Cotera A, Benavente D, Laguna J, Segovia E, Pacheco A, Galdo T
Sección de Nefrología, Departamento de Medicina, Hospital Clínico, Universidad de Chile.
Nefrologia. 2003;23(1):47-52.
A chest X-ray has been routinely used to evaluate possible complications of a catheter installed for hemodialysis. The objective of the present study was to evaluate the utility of routine chest X-ray to detect complications derived from the installation of temporary catheters through a jugular vein access. We studied prospectively 95 successive jugular catheters for hemodialysis. After installation the operator answered a questionnaire that asked for details of the procedure and his opinion of the utility of a chest X-ray to detect a complication in each particular case. A chest X-ray was done in every patient and analyzed blindly. There were 17 minor complications: 7 arterial punctures, 5 neck hamatomas and 5 malpositions of catheters. No major complications were found. Sixty per cent of the catheters that required three or more punctures had a complication vs only 10% of the ones that required two or less puncture (p < 0.05). In five occasions the catheters were malpositioned, in four of these cases a complication was suspected. The wire guide was twisted in all of these cases. The procedure was considered of medium or high difficulty in four of the five malpositioned catheters, in contrast a medium or highly difficult case was considered only in 13 of the 90 well positioned catheters (p < 0.05). The time employed for the catheters installation was significantly higher for the malpositioned catheters. In 29.5% of the cases the operator considered a chest X-ray necessary, 2/3 of the cases did not have a well founded clinical suspicion of complication. We conclude that routine chest X-ray after installation of a jugular catheter for hemodialysis has a low diagnostic value for the detection of complications derived from the procedure and should be ordered only when clinical features suggest a complication.
胸部X光检查一直被常规用于评估为血液透析而安装的导管可能出现的并发症。本研究的目的是评估常规胸部X光检查在检测经颈静脉通路安装临时导管所引发并发症方面的效用。我们前瞻性地研究了95根连续用于血液透析的颈静脉导管。安装后，操作人员回答了一份问卷，问卷询问了操作细节以及他对于在每个具体病例中通过胸部X光检查检测并发症效用的看法。对每位患者都进行了胸部X光检查并进行盲法分析。出现了17例轻微并发症：7例动脉穿刺、5例颈部血肿和5例导管位置不当。未发现严重并发症。需要三次或更多次穿刺的导管中有60%出现了并发症，而需要两次或更少次穿刺的导管中只有10%出现并发症（p<0.05）。有5次导管位置不当，其中4例怀疑有并发症。在所有这些病例中导丝都发生了扭曲。在5根位置不当的导管中有4根该操作被认为难度为中等或高难度，相比之下，在90根位置良好的导管中只有13根被认为是中等或高难度病例（p<0.05）。位置不当的导管安装所用时间明显更长。在29.5%的病例中操作人员认为有必要进行胸部X光检查，其中三分之二的病例并无对并发症有充分根据的临床怀疑。我们得出结论，为血液透析安装颈静脉导管后进行常规胸部X光检查对于检测该操作引发的并发症诊断价值较低，只有在临床特征提示有并发症时才应安排检查。
