Wadełek Jacek, Drobiński Dominik, Szewczyk Piotr, Abbas Fouad, Franczyk Marzena, Niewińska Monika, Majstrak Franciszek, Gałazka Zbigniew, Kański Andrzej
II Klinika Anestezjologii i Intensywnej Terapii Warszawskiego UM.
Anestezjol Intens Ter. 2009 Apr-Jun;41(2):110-3.
Reliable temporary vascular access is necessary for haemodialysis when the establishment of permanent access is not possible. Double-lumen catheters are favoured in most cases. These catheters are commonly inserted percutaneously using anatomic landmarks, but the technique is far from being perfect and serious complications may occur during the procedure. We describe a serious and potentially lethal complication of internal jugular venous cannulation.
A 50-year-old woman was transferred from another hospital because of misplacement of a tunnelled permanent haemodialysis catheter and internal bleeding. A computed tomographic angiogram of the chest revealed that the catheter had migrated to the mediastinum. Emergency surgery with cardiopulmonary bypass was performed, the catheter removed, and the damaged left internal jugular and right subclavian veins were reconstructed.
Migration of a dialysis catheter outside the vascular bed is a potentially lethal complication. Removal of a misplaced catheter may lead to massive uncontrolled bleeding and should be managed surgically.
当无法建立永久性血管通路时，可靠的临时血管通路对于血液透析是必要的。在大多数情况下，双腔导管更受青睐。这些导管通常通过使用解剖标志经皮插入，但该技术远非完美，并且在操作过程中可能会发生严重并发症。我们描述了一例颈内静脉插管的严重且可能致命的并发症。
一名50岁女性因隧道式永久性血液透析导管误置和内出血从另一家医院转诊而来。胸部计算机断层血管造影显示导管已迁移至纵隔。进行了体外循环下的急诊手术，取出导管，并重建了受损的左颈内静脉和右锁骨下静脉。
透析导管迁移至血管床外是一种潜在的致命并发症。取出误置的导管可能导致大量无法控制的出血，应通过手术处理。
