锁骨下静脉穿刺置管术在造血干细胞移植中的应用

目的:探讨锁骨下静脉穿刺置管术在造血干细胞移植中的操作方法,失误分析及并发症的预防。方法:回顾性分析1996～2004年30例造血干细胞移植患者锁骨下静脉穿刺置管的应用及并发症防治。结果:28例患者成功地经右侧锁骨下静脉穿刺置管,其中1例损伤锁骨下动脉,2例误入颈内静脉。2例经右侧穿刺失败,改行左侧锁骨下静脉穿刺成功。置管平均39d(27～65d),3例分别于置管后18d,22d,36d发生部分阻塞,2例分别于置管后24d,38d发生脱落。30例均未发生经导管感染。结论:锁骨下静脉穿刺置管是造血干细胞移植中的重要环节。熟悉锁骨下静脉的解剖位置和正确操作是置管成功和避免并发症的关键,预防性应用抗生素,全环境保护,精心护理是预防导管感染、阻塞、脱落的保征。

Application of subclavian vein catheterization in Hematopoietic stem cell transplantation

Objective: To investigate the operative procedure,misplay and value of subclavian vein catheterization in 30 cases of hematopoietic stem cell transplantation from 1996 to 2004 retrospectively.Results:28 patients were punctured through the right subclavian vein successfully.The subclavian artery in 1 case of them was damaged. In 2 cases the catheters were passed into internal jugular vein by accident.2 patients failed from puncturing the right subclavian vein,and then they were punctured through the left subclavian vein.The time of maitenance-ance of catheterization ranged from 27 to 65(median 39)days.The catheters were obstructed temporarily in 3 cases on 18 d,22 d,36 d,and dropped out in 2 cases on 24 d,38 d after catheterization,respectively.All of 30 patients had no catheter infection.Conclusion:Recognition of anatomy of subclavian vein and correct operative technique were of key importance for successful catheterization and avoidance of complications.Antibiotics,total protective environment(TPE)and nursing care should be applied to prevent from infection,obstruction and fall off of the catheter: they are important for subclavian vein catheterization in hematopoietic stem cell transplantation.