Lux E A
Abteilung für Anaesthesiologie und Intensivtherapie, Kreiskrankenhauses Wolfen.
Zentralbl Chir. 1992;117(8):427-31.
We introduced in the years 1984-1989 317 central venous catheters. Our results and conclusions for using those catheters in smaller hospitals are described.
4 physicians inserted under standardized conditions 317 central venous catheters in the intensive care unit using the transmuscular way for puncturing the V. jugularis interna and the infraclavicular way for puncturing the V. subclavia.
Puncturing the V. basilica complications were not registered. By the V. subclavia route a Pneumothorax rate of 1.7% and an arterial puncture rate of 4.1% were found compared with a 4% arterial puncture rate using the V. jugularis interna. We couldn't find the V. subclavia in 3.4% and the V. jugularis interna in 8%. The complication rate decreased with increasing experience of the physicians. The positions of the catheters in the venous system were not appropriate in 46.9% of the cases after puncture of the V. basilica and in 1.3% after puncture of V. subclavia. Wrong catheter positions were not found after puncturing the V. jugularis interna. Complications as thrombophlebitis were observed in 6.5% after puncturing the V. basilica and 1.1% of the cases after V. subclavia puncture.
Central venous catheters can be safely used also in smaller hospitals if applied by a standardized method. A limited team of physicians can get enough experiences also in a slight number of patients, so that complication rates as low as in international statistics were found.
1984年至1989年期间，我们共置入了317根中心静脉导管。本文描述了在小型医院使用这些导管的结果和结论。
4名医生在标准化条件下，于重症监护病房采用经肌间途径穿刺颈内静脉和锁骨下途径穿刺锁骨下静脉的方法，置入了317根中心静脉导管。
未记录到穿刺贵要静脉的并发症。经锁骨下静脉途径，气胸发生率为1.7%，动脉穿刺率为4.1%；而经颈内静脉途径的动脉穿刺率为4%。我们发现3.4%的患者未找到锁骨下静脉，8%的患者未找到颈内静脉。并发症发生率随着医生经验的增加而降低。穿刺贵要静脉后，46.9%的病例导管在静脉系统中的位置不合适；穿刺锁骨下静脉后，这一比例为1.3%。穿刺颈内静脉后未发现导管位置错误。穿刺贵要静脉后，6.5%的病例出现血栓性静脉炎等并发症；穿刺锁骨下静脉后，这一比例为1.1%。
如果采用标准化方法应用中心静脉导管，在小型医院也可安全使用。有限的医生团队即使在少量患者中也能积累足够的经验，从而使并发症发生率与国际统计数据相当低。
