Bagwell C E, Salzberg A M, Sonnino R E, Haynes J H
Department of Surgery, Medical College of Virginia/Virginia Commonwealth University, Richmond 23298-0015, USA.
J Pediatr Surg. 2000 May;35(5):709-13. doi: 10.1053/jpsu.2000.6029.
Placement of central venous catheters, although often considered to be a relatively safe and "junior"-level procedure, may be associated with life-threatening complications.
A recent surgical death associated with placement of a central venous catheter at this Institution led to submission of a questionnaire to pediatric surgeons referenced through the American Pediatric Surgical Association directory regarding knowledge of similar incidents and information regarding catheter placement-related complications.
Results to this response, although anecdotal, provided data regarding complications of an acute nature, which fell into the categories of pneumothorax, hydrothorax, cardiac tamponade, and hemothorax. Of 10 children with cardiac tamponade, 7 were infants, and most complications were associated with needle stick for access, with symptoms developing within minutes up to 12 hours after the procedure. Drainage of the tamponade was performed by aspiration alone in 3 cases; surgical drainage in 6 children resulted in survival in 9 of the 10 patients. Hemothorax was described in 19 patients and appeared to be more common in children in the 1- to 6-year age group, usually associated with percutaneous access techniques. Thoracotomy for hemothorax was performed in 16 children with 11 survivors. Vascular injury to subclavian artery, vein, or superior vena caval were noted in most at operation.
Although data included in this review are entirely anecdotal and not subject to scientific scrutiny or analysis, certain conclusions appear evident. Inherent risks of central venous catheters are intrinsic and should be discussed with the family in obtaining preoperative consent, including life-threatening risks that may necessitate urgent surgical intervention (by thoracotomy or other means). Certain technical aspects of the procedure should be rigidly followed with an experienced surgeon in attendance throughout the procedure. Rapid evaluation should be performed for any unexplained problems that occur in the operating theatre or during the early postoperative period.
尽管中心静脉导管置入术通常被认为是一种相对安全且“初级”的操作，但可能会伴有危及生命的并发症。
该机构近期发生了一例与中心静脉导管置入相关的手术死亡事件，由此向通过美国小儿外科协会名录查询到的小儿外科医生发放了一份问卷，内容涉及类似事件的知晓情况以及导管置入相关并发症的信息。
尽管此次回复的结果只是轶事性的，但提供了有关急性并发症的数据，这些并发症包括气胸、胸腔积液、心脏压塞和血胸。在10例心脏压塞患儿中，7例为婴儿，大多数并发症与穿刺置管有关，症状在操作后数分钟至12小时内出现。10例患者中有3例仅通过穿刺抽吸进行了心脏压塞引流；6例患儿接受了手术引流，其中9例存活。19例患者出现血胸，在1至6岁年龄组的儿童中似乎更为常见，通常与经皮穿刺技术有关。16例血胸患儿接受了开胸手术，其中11例存活。手术中大多发现了锁骨下动脉、静脉或上腔静脉的血管损伤。
尽管本综述所纳入的数据完全是轶事性的，未经科学审查或分析，但某些结论似乎很明显。中心静脉导管的固有风险是内在的，在获得术前同意时应与家属讨论，包括可能需要紧急手术干预（开胸手术或其他方式）的危及生命的风险。该操作的某些技术方面应严格遵循，整个过程需有经验丰富的外科医生在场。对于手术室或术后早期出现的任何不明原因问题，应进行快速评估。
