Metz R I, Lucking S E, Chaten F C, Williams T M, Mickell J J
Department of Pediatrics, Children's Medical Center, Medical College of Virginia, Richmond 23298.
Pediatrics. 1990 Apr;85(4):531-3.
The axillary vein was evaluated as an alternative access site for central venous catheterization in critically ill infants and children. Children were placed in the Trendelenberg position (when possible) with arm abducted 100 to 130 degrees. The vein was entered parallel and inferior to the artery. Success rate for catheterization was 79% (41/52). Catheter diameter range was 3 to 8.5 F and catheter length range was 5 to 30.5 cm. Median patient weight was 7.0 kg (3.0 to 59 kg). Median age was 0.91 years (14 days to 9 years). All central lines ended in the subclavian, innominate, or superior vena cava. Median catheter duration was 8 days (2 to 22 days). A total of 338 patient catheter-days were studied. Central venous pressure was successfully monitored in five of five attempts. Complications with insertion (3.8% of attempts) included one pneumothorax and one hematoma. Complications during catheter duration (9.8% of catheters, 1.1% per catheter-day) included one instance each of venous stasis, venous thrombosis, catheter sepsis, and parenteral nutrition infiltration. No complication contributed to a patient mortality. Success and complication rates were comparable with those in jugular catheterization studies in children. The axillary approach is an acceptable route for central venous catheterization in critically ill infants and children.
对危重症婴幼儿及儿童，评估了腋静脉作为中心静脉置管的替代穿刺部位。患儿（尽可能）置于头低脚高位，手臂外展100至130度。在动脉平行且下方进针穿刺静脉。置管成功率为79%（41/52）。导管直径范围为3至8.5F，导管长度范围为5至30.5cm。患者中位体重为7.0kg（3.0至59kg）。中位年龄为0.91岁（14天至9岁）。所有中心静脉导管均终止于锁骨下静脉、无名静脉或上腔静脉。导管中位留置时间为8天（2至22天）。共研究了338个患者导管日。5次尝试中有5次成功监测到中心静脉压。置管相关并发症（占尝试次数的3.8%）包括1例气胸和1例血肿。导管留置期间的并发症（占导管的9.8%，每导管日1.1%）包括静脉淤滞、静脉血栓形成、导管败血症和肠外营养渗漏各1例。无并发症导致患者死亡。成功率和并发症发生率与儿童颈内静脉置管研究中的结果相当。腋静脉入路是危重症婴幼儿及儿童中心静脉置管的一种可接受途径。
