Skandalos I, Hatzibaloglou A, Evagelou I, Ntitsias T, Samaras A, Visvardis G, Mavromatidis K, Karamoshos K
Second Surgical Department, General Hospital Papageorgiou, Thessaloniki, Greece.
Int J Artif Organs. 2005 Jun;28(6):583-90. doi: 10.1177/039139880502800607.
Fourteen cases of malposition of a permanent central vein catheter for hemodialysis or poor blood flow associated with thrombosed central veins but correct catheter positioning, in 13 patients suffering from end stage renal disease, presented from September 1991 to December 2003 among 385 permanent central vein catheters for hemodialysis (3.6%). There were 8 episodes of catheter tip malplacement in the azygos vein (1 case), hemiazygos vein (1), left internal thoracic (mammalian) vein (1), contralateral innominate vein (5) and 6 cases with correct anatomical catheter tip placement but with blood inflow from the catheter through the collateral vein system because of thrombosis of a major vein trunk (hemiazygos vein system (2), azygos vein (2), ascending lumbar veins (1), or portal vein system (1)). The malposition was diagnosed using roentgenography, with or without contrast, and computer tomography. In 3 cases the catheter was removed, in 5 cases the position was corrected. In the remaining 6 cases its function was maintained using anticoagulation or/and thrombolytic therapy. In conclusion, the placement of a permanent central vein catheter for hemodialysis must be followed by simple or contrast medium x-ray evaluation of its correct position or function. The malposition must be corrected whereas in the case where there is no alternative solution the function of the catheter may be maintained in the incorrect position using a combination of anticoagulation or/and thrombolytic therapy.
1991年9月至2003年12月期间，在385根用于血液透析的永久性中心静脉导管中，有14例出现位置不当或血流不佳的情况（占3.6%），这些情况与中心静脉血栓形成有关，但导管位置正确。13例终末期肾病患者中，有8例导管尖端误置于奇静脉（1例）、半奇静脉（1例）、左胸廓内（乳房）静脉（1例）、对侧无名静脉（5例）；还有6例导管尖端解剖位置正确，但由于主要静脉干（半奇静脉系统（2例）、奇静脉（2例）、腰升静脉（1例）或门静脉系统（1例））血栓形成，导致血液通过侧支静脉系统从导管流入。通过有或无造影剂的X线摄影及计算机断层扫描诊断出位置不当。3例导管被拔除，5例位置得到纠正。其余6例通过抗凝或/和溶栓治疗维持其功能。总之，放置用于血液透析的永久性中心静脉导管后，必须通过简单或造影剂X线评估其正确位置或功能。位置不当必须纠正，而在没有其他解决办法的情况下，可使用抗凝或/和溶栓治疗相结合的方法在不正确的位置维持导管功能。
