Polos P G, Sahn S A
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston.
J Crit Illn. 1993 Jun;8(6):660-74.
Malpositioning of a central venous catheter can cause potentially life-threatening complications. Knowledge of thoracic anatomy and close attention to proper insertion technique increase the likelihood of, but do not ensure, proper placement. Selection of a right-sided venous entry site reduces the risk of malpositioning. The return of nonpulsatile, dark-colored blood is a strong, but not infallible, indication of venous placement. Do not assume that venous system valves preclude malpositioning. Use chest films to confirm accurate insertion. When these are equivocal, take simultaneous blood samples from a peripheral artery and the central line; the samples will have markedly different blood gas levels if the catheter is in a vein.
中心静脉导管位置不当可导致潜在的危及生命的并发症。了解胸部解剖结构并密切关注正确的插入技术可增加正确放置的可能性，但不能确保正确放置。选择右侧静脉穿刺部位可降低位置不当的风险。回抽无搏动、深色血液是静脉置管的有力但并非绝对可靠的指征。不要认为静脉系统瓣膜可防止位置不当。使用胸部X线片确认准确插入。当结果不明确时，同时从外周动脉和中心静脉取血样；如果导管在静脉内，血样的血气水平会有明显差异。
