Storme L, Ouali M, Ganga-Zandzou P S, Klosowski S, Rakza T, Fassler C, Haouari N, Kacet N, Lequien P
Service de médecine néonatale, hôpital Jeanne-de-Flandre, CHRU, Lille, France.
Arch Pediatr. 1999 Apr;6(4):386-90. doi: 10.1016/s0929-693x(99)80219-x.
The aim of the study was to compare the success/failure rate and complications of insertion into the umbilical vein, of either double-lumen catheters (Charrière diameter 04, length 13 and 30 cm) or single-lumen catheters (Charrière diameter 05, length 40 cm) in a population of neonates admitted to a neonatal intensive care unit. The numbers of insertions of additional peripheral venous catheters were also compared.
The population was divided into two groups according to the severity of the respiratory failure. Group 1 (n = 52): normal hemodynamic parameters and moderate respiratory failure (FiO2 < 0.6): only single-lumen catheters were used. Group 2 (n = 56): low systemic pressure requiring vascular filling and/or inotropic drugs infusion and/or severe respiratory failure (FiO2 > 0.6): in this group, either single-lumen catheters or double-lumen catheters were inserted.
The success rate of insertion of double-lumen catheters and of single-lumen catheters were similar (61% vs 71%: P = 0.7). Nineteen double-lumen catheters were inserted in the group 2. The average duration of double-lumen umbilical catheterization was not significantly different from simple-lumen catheterization (4.9 +/- 2.2 vs 4.6 +/- 2.2 days). Complications relating to the umbilical venous catheterization were uncommon: three catheter obstructions (two with single-lumen catheter, one with double-lumen catheters), two nosocomial infections (both with single-lumen catheter), one hydropericardium (with single-lumen catheter). In group 2, more peripheral venous catheters were required during the first 72 hours of life after insertion of single-lumen catheter than after insertion of double-lumen catheters (average number of peripheral venous catheters per infant: 1.6 +/- 0.83 vs 1 +/- 0.35 respectively; P < 0.01).
Feasibility and complication rate of umbilical double-lumen catheters were similar to those of single-lumen catheters. The use of umbilical double-lumen catheters reduces the need of peripheral venous catheters.
本研究的目的是比较在新生儿重症监护病房收治的新生儿群体中，双腔导管（外径04，长度13和30厘米）或单腔导管（外径05，长度40厘米）插入脐静脉的成功率/失败率及并发症情况。还比较了额外外周静脉导管的插入数量。
根据呼吸衰竭的严重程度将人群分为两组。第1组（n = 52）：血流动力学参数正常且为中度呼吸衰竭（FiO₂ < 0.6）：仅使用单腔导管。第2组（n = 56）：需要血管充盈和/或输注血管活性药物及/或严重呼吸衰竭（FiO₂ > 0.6）：该组插入单腔导管或双腔导管。
双腔导管和单腔导管的插入成功率相似（61%对71%：P = 0.7）。第2组插入了19根双腔导管。双腔脐静脉置管的平均持续时间与单腔置管无显著差异（4.9 ± 2.2天对4.6 ± 2.2天）。与脐静脉置管相关的并发症并不常见：3例导管阻塞（2例单腔导管，1例双腔导管），2例医院感染（均为单腔导管），1例心包积液（单腔导管）。在第2组中，插入单腔导管后出生后72小时内比插入双腔导管后需要更多的外周静脉导管（每名婴儿外周静脉导管的平均数量分别为1.6 ± 0.83对1 ± 0.35；P < 0.01）。
脐双腔导管的可行性和并发症发生率与单腔导管相似。使用脐双腔导管可减少对外周静脉导管的需求。
