Kerr Andrew, Pathalapati Radhika, Qiuhu Shi, Baumstein Donald
Department of Radiology, New York Medical College-Metropolitan Hospital, New York, New York 10029, USA.
J Vasc Interv Radiol. 2008 Aug;19(8):1176-9. doi: 10.1016/j.jvir.2008.04.027.
To determine whether placing a purse-string suture at the tunnel exit site at the time of tunneled dialysis catheter (TDC) insertion will decrease postprocedural bleeding.
In a retrospective single-center, single-operator study, 51 patients in the control group had TDCs inserted without purse-string sutures at the tunnel exit site and 50 patients in the experimental group had TDCs inserted with purse-string sutures at the tunnel exit site. The patients' charts were evaluated for postprocedural progress notes describing bleeding, plasma hemoglobin levels before and after catheter insertion, and transfusion of packed red blood cells in the first 5 days after catheter insertion.
Thirteen patients in the control group (25.4%) and three patients in the experimental group (6%) had postprocedural chart notes describing bleeding. The difference between the two groups was highly significant (P = .0124). Six percent of patients in the control group and none of the patients in the experimental group required prolonged compression or compression dressing placement after catheter insertion. There was a significant mean hemoglobin decrease of 0.3 g/dL after catheter insertion in the control group and an insignificant mean hemoglobin decrease of 0.1 g/dL in the experimental group. The difference in hemoglobin decrease between the two groups was not significant. The difference in the number of patients requiring transfusion in the 5 days after catheter insertion (eight of 51 vs nine of 50) was not significant.
Venous bleeding after TDC insertion is a complication that merits attention. Routine purse-string suture placement at the tunnel exit site is a minor change in standard technique that can nearly eliminate this problem, as reflected in postprocedural chart notes.
确定在置入隧道式透析导管（TDC）时在隧道出口处放置荷包缝合线是否会减少术后出血。
在一项回顾性单中心、单操作者研究中，51例对照组患者在隧道出口处置入TDC时未放置荷包缝合线，50例试验组患者在隧道出口处置入TDC时放置了荷包缝合线。评估患者病历，查看术后病程记录中关于出血的描述、导管置入前后的血浆血红蛋白水平以及导管置入后前5天内浓缩红细胞的输注情况。
对照组有13例患者（25.4%）、试验组有3例患者（6%）的术后病程记录中有出血描述。两组之间的差异具有高度显著性（P = 0.0124）。对照组6%的患者在导管置入后需要长时间压迫或放置压迫敷料，而试验组无患者需要。对照组导管置入后血红蛋白平均显著下降0.3 g/dL，试验组血红蛋白平均下降0.1 g/dL，差异不显著。两组导管置入后5天内需要输血的患者数量差异（51例中的8例对50例中的9例）不显著。
TDC置入后的静脉出血是一种值得关注的并发症。如术后病程记录所示，在隧道出口处常规放置荷包缝合线是标准技术中的一个微小改变，几乎可以消除这个问题。
