困难置管血液肿瘤婴幼儿2种静脉通路应用效果比较

目的比较经股静脉中段置入PICC与经股静脉置入CVC在置管困难血液肿瘤婴幼儿中的应用效果。方法回顾性分析2014年1月至2019年6月置管困难肿瘤婴幼儿140例的临床资料,其中67例采用经股静脉中段置入PICC,73例采用经股静脉置入CVC。比较两组导管成本费用、置管时间、导管留置时间和导管并发症发生率的差异。结果 PICC组费用总支出、平均每日维护费用、置管时间低于/短于CVC组,导管留置时间长于CVC组(均P0.01);两组出口部位感染、堵管和总并发症发生率差异有统计学意义(P0.05,P0.01),而导管相关性血流感染、滑脱和静脉炎等发生率差异无统计学意义(均P0.05)。结论经股静脉中段置入PICC在成本支出、置管时间、留置时间和导管并发症方面均优于股静脉CVC,是置管困难血液肿瘤婴幼儿安全、可行的静脉通路。     

The great saphenous vein for central venous access and haemodialysis

Background. Utilising an open surgical technique the Great Saphenousvein in the proximal thigh can be used for the insertion ofcentral venous catheters for haemodialysis. This approach issafe and efficacious, and may be performed under local or generalanaesthesia. This technique is of particular importance in patientsrequiring vascular access for haemodialysis in whom the uppercentral veins are stenosed and the femoral vessels are not amenableto percutaneous cannulation. Methods. The Great saphenous vein is exposed via a surgicalincision in the thigh. The central venous catheter is then insertedand advanced until in the desired position, as confirmed onfluoroscopy. Results. Seven Great saphenous catheters were placed over aperiod of six months. All catheters insertions were technicalsuccesses with completion of at least one dialysis session.Primary patency rates were 57%, 49%, 23% at 30, 60 and 90 daysrespectively. Conclusion. The great saphenous vein offers an additional sitefor the insertion of central venous catheters. These data demonstrateequivalence in patency between this novel technique and percutaneousfemoral vein cannulation.     

Comparison of different near-infrared spectroscopic cerebral oxygenation indices with central venous and jugular venous oxygenation saturation in children

BACKGROUND: We compared two different near-infrared spectrophotometers: cerebral tissue oxygenation index (TOI) measured by NIRO 200 and regional cerebral oxygenation index (rSO(2)) measured by INVOS 5100 with venous oxygen saturation in the jugular bulb (SjO(2)) and central SvO(2) from the superior caval vein (SVC) during elective cardiac catheterization in children. METHODS: A prospective observational clinical study in 31 children with congenital heart defects in a catheterization laboratory was undertaken. TOI was compared with SjO(2) in the left jugular bulb and with SvO(2). rSO(2) was compared with SjO(2) from the right jugular bulb and SvO(2). Linear regression analysis and Pearson's correlation coefficient were calculated and Bland-Altman analyses were performed. RESULTS: Cerebral TOI and SjO(2) were significantly correlated (r = 0.56, P < 0.0001), as well as TOI and SvO(2) with r = 0.74 (P < 0.0001). Bland-Altman plots showed a mean bias of -4.3% with limits of agreement of 15.7% and -24.3% for TOI and SjO(2) and a mean bias of -4.9% with limits of agreement of 10.3% and -20.1% for TOI and SvO(2). Cerebral rSO(2) and SjO(2) showed a significant correlation (r = 0.83, P < 0.0001) and rSO(2) and SvO(2) showed excellent correlation with r = 0.93 (P < 0.0001). Bland-Altman plots showed a mean bias of -5.2% with limits of agreement of between 8.4% and -18.8% for rSO(2) and SjO(2) and a mean bias of 5.6% with limits of agreement of 13.4% and -2.2% for rSO(2) and SvO(2). CONCLUSIONS: Both near-infrared spectroscopy devices demonstrate a significant correlation with SjO(2) and SvO(2) values; nevertheless both devices demonstrate a substantial bias of the measurements to both SjO(2) and SvO(2).     

Usefulness of Groshong catheters for central venous access via the external jugular vein.

This study was designed to evaluate the usefulness of central venous access via the external jugular vein (EJV) employing Groshong catheters, and to compare the complications with those of conventional internal jugular venous catheterization. Central venous access was achieved by insertion of a single-lumen 4.0 Fr Groshong catheter via the EJV or internal jugular vein (IJV) with a single puncture. Complications associated with insertion and central venous catheter-related bloodstream infection (CVC-RBSI) were evaluated from the database. Two hundred and twenty-five patients received 400 catheters for a total period of 5377 catheter-days. Ninety-six patients underwent 201 internal jugular venous catheter (IJV-C) procedures for 2381 catheter-days, and 129 patients underwent 199 external jugular venous catheter (EJV-C) procedures for 2996 catheter-days. Use of EJV-C was associated with a longer catheter insertion length (p < .01) and period (p < .01), a larger number of operations (p < .01), and more frequent use of total parenteral nutrition (TPN) (p < .01) and less frequent use of chemotherapy (p < .01) than for IJV-C. However, there were no significant differences (NS) in complications associated with insertion and CVC-RBSI between IJV-C and EJV-C. There were no significant differences such complications as malposition, oozing or hematoma formation of insertion site, arterial bleeding, nerve damage, pneumothorax, and phlebitis between IJV-C and EJV-C. Moreover, EJV-C was not associated with morbidities such as pneumothorax, arterial bleeding, and nerve damage. Thus the study concluded that EJV-C using Groshong catheters has no severe complications and has the same rates of CVC-RBSI as conventional IJV-C for central venous access.     

