Qureshi Athar M, Rhodes John F, Appachi Elumulai, Mumtaz Muhammad A, Duncan Brian W, Asnes Jeremy, Radavansky Penny, Latson Larry A
Department of Pediatric and Congenital Heart Disease, The Children's Hospital at the Cleveland Clinic, Cleveland, OH, USA.
Pediatr Crit Care Med. 2007 May;8(3):248-53. doi: 10.1097/01.PCC.0000265327.93745.89.
Critically ill children with cardiac disease often require prolonged central venous access. Thrombosis of systemic veins or the need to preserve vessels for future cardiac procedures limits sites for placement of central venous catheters in these patients. This study evaluates the use of Broviac placement via the transhepatic approach for this patient population.
A retrospective review.
A tertiary care center.
All children with complex congenital heart disease who underwent transhepatic Broviac placement between May 2000 and April 2004.
Transhepatic Broviac placement.
Thirty-two children with a median age of 5 months (20 days-5.3 yrs) and a median weight of 4.2 kg (2.2-24.9 kg) underwent 40 transhepatic Broviac placements. There were three (8.8%) procedural-related complications. One patient suffered an intra-abdominal bleed requiring an urgent laparotomy and removal of the Broviac, one patient required transfusion because of a mild self-contained intra-abdominal bleed, and one patient developed temporary complete heart block. There was one catheter infection. Thrombus was noted by echocardiography on the tip of two Broviacs; however, no intracardiac vegetations or embolic events occurred. There was no mortality related to the procedure. Broviacs remained in place for a median of 36 days (1 day-6 months). Five Broviacs were dislodged inadvertently (two during cardiac massage and three resulting from patient manipulation). The remaining Broviacs were electively removed safely without coil embolization. At a median follow-up of 3.5 months (10 days-3 yrs), there have been no long-term complications related to the Broviacs.
Transhepatic Broviac catheters can be used safely in critically ill children with cardiac disease and remain indwelling for adequate periods of time. This modality of prolonged vascular access should be considered for children whose veins are occluded or need to be preserved for future procedures.
患有心脏病的重症儿童通常需要长期的中心静脉通路。全身静脉血栓形成或为未来心脏手术保留血管的需求限制了这些患者中心静脉导管的放置部位。本研究评估经肝途径放置Broviac导管在这类患者中的应用。
一项回顾性研究。
一家三级医疗中心。
2000年5月至2004年4月期间接受经肝Broviac导管放置术的所有患有复杂先天性心脏病的儿童。
经肝Broviac导管放置术。
32名儿童接受了40次经肝Broviac导管放置术，中位年龄5个月（20天至5.3岁），中位体重4.2千克（2.2至24.9千克）。有3例（8.8%）与操作相关的并发症。1例患者发生腹腔内出血，需要紧急剖腹手术并取出Broviac导管；1例患者因轻度腹腔内自发出血需要输血；1例患者出现暂时性完全性心脏传导阻滞。发生1例导管感染。超声心动图显示2根Broviac导管尖端有血栓形成；然而，未发生心内赘生物或栓塞事件。无与手术相关的死亡病例。Broviac导管中位留置时间为36天（1天至6个月）。5根Broviac导管意外移位（2根在心脏按压期间，3根因患者自行操作）。其余Broviac导管均安全地择期取出，未进行线圈栓塞。中位随访3.5个月（10天至3年），未出现与Broviac导管相关的长期并发症。
经肝Broviac导管可安全用于患有心脏病的重症儿童，并能在适当时间内留置。对于静脉闭塞或需要为未来手术保留静脉的儿童，应考虑采用这种延长血管通路的方式。
