McIntosh B B, Dulchavsky S A
Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan.
Crit Care Clin. 1992 Oct;8(4):807-18.
Critically ill patients who are not candidates for percutaneously placed arterial and venous lines require surgical cutdown. Although significant complications may arise from inadvertent injury to the vessel or associated structures during arterial and venous cutdown, these complications can be minimized by meticulous technique. With attention to site selection and catheter care, the useful life of these complex catheters approaches that of percutaneously placed devices. Finally, although the sequelae of placement by these techniques--including wound and catheter infection, distal ischemia, and vessel ligation--are increased, the need for appropriate intravascular access in these patients far outweighs the potential risks.
对于不适合经皮放置动静脉导管的重症患者，需要进行外科切开置管。尽管在动静脉切开置管过程中，因意外损伤血管或相关结构可能会引发严重并发症，但通过细致的操作技术可将这些并发症降至最低。注意部位选择和导管护理，这些复杂导管的使用寿命接近经皮放置装置。最后，尽管通过这些技术置管的后遗症（包括伤口和导管感染、远端缺血和血管结扎）会增加，但这些患者对合适血管内通路的需求远远超过潜在风险。
