite adequate surgical drainage, the case proved to be fatal. Venous catheters should be regarded as a potential source of septicaemia and occult abscess formation.     

Survival of 2 extreme preterm neonates with cardiac tamponade as a complication of percutaneous central venous catheterization

We report 2 extreme preterm neonates who developed cardiac tamponade secondary to perforation of the myocardium by the percutaneous silastic central venous catheters, which were inserted for parental nutrition. Percutaneous pericardiocentesis was performed and pericardial effusion was aspirated, later proved by analysis to be total parental nutrition. The lines were removed and the patients successfully resuscitated and survived, both were sent home in good condition.     

Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial

Jacques Merrer, MD; Bernard De Jonghe, MD; Franck Golliot, MS; Jean-Yves Lefrant, MD; Brigitte Raffy, MD; Eric Barre, MD; Jean-Philippe Rigaud, MD; Dominique Casciani, MD; Benoît Misset, MD; Christophe Bosquet, MD; Hervé Outin, MD; Christian Brun-Buisson, MD; Gérard Nitenberg, MD; for the French Catheter Study Group in Intensive Care

JAMA. 2001;286:700-707.

Context  Whether venous catheterization at the femoral site is associated with an increased risk of complications compared with that at the subclavian site is debated.

Objective  To compare mechanical, infectious, and thrombotic complications of femoral and subclavian venous catheterization.

Design and Setting  Concealed, randomized controlled clinical trial conducted between December 1997 and July 2000 at 8 intensive care units (ICUs) in France.

Patients  Two hundred eighty-nine adult patients receiving a first central venous catheter.

Interventions  Patients were randomly assigned to undergo central venous catheterization at the femoral site (n = 145) or subclavian site (n = 144).

Main Outcome Measures  Rate and severity of mechanical, infectious, and thrombotic complications, compared by catheterization site in 289, 270, and 223 patients, respectively.

Results  Femoral catheterization was associated with a higher incidence rate of overall infectious complications (19.8% vs 4.5%; P<.001; incidence density of 20 vs 3.7 per 1000 catheter-days) and of major infectious complications (clinical sepsis with or without bloodstream infection, 4.4% vs 1.5%; P = .07; incidence density of 4.5 vs 1.2 per 1000 catheter-days), as well as of overall thrombotic complications (21.5% vs 1.9%; P<.001) and complete thrombosis of the vessel (6% vs 0%; P = .01); rates of overall and major mechanical complications were similar between the 2 groups (17.3% vs 18.8 %; P = .74 and 1.4% vs 2.8%; P = .44, respectively). Risk factors for mechanical complications were duration of insertion (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.08 per additional minute; P<.001); insertion in 2 of the centers (OR, 4.52; 95% CI, 1.81-11.23; P = .001); and insertion during the night (OR, 2.06; 95% CI, 1.04-4.08; P = .03). The only factor associated with infectious complications was femoral catheterization (hazard ratio [HR], 4.83; 95% CI, 1.96-11.93; P<.001); antibiotic administration via the catheter decreased risk of infectious complications (HR, 0.41; 95% CI, 0.18-0.93; P = .03). Femoral catheterization was the only risk factor for thrombotic complications (OR, 14.42; 95% CI, 3.33-62.57; P<.001).

Conclusion  Femoral venous catheterization is associated with a greater risk of infectious and thrombotic complications than subclavian catheterization in ICU patients.

     

Cerebral venous thrombosis presenting as a complication of inflammatory bowel disease

Cerebral venous thrombosis is an uncommon and diverse entity accounting for less than 1% of strokes. It can present with a variety of clinical symptoms ranging from isolated headaches to deep coma making the clinical diagnosis difficult. We present a rare case of cerebral venous thrombosis secondary to dehydration and inflammatory bowel disease.     

Compressive femoral neuropathy: a rare complication of anticoagulation

The most common coagulation disorder associated with warfarin use is bleeding, but compressive femoral neuropathy is an unusual presentation. A 63-year-old man with compressive femoral neuropathy from an iliacus haematoma is reported. The diagnosis was confirmed on magnetic resonance imaging and treated conservatively with good clinical response and radiological evidence of resolution.     

A clinical and microbiological study of venous catheterization

In a prospective study of 210 intravenous catheters and needles 31 (15%) swabs yielded 34 microbial isolates. Twenty-eight were “non-pathogenic” skin commensals and six were “pathogenic” organisms. Commensals were isolated predominantly from catheters left in situ for only a short time (up to two days) and pathogenic organisms most frequently from specimens left in situ for a longer time. Correlation was not confirmed between colonization and infection, antibiotic therapy or phlebitis. All samples of IV fluids were sterile on culture. Changing the IV catheter at least every two days is recommended.