Bour E S, Weaver A S, Yang H C, Gifford R R
Department of Surgery, Pennsylvania State University College of Medicine, Hershey 17033.
Surg Gynecol Obstet. 1990 Jul;171(1):33-9.
Transvenous access for acute hemodialysis has advanced recently with the introduction of a double lumen Silastic (silicone rubber), Dacron-cuffed (polyester) catheter (Quinton PermCath), which has a better patient acceptance than the stiff Teflon (polytetrafluoroethylene) catheters. We present our experience with 53 PermCath catheters placed in 49 patients (eight to 80 years old). Twenty-two catheters were used for initiation of dialysis, 17 as a bridge to permanent hemoaccess, two as a bridge to peritoneal dialysis and 12 for chronic hemoaccess. We have achieved better success with insertion of catheters through the jugular system (external in 22 instances and internal in 30) by cutdown with fluoroscopic positioning of the catheter tip at the second to third intercostal space. Arterial port alignment was toward the center of the vena cava to reduce sucking against the caval wall during dialysis. No catheter failed to function with this positioning technique. Average catheter use was 84 days with a range of one to 573 days. Catheter thrombosis occurred 40 times in ten patients and was treated successfully in all with the infusion of streptokinase or urokinase. Four patients received chronic warfarin for repeated clotting. Four patients had catheter sepsis that resolved with removal of the catheter and administration of antibiotics. We conclude that the PermCath is an improved means for hemoaccess with a low complication rate. Our key to successful functioning of the PermCath is careful fluoroscopic positioning of the catheter tip.
随着双腔硅橡胶、涤纶套囊导管（昆顿PermCath）的引入，急性血液透析的经静脉通路近来有了进展，该导管比坚硬的聚四氟乙烯导管更易被患者接受。我们介绍了在49例患者（年龄8至80岁）中放置53根PermCath导管的经验。22根导管用于开始透析，17根作为通向永久性血液通路的桥梁，2根作为通向腹膜透析的桥梁，12根用于慢性血液通路。我们通过经颈静脉系统插入导管（22例为颈外静脉，30例为颈内静脉）并在透视下将导管尖端定位在第二至第三肋间间隙处进行切开，取得了更好的成功率。动脉端口朝向腔静脉中心，以减少透析期间对腔静脉壁的抽吸。采用这种定位技术，没有导管无法发挥作用。导管平均使用时间为84天，范围为1至573天。10例患者发生导管血栓形成40次，所有患者均通过输注链激酶或尿激酶成功治疗。4例患者因反复凝血接受了长期华法林治疗。4例患者发生导管败血症，通过拔除导管并给予抗生素后得以解决。我们得出结论，PermCath是一种并发症发生率低的改进型血液通路手段。我们使PermCath成功发挥作用的关键是在透视下仔细定位导管尖端。
