Unal Ali Ekrem, Bayar Sancar, Arat Mutlu, Ilhan Osman
Department of General Surgery, Section of Surgical Oncology, Ankara University Medical School, Ahmet Rasim sok 35/6, Cankaya, Ankara 06550, Turkey.
Transfus Apher Sci. 2003 Feb;28(1):9-12. doi: 10.1016/S1473-0502(02)00094-0.
Central venous catheters (CVC) are frequently used for stem cell collection and recurrent therapeutic hemapheresis procedures for patients with poor peripheral venous access. There is a tendency to prefer a right sided approach for insertion of a CVC via the subclavian route. We designed a sequential randomized study to examine the issue of catheter insertion side and analyzed all the technical data on surgical skill and observed complications.
Seventy-five patients who are candidates for stem cell collection and high dose chemotherapy underwent placement of Hickman catheters via the percutaneous subclavian vein (SCV) route. One experienced surgeon inserted 12F, double lumen, tunnelled, silicon based catheters in the operation room via fluoroscopic control. All of the procedure related complications, morbidity and mortality were analyzed on the basis of the side of catheter insertion.
The total rate of malpositioning in this series was 14.66%. The Jugular vein was the most common malpositioning site (66.6%). We observed a statistically significant difference in malpositioning between left versus right sided attempts, at 5.55% versus 20.51%, respectively (p = 0.032). The routes of malpositioning encountered for left sided attempts were the right SCV and the left internal jugular vein, the right internal jugular vein (n = 5), the left SCV vein (n = 2), and one left internal jugular vein. There was no significant difference between the right and left sided attempts for mechanical complications other than malpositioning (p < 0.05).
In this study the rate of malpositioning was greater in the right sided approach (p = 0.032) and the other mechanical complication rates did not differ for the two methods. Our results indicate that there is no need for hesitancy in using left sided attempts at CVC insertion.
中心静脉导管（CVC）常用于外周静脉通路不佳的患者进行干细胞采集和反复治疗性血液成分单采程序。通过锁骨下途径插入CVC时，倾向于选择右侧入路。我们设计了一项序贯随机研究来探讨导管插入侧的问题，并分析了所有关于手术技巧和观察到的并发症的技术数据。
75例适合进行干细胞采集和高剂量化疗的患者通过经皮锁骨下静脉（SCV）途径放置希克曼导管。一名经验丰富的外科医生在手术室通过荧光透视控制插入12F双腔隧道式硅胶导管。根据导管插入侧分析所有与手术相关的并发症、发病率和死亡率。
本系列中导管位置异常的总发生率为14.66%。颈静脉是最常见的位置异常部位（66.6%）。我们观察到左侧与右侧尝试在位置异常方面存在统计学显著差异，分别为5.55%和20.51%（p = 0.032）。左侧尝试时遇到的位置异常途径为右侧SCV和左侧颈内静脉、右侧颈内静脉（n = 5）、左侧SCV静脉（n = 2）以及一条左侧颈内静脉。除位置异常外，左侧与右侧尝试在机械并发症方面无显著差异（p < 0.05）。
在本研究中，右侧入路的位置异常发生率更高（p = 0.032），两种方法的其他机械并发症发生率无差异。我们的结果表明，在进行CVC插入的左侧尝试时无需犹豫。
