Le Noel Anne, Goffrais Martine, Almayrac Agnès, Riou Bruno, Langeron Olivier, Raux Mathieu
Departments of aAnaesthesiology and Critical Care bEmergency Medicine and Surgery, Pitié Salpêtrière University Hospital cFaculty of Medicine, Pierre et Marie Curie University dVygon, Paris, France.
Eur J Emerg Med. 2015 Aug;22(4):260-5. doi: 10.1097/MEJ.0000000000000145.
Despite now being rarely used in the prehospital and emergency department arena because of their excessive length and low inner diameter, narrow-bore central venous catheters (CVC) are sometime used to perform fluid resuscitation using a rapid infusion pump to enhance delivered flow. In this bench study, we tested the hypothesis that the delivered flow rate downstream from the catheter connected to a rapid infusion pump would be significantly lower than the preset flow rate, and this difference would be affected by the catheter size.
Eight units of each type of catheter [two 15 and 20 cm narrow-bore CVC and three 14, 16 and 18 G peripheral venous catheters (PVC)] were connected to a rapid infusion device and were tested with physiological saline. Measurements were repeated using glycerol solution with a viscosity similar to that of packed red blood cells. Infusion pump flow rates were preset to 100, 200, 300 and 400 ml/min. Flow rates were measured downstream from catheters, each connected to a rapid infusion device.
The downstream flow rate remained lower than the preset flow rate except with the 14 and the 16 G PVC at 100 ml/min (P<0.001). The type of catheter significantly impacted the flow rates measured with physiological saline (F4,105=1008.83, P<0.001) and glycerol solution (F4,105=1843.46, P<0.001).
Using a rapid infusion device, the delivered flow rate was lower than the preset flow rate. Even PVCs are better than narrow-bore CVC, neither is the most suitable cannula for patients requiring massive resuscitation.
尽管由于其长度过长和内径较小，窄孔中心静脉导管（CVC）如今很少在院前和急诊科使用，但有时仍会使用快速输液泵来进行液体复苏以提高输注流量。在这项实验台研究中，我们检验了以下假设：连接到快速输液泵的导管下游的输送流速将显著低于预设流速，并且这种差异会受到导管尺寸的影响。
每种类型的导管各取八根[两根15厘米和20厘米的窄孔CVC以及三根14、16和18G外周静脉导管（PVC）]连接到快速输液装置，并使用生理盐水进行测试。使用粘度与浓缩红细胞相似的甘油溶液重复测量。输液泵流速预设为100、200、300和400毫升/分钟。在连接到快速输液装置的每根导管下游测量流速。
除了14G和16G的PVC在100毫升/分钟时，下游流速仍低于预设流速（P<0.001）。导管类型对用生理盐水（F4,105 = 1008.83，P<0.001）和甘油溶液（F4,105 = 1843.46，P<0.001）测量的流速有显著影响。
使用快速输液装置时，输送流速低于预设流速。即使PVC比窄孔CVC更好，但对于需要大量复苏的患者来说，两者都不是最合适的插管。
