Postel J P, Quintard J M, Ricard J, Delaplace R, Bernard F, Canarelli J P
Département d'Anesthésie-Réanimation B, CHRU d'Amiens.
Chir Pediatr. 1990;31(4-5):219-22.
Since 1977, the authors have performed 708 percutaneous catheterizations of superior vena cava in pediatric patients (from premature infant of 15 year old children). The greater part of these catheterizations concerns the internal jugular vein. Subclavian catheterization was rapidly abandoned because it is judged too dangerous in children. The evolution of the quality of materials, and the increasing technical experience of operators, both allowed to enlarge indications of percutaneous catheterization. That suppose a nearly total suppression of mechanical and infectious complications. The analysis of 7 severe vascular injuries in 445 patients made the authors change their technics and apply a very strict method: choice of a frontal access to internal jugular vein; catheterization performed in operating room, under anesthesia; percutaneous puncture with a lew diameter short catheter (external diameter: 9/10 mm); Seldinger technic and radioscopy; silicone catheters with or without a cuff, systematic tunellisation; operators having a very good practice of venous access in children. The analysis of the three last years shows no immediate mechanical complication and very little infections among 263 catheterizations.
自1977年以来，作者已对小儿患者（从早产儿到15岁儿童）进行了708次经皮上腔静脉插管。这些插管大部分涉及颈内静脉。锁骨下静脉插管很快就被放弃了，因为它在儿童中被认为过于危险。材料质量的改进以及操作人员技术经验的增加，都使得经皮插管的适应证得以扩大。这几乎完全消除了机械性和感染性并发症。对445例患者中7例严重血管损伤的分析促使作者改变了技术并采用了非常严格的方法：选择经前路进入颈内静脉；在手术室麻醉下进行插管；使用小直径短导管（外径：9/10毫米）进行经皮穿刺；采用Seldinger技术并进行透视；使用有或无袖套的硅胶导管，进行系统性隧道化；操作人员要非常熟练地进行儿童静脉穿刺。对最近三年的分析显示，在263次插管中没有立即出现机械性并发症，感染也很少。
