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肾静脉内导管位置异常——一种与外周静脉穿刺中心静脉置管相关的罕见并发症

[Catheter malposition in the renal vein--a rare complication related to a peripherally inserted central catheter].

作者信息

Josiak Krystian, Mysiak Andrzej, Kobusiak-Prokopowicz Małgorzata, Ciesielska Agnieszka, Kurcz Jacek

机构信息

Katedra i Klinika Kardiologii, Akademia Medyczna, ul. Wybrzeze Ludwika Pasteura 4, 50-361 Wrocław, Poland.

出版信息

Kardiol Pol. 2007 Aug;65(8):982-4.

Abstract

In cardiology intensive care units central venous access is often needed for intravenous infusion of multiple strong acting or hypertonic therapeutic agents such as catecholamines, antibiotics, kalium chloride solutions or parenteral nutrition, as well as for central venous pressure measurements. Currently, access devices include centrally inserted central venous catheters (CVC) and peripherally inserted central venous catheters (PICC). Because of the relative ease of placement, reduced rates of severe complications, such as pneumothorax, great vessel perforation or bleeding, and lower costs in comparison to CVCs, PICCs have been widely used. The PICC has risks, however, with the most frequently occurring complications being catheter malposition followed sometimes by thrombosis, infection or even perforation of the vessel. We present a case of an uncomplicated unsatisfactory location of the catheter tip in the right renal vein, found accidentally during chest angio-CT. Although PICCs are considered to be safe and easy to insert, the proper catheter tip placement is highly unreliable and should be carefully assessed.

摘要

在心脏病重症监护病房,通常需要进行中心静脉置管,以便静脉输注多种强效或高渗治疗药物,如儿茶酚胺、抗生素、氯化钾溶液或肠外营养制剂,同时也用于测量中心静脉压。目前,置管设备包括中心静脉导管(CVC)和外周静脉穿刺中心静脉导管(PICC)。由于PICC相对易于放置,严重并发症(如气胸、大血管穿孔或出血)的发生率较低,且与CVC相比成本更低,因此已被广泛应用。然而,PICC也存在风险,最常见的并发症是导管位置不当,有时随后会出现血栓形成、感染甚至血管穿孔。我们报告一例在胸部血管CT检查时意外发现的导管尖端位于右肾静脉且无并发症的不满意位置的病例。尽管PICC被认为安全且易于插入,但导管尖端的正确放置高度不可靠,应仔细评估。

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