Murr M M, Rosenquist M D, Lewis R W, Heinle J A, Kealey G P
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242.
J Burn Care Rehabil. 1991 Nov-Dec;12(6):576-8. doi: 10.1097/00004630-199111000-00014.
A prospective study was undertaken to determine the safety of femoral vein catheterization in patients with burns. Forty-two patients had a total of 275 catheterizations and were divided into two groups: group 1, femoral vein catheterization = 80 catheters and group 2, nonfemoral vein catheterization = 195 catheters (180 subclavian, 8 internal jugular, and 7 supraclavicular). All catheters were changed to new sites every 48 hours, and dressings were changed every 24 hours. Bacteriologic surveillance was accomplished by submitting the tip and subcutaneous segment of the catheter for semiquantitative cultures. Skin exit-site cultures were obtained, and blood was drawn through the catheters for fungal-isolator cultures before removal. Catheter colonization was defined as greater than or equal to 5 colony-forming units on either the subcutaneous segment or the catheter tip. Catheter-related sepsis was diagnosed when the same organism was recovered from the fungal isolator bottle and either part of the catheter and when there was no other identifiable source of sepsis. The rate of occurrence of colonized catheters was 7.5% (6 of 80) in the femoral vein catheterization group and 13.8% (27 of 195) in the nonfemoral vein catheterization group. Catheter-related sepsis occurred in 2.5% (2 of 80) of femoral and 1% (2 of 195) of nonfemoral catheters. None of these differences are statistically significant. There were no noninfectious complications from femoral vein catheterization. Two subclavian catheters had to be repositioned. This study suggests that central venous access in patients with burns can be safely employed with the use of the femoral vein.
开展了一项前瞻性研究，以确定烧伤患者股静脉置管的安全性。42例患者共进行了275次置管，并分为两组：第1组，股静脉置管80次；第2组，非股静脉置管195次（180次锁骨下静脉置管、8次颈内静脉置管和7次锁骨上静脉置管）。所有导管每48小时更换至新部位，敷料每24小时更换。通过提交导管尖端和皮下段进行半定量培养来完成细菌学监测。获取皮肤出口部位培养物，并在拔除导管前通过导管抽取血液进行真菌隔离培养。导管定植定义为皮下段或导管尖端的菌落形成单位大于或等于5个。当从真菌隔离瓶以及导管的任何一部分中分离出相同的微生物，且没有其他可识别的败血症来源时，诊断为导管相关性败血症。股静脉置管组导管定植发生率为7.5%（80例中的6例），非股静脉置管组为13.8%（195例中的27例）。股静脉导管相关性败血症发生率为2.5%（80例中的2例），非股静脉导管为1%（195例中的2例）。这些差异均无统计学意义。股静脉置管未出现非感染性并发症。两根锁骨下静脉导管需要重新定位。本研究表明，烧伤患者可安全地使用股静脉进行中心静脉置管。
