Cho Jin-Beom, Park Il-Young, Sung Ki-Young, Baek Jong-Min, Lee Jun-Hyun, Lee Do-Sang
Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea.
J Korean Surg Soc. 2013 Nov;85(5):244-7. doi: 10.4174/jkss.2013.85.5.244. Epub 2013 Oct 25.
Subclavian venous catheterization was once widely used for volume resuscitation, emergency venous access, chemotherapy, parenteral nutrition, and hemodialysis. However, its use has drastically reduced recently because of life-threatening complications such as hemothorax, pneumothorax. In this case, a patient admitted for a scheduled operation underwent right subclavian venous catheterization for preoperative, intraoperative, and postoperative volume resuscitation and parenteral nutrition. The procedure was performed by an experienced senior resident. Despite detecting slight resistance during the guidewire insertion, the resident continued the procedure to the point of being unable to advance or remove it, then attempted to forcefully remove the guidewire, but it broke and became entrapped within the thorax. We tried to remove the guidewire through infraclavicular skin incision but failed. So video-assisted thoracoscopic surgery was used to remove the broken guidewire. This incident demonstrates the risks of subclavian venous catheterization and the importance of using a proper and gentle technique.
锁骨下静脉置管曾经广泛用于容量复苏、紧急静脉通路建立、化疗、肠外营养及血液透析。然而，由于诸如血胸、气胸等危及生命的并发症，其使用近来已大幅减少。在本病例中，一名因择期手术入院的患者接受了右锁骨下静脉置管，用于术前、术中和术后的容量复苏及肠外营养。该操作由一名经验丰富的高年住院医师进行。尽管在插入导丝过程中察觉到轻微阻力，该住院医师仍继续操作，直至无法推进或拔出导丝，随后试图强行拔出导丝，但导丝断裂并陷入胸腔。我们试图通过锁骨下皮肤切口取出导丝，但未成功。于是采用电视辅助胸腔镜手术取出断裂的导丝。这一事件表明了锁骨下静脉置管的风险以及采用恰当且轻柔技术的重要性。
