Cadman A, Lawrance J A L, Fitzsimmons L, Spencer-Shaw A, Swindell R
University of Manchester Medical School, Manchester, UK.
Clin Radiol. 2004 Apr;59(4):349-55. doi: 10.1016/j.crad.2003.11.015.
To establish the relationship between the tip position of tunnelled central venous catheters (CVC) and the incidence of venous thrombosis.
A randomly sampled, retrospective review of 428 CVC inserted into 334 patients was performed. The chest radiograph obtained post-catheter insertion, as well as follow-up radiographs, linograms, venograms and Doppler ultrasounds (US), were reviewed.
The median follow-up was 72 days (range 1-720 days), with a total follow-up of 23,040 line days. Venous thrombosis occurred in five out of 191 (2.6%) CVC in a distal position (distal third of the superior vena cava (SVC) or right atrium (RA)), five of 95 (5.3%) in an intermediate position (middle third of the SVC) and 20 of 48 (41.7%) in a proximal position (proximal third SVC or thoracic inlet veins). There was a significant difference in thrombosis rate between lines sited with the tip in a distal compared with a proximal position (p<0.0005). CVC with tips in a proximal position were 16 times more likely to thrombose than those in a distal position. None of the 58 CVC with the tip located in the RA thrombosed or caused complications.
Distal placement of tunnelled CVC, either in the distal third of the SVC or proximal RA is optimal.
建立隧道式中心静脉导管（CVC）尖端位置与静脉血栓形成发生率之间的关系。
对334例患者插入的428根CVC进行随机抽样回顾性研究。回顾了导管插入后获得的胸部X线片以及随访X线片、线性图、静脉造影和多普勒超声（US）。
中位随访时间为72天（范围1 - 720天），总随访时间为23,040导管日。191根远端位置（上腔静脉（SVC）或右心房（RA）远端三分之一）的CVC中有5根（2.6%）发生静脉血栓形成，95根中间位置（SVC中间三分之一）的CVC中有5根（5.3%）发生，48根近端位置（SVC近端三分之一或胸廓入口静脉）的CVC中有20根（41.7%）发生。导管尖端位于远端与近端位置的血栓形成率有显著差异（p<0.0005）。尖端位于近端位置的CVC发生血栓形成的可能性是远端位置CVC的16倍。58根尖端位于RA的CVC均未发生血栓形成或引起并发症。
隧道式CVC的最佳放置位置是SVC远端三分之一或RA近端。
