Hong Joon H
Department of Surgery, State University of New York, Downstate Medical Center, New York 11203, USA.
J Vasc Access. 2010 Jan-Mar;11(1):59-62. doi: 10.1177/112972981001100112.
Central venous catheters are currently used for long-term hemodialysis (HD) in a large number of patients. When the catheter needs to be removed, the removal is usually achieved without difficulty after dissection of the cuff from the tunnel. However, when the catheter is stuck in the central vein, the removal becomes complex or unsuccessful. Herein, a simple and easy technique is described for the removal of an HD catheter stuck in the central vein.
Attempts were made to remove an HD catheter from a 65-year-old male by making an incision in the skin over the exit site of the catheter to dissect the cuff from the tunnel and by pulling the catheter, but without success because the catheter was stuck in the central vein. Through a second skin incision in the neck, the subcutaneous portion of the catheter was retrieved from the tunnel and then an introducer sheath was inserted over the catheter into the internal jugular vein while the catheter was held in place. The sheath was advanced around the catheter into the central vein. The catheter was then easily pulled out from the central vein.
The reported cases of stuck catheters in the literature were reviewed to acknowledge the difficulties encountered in the removal attempts. The technique described herein can be used for the removal of a variety of catheters and wires stuck in the central vein.
目前，大量患者在长期血液透析（HD）时使用中心静脉导管。当需要拔除导管时，通常在将袖套从隧道中分离后，拔除过程并不困难。然而，当导管卡在中心静脉时，拔除就会变得复杂或失败。在此，描述了一种简单易行的技术，用于拔除卡在中心静脉的血液透析导管。
尝试通过在导管出口部位的皮肤上做切口，将袖套从隧道中分离并牵拉导管，从一名65岁男性身上拔除血液透析导管，但未成功，因为导管卡在了中心静脉。通过在颈部做第二个皮肤切口，从隧道中取出导管的皮下部分，然后在固定导管的同时，将引导鞘套在导管上插入颈内静脉。将鞘套沿导管推进至中心静脉。然后，导管很容易就从中心静脉中拔出。
回顾了文献中报道的导管卡住的病例，以了解拔除尝试中遇到的困难。本文所述技术可用于拔除卡在中心静脉的各种导管和导丝。