Central venous access in children via the external jugular vein

Sixty-two children undergoing cardiac surgery were surveyed for the presence of external jugular veins. When present, these were used as a route for central venous catheterisation using a 'J' wire Seldinger technique. Only 54% of attempted insertions were successful but the results support greater efficacy in older children.     

Long-term hyperalimentation in children through saphenous central venous catheterization

During a 3.5 year period, 151 Silastic central venous catheters were inserted into the inferior vena cava through the saphenous vein in 132 children younger than age 19 years at UCLA Hospital. The major indications for catheter insertion included inflammatory bowel disease, cancer or bone marrow transplantation, and short bowel syndrome. The 151 catheters were used for a total of 13,288 days of fluid administration (mean 88 days). Complications requiring removal of the catheter occurred in 31 patients, but there were no deaths attributable to complications from the catheters. The total incidence of complications was one per 225 days of catheter use, less than that occurring in catheters placed in the external jugular and cephalic veins in young children in our hospital. The ease of insertion, the low complication rate and the simplicity of patient management when catheters are placed into the vena cava through the saphenous vein appear to make this an optimal site for administering parenteral nutrition in infants and children.     

Percutaneous central venous catheterization in children: first line choice for venous access

Percutaneous central venous (CV) catheters using the jugular and subclavian veins have been widely used for hemodynamic monitoring and for venous access in difficult clinical situations. However, peripheral venous cutdowns (PVC) still remain the primary mode of short-term venous access in children. To evaluate percutaneous CV line insertion as a routine procedure, a prospective study of 115 patients (75 CV and 40 PVC) was performed. Ages ranged from 1 day to 17 years; age and weight were similar in both groups. Eighty-three CV lines were attempted, with a success rate of 93%, while 82% of 49 PVC insertions were successful. Complications occurred in 11 (14%) patients with CV access and 31 (78%) with PVC lines. In the latter group, poor flow was a problem in 65%, infiltration in 37.5%, and phlebitis in 27.5%. In the CV group, arterial puncture occurred during insertion in 2 (3%) patients with no adverse sequelae, catheter slippage occurred in 4 (5%), and poor flow in 2 (3%). A large majority (79.2%) of CV lines functioned successfully until no longer needed, as compared with 15% of PVC catheters. The latter were removed before completion of treatment because of poor flow (40%), phlebitis (20%), or catheter problems (10%). Catheter sepsis was documented in only one CV line. Two cutdowns had major local infections. The average catheter longevity was 10.2 days for CV lines, 4.1 days for PVC.(ABSTRACT TRUNCATED AT 250 WORDS)     

Central venous access with occlusive superior central venous thrombosis.

Thrombotic occlusion of the entire superior central venous system is a rare complication of central venous catheterization. Three patients are presented with complete occlusion of the superior vena cava secondary to prolonged central venous catheterization. Thrombotic occlusion of the superior vena cava precludes central venous access by conventional techniques. Thoracotomy with direct catheterization of the right atrium and inferior vena cava cannulation represent alternative approaches but may be associated with significant morbidity. The present report describes a unique combined angiographic/operative technique designed to obtain central venous access with low morbidity in patients with occlusive thrombosis of the superior central venous system.     

Internal jugular versus subclavian vein catheterization for central venous catheterization in orthotopic liver transplantation

The aim of this study was to compare incidence rates of mechanical and infectious complications associated with central venous catheterization via the internal jugular vein (IJV) versus the subclavian vein (SV) among 45 consecutive patients undergoing orthotopic liver transplantation (OLT) between January 2000 and June 2004. The subjects were divided into two groups according to the site of central venous catheterization (IJV or SV). We recorded each patient's physical characteristics, international normalized ratio (INR), partial thromboplastin time, platelet levels, number of puncture attempts, success/failure of central venous catheterization, duration of catheter placement, occurrence of catheter tip misplacement, arterial puncture, incidence of hematoma or pneumothorax, catheter-related infection, or bacterial colonization of the catheter. Senior staff anesthesiologists performed 22 SV and 23 IJV catheterizations for the 45 OLT procedures. The SV and IVJ groups both had minor coagulation abnormalities with slightly increased INR values at the time of catheterization. There were no significant differences between the groups with respect to success of central venous catheterization (100% for both), numbers of attempted punctures, duration of catheter placement, and incidence rates of mechanical and infectious complications. Both groups showed high frequencies of catheter tip misplacement, with right atrium as the site of misplacement in all cases. Two patients in the IJV group (8.7%) developed hematomas after accidental carotid artery puncture. The results suggest that, when performed by experienced anesthesiologists, central venous catheterization via the SV is an acceptable alternative to IJV catheterization for patients undergoing OLT.     

Ultrasound for central venous access

The first 150 words of the full text of this article appear below. Key points Complications of central venous catheterization(CVC) can be serious and often go unreported. It is often possibleto predict patients in whom CVC will be difficult. Use of real-timeultrasound to guide needle insertion has been demonstrated toimprove success rates and reduce complications. NICE currentlyrecommend the use of ultrasound for placing catheters in theinternal jugular vein in adults. Portable machines are relativelycheap to purchase and training is available in their use.