McGee W T, Moriarty K P
Department of Medicine, Baystate Medical Center, Springfield, MA, USA.
J Intensive Care Med. 1996 Jan-Feb;11(1):19-22. doi: 10.1177/088506669601100104.
We determine if use of 16-cm central venous catheters (CVC) minimizes dangerous intracardiac catheter placements. We conducted a prospective study in a large community teaching hospital. Consecutive patients (n = 127) who required a CVC via either the internal jugular (IJV) or the subclavian vein (SCV) were assessed using 16 (n = 102) or 20-cm (n = 25) catheters. The main outcome measurements were (1) intracardiac placement of central venous catheters, and (2) relationship of right- or left-sided internal jugular or subclavian vein insertions to intracardiac catheter placement. Use of a 20-cm CVC resulted in 14 of 25 (56%) intracardiac placements compared with 11 of 102 (11%) using a 16-cm catheter (p < 0.0001). All intracardiac placements with the 16-cm CVC were from right-sided approaches: IJV 7 of 38 (16%), SCV 4 of 18 (18%). Use of a 16-cm CVC to access the central circulation from either the SCV or the IJV results in a significantly greater proportion of safe catheter placements than using longer CVCs, and it should become the standard of care.
我们确定使用16厘米的中心静脉导管（CVC）是否能将危险的心内导管置入风险降至最低。我们在一家大型社区教学医院进行了一项前瞻性研究。对通过颈内静脉（IJV）或锁骨下静脉（SCV）需要置入CVC的连续患者（n = 127）使用16厘米（n = 102）或20厘米（n = 25）的导管进行评估。主要结局指标为：（1）中心静脉导管的心内置入情况；（2）右侧或左侧颈内静脉或锁骨下静脉穿刺与心内导管置入的关系。使用20厘米的CVC时，25例中有14例（56%）发生心内置入，而使用16厘米导管时102例中有11例（11%）发生心内置入（p < 0.0001）。使用16厘米CVC发生的心内置入均来自右侧入路：颈内静脉38例中有7例（16%），锁骨下静脉18例中有4例（18%）。与使用更长的CVC相比，使用16厘米的CVC经锁骨下静脉或颈内静脉进入中心循环可显著提高安全导管置入的比例，应成为护理标准。
