右侧颈内静脉留置带涤纶套双腔导管血液透析的临床应用

目的评价经皮下隧道留置带涤纶套导管建立长期血液透析通路的效果。方法采用Seldinger技术穿刺右颈内静脉导入导丝，然后根据中心静脉、双腔留置导管在体表投影确定皮下隧道位置，并应尽量使导管柔和弯曲以避免导管扭曲折叠。用隧道针将导管引入穿刺部位，涤纶套距离皮肤出口位置要在2cm以上。依次将软硬扩张导管顺导丝插入深静脉内，最后留置导管通过撕脱型外套送入血管。结果行右颈内静脉带涤纶套双腔导管插入术共计13例，其中1例因尿毒症并发症死亡，12例患者仍然继续应用该导管透析。结论深静脉留置带涤纶套导管可长期保留，感染率低，栓塞率低，可满足透析要求，适合于用传统方法无法建立长期透析通路的患者。

Application of right Internal jugular cuffed dual lumen catheter in hemodialysis patients

Objective To evaluate the effects of cuffed catheter as the permanent hemodialysis access. Methods The standard Seldinger technique was used for guidewire insertion in right internal jugular. The tan-nel was designed according to the transfer signs of the vein. In choosing the catheter exit site, it was also impor-tant to keep in mind that the final subcutaneous position of the catheter would take on a gentle bend to avoid any kinking of the catheter. Using a standard tunneling device, the cuffed catheter was pulled through subcutaneously up to the entrance of the guidewire, until the Dacron cuff of the catheter was placed subcutaneously at least 2.0 cm beyond the exit site. Soft and hard dilator was then placed over the gnidewire and the cuffed catheter was then inserted through the peel-away sheath. Results The operations were performed in 13 patients. There was one patient died of uremia complication with normal catheter function. Twelve patients were still using the cuffed catheters at the end of the investigation. Conclusion The cuffed catheter hemodialysis access can be kept for u-sing for a relative long time with low rate of infection and thrombosis and is a good choice for the patients who can not use the traditional method to set up vascular access.