García-Galiana E, Sanchis-Gil V, Martínez-Navarrete M Á
Servicio de Anestesiología y Reanimación, Fundación Instituto Valenciano de Oncología (FIVO), Valencia, España.
Servicio de Anestesiología y Reanimación, Fundación Instituto Valenciano de Oncología (FIVO), Valencia, España.
Rev Esp Anestesiol Reanim. 2015 Mar;62(3):157-60. doi: 10.1016/j.redar.2014.04.012. Epub 2014 Jun 12.
Central venous catheterization is a very common technique, although its complications can be multiple and sometimes fatal. A case is presented of cardiac tamponade by parenteral nutrition a few hours after moving a central venous catheter peripherally inserted a few days before. The diagnosis was made by echocardiography, and an emergency pericardiocentesis was performed, achieving complete recovery of the patient. Peripherally inserted central venous catheters are more likely to change their position secondary to the movements of the patient's arm, thus it is important to use soft catheters, make sure the tip lies above the carina to avoid perforation of the pericardial reflexion, and fix it well to the skin. Diagnosis must be made as soon as possible, given the high mortality rate of this complication, and the essential diagnostic tool is echocardiography. Elective treatment consists of early catheter withdrawal and emergency pericardiocentesis.
中心静脉置管是一种非常常见的技术，尽管其并发症可能多种多样，有时甚至会致命。本文介绍了一例患者，其在数天前外周置入的中心静脉导管移位后数小时，因肠外营养导致心脏压塞。通过超声心动图做出诊断，并进行了紧急心包穿刺术，患者完全康复。外周置入中心静脉导管更易因患者手臂活动而改变位置，因此使用柔软导管、确保导管尖端位于隆突上方以避免心包折返处穿孔并将其妥善固定于皮肤上非常重要。鉴于该并发症的高死亡率，必须尽快做出诊断，而超声心动图是重要的诊断工具。选择性治疗包括早期拔除导管和紧急心包穿刺术。
