Al-Hwiesh Abdulla K, Abdul-Rahaman Ibrahiem Saeed
Department of Internal Medicine, Nephrology Division, King Fahd Hospital of the University, King Faisal University, Al-Khobar, Saudi Arabia.
Saudi J Kidney Dis Transpl. 2007 Mar;18(1):37-42.
Femoral veins have been used for decades to position temporary hemodialysis catheters. Few reports, however, describe its use for permanent vascular access. This study describes the use of tunneled femoral vein catheters as permanent vascular accesses. Fourteen chronic hemodialysis patients (nine males and five females) had tunneled central venous catheters placed in the femoral vein from November 2004 to July 2005. The age of the patients ranged from 21 to 68 years with a mean of 49.8 +/- 5.9 years. Placement of a catheter via the internal jugular veins was impossible in 10 patients whose course was complicated by thrombosis or strictures of the superior vena cava. The remaining four patients had exhausted conventional access sites. The insertion of the femoral catheters involved a subcutaneous tunnel that was created by retrograde passage of the catheter through the cannula to the point of exit at a preselected site in the ipsilateral thigh away from the groin. The life span of the tunneled femoral catheter ranged between 32-240 days; median time in place was 182 days. There were four incidences of tunnel infection with Pseudomonas aeruginosa, E. coli, and Streptococcus epidermidis, which were treated successfully without the need for catheter removal. Other complications such as bleeding, kinking, migration of the catheter, arterial puncture, retroperitoneal or femoral hematomas were not observed. We conclude that tunneled femoral catheters are suitable alternatives for long-term hemodialysis access. Additional studies with a greater sample size are needed to confirm this conclusion.
几十年来，股静脉一直被用于放置临时血液透析导管。然而，很少有报告描述其用于永久性血管通路的情况。本研究描述了带隧道的股静脉导管作为永久性血管通路的应用。2004年11月至2005年7月，14例慢性血液透析患者（9例男性和5例女性）在股静脉置入了带隧道的中心静脉导管。患者年龄在21至68岁之间，平均年龄为49.8±5.9岁。1名患者因上腔静脉血栓形成或狭窄导致颈内静脉置管困难，其余4例患者常规血管通路已用尽。股静脉导管的置入包括一个皮下隧道，通过将导管逆行穿过套管到达同侧大腿远离腹股沟的预选出口点来创建。带隧道的股静脉导管的使用寿命在32至240天之间；中位留置时间为182天。有4例发生隧道感染，病原菌为铜绿假单胞菌、大肠杆菌和表皮葡萄球菌，经治疗成功，无需拔除导管。未观察到其他并发症，如出血、导管扭曲、移位、动脉穿刺、腹膜后或股部血肿。我们得出结论，带隧道的股静脉导管是长期血液透析通路的合适替代方案。需要更多样本量的进一步研究来证实这一结论。
