Choron Rachel L, Wang Andrew, Van Orden Kathryn, Capano-Wehrle Lisa, Seamon Mark J
Division of Trauma Surgery, Department of Surgery, Cooper University Hospital and Cooper Medical School at Rowan University, Camden, New Jersey, USA.
Am Surg. 2015 May;81(5):527-31. doi: 10.1177/000313481508100538.
Central venous catheterization (CVC) is often necessary during initial trauma resuscitations, but may cause complications including catheter-related blood stream infection (CRBSI), deep venous thrombosis (DVT), pulmonary emboli (PE), arterial injury, or pneumothoraces. Our primary objective compared subclavian versus femoral CVC complications during initial trauma resuscitations. A retrospective review (2010-2011) at an urban, Level-I Trauma Center reviewed CVCs during initial trauma resuscitations. Demographics, clinical characteristics, and complications including: CRBSIs, DVTs, arterial injuries, pneumothoraces, and PEs were analyzed. Fisher's exact test and Student's t test were used; P ≤ 0.05 was considered statistically significant. Overall, 504 CVCs were placed (subclavian, n = 259; femoral, n = 245). No difference in age (47 ± 22 vs 45 ± 23 years) or body mass index (28 ± 6 vs 29 ± 16 kg/m(2)) was detected (P > 0.05) in subclavian vs femoral CVC, but subclavian CVCs had more blunt injuries (81% vs 69%), greater systolic blood pressure (95 ± 55 vs 83 ± 43 mmHg), greater Glasgow Coma Scale (10 ± 5 vs 9 ± 5), and less introducers (49% vs 73%) than femoral CVCs (all P < 0.05). Catheter related arterial injuries, PEs, and CRBSIs were similar in subclavian and femoral groups (3% vs 2%, 0% vs 1%, and 3% vs 3%; all P > 0.05). Catheter-related DVTs occurred in 2 per cent of subclavian and 9 per cent of femoral CVCs (P < 0.001). There was a 3 per cent occurrence of pneumothorax in the subclavian CVC population. In conclusion, both subclavian and femoral CVCs caused significant complications. Subclavian catheter-related pneumothoraces occurred more commonly and femoral CRBSIs less commonly than expected compared with prior literature in nonemergent scenarios. This suggests that femoral CVC may be safer than subclavian CVC during initial trauma resuscitations.
在初始创伤复苏期间，中心静脉置管（CVC）常常是必要的，但可能会引发包括导管相关血流感染（CRBSI）、深静脉血栓形成（DVT）、肺栓塞（PE）、动脉损伤或气胸等并发症。我们的主要目的是比较初始创伤复苏期间锁骨下静脉置管与股静脉置管的并发症情况。对一家城市一级创伤中心2010 - 2011年期间初始创伤复苏时的CVC进行回顾性研究。分析了人口统计学、临床特征以及并发症，包括CRBSI、DVT、动脉损伤、气胸和PE。采用Fisher精确检验和学生t检验；P≤0.05被认为具有统计学意义。总体而言，共置入504根CVC（锁骨下静脉置管，n = 259；股静脉置管，n = 245）。锁骨下静脉置管与股静脉置管在年龄（47±22岁对45±23岁）或体重指数（28±6对29±16 kg/m²）方面未检测到差异（P>0.05），但锁骨下静脉置管钝性损伤更多（81%对69%），收缩压更高（95±55对83±43 mmHg），格拉斯哥昏迷量表评分更高（10±5对9±5），且使用引导器的比例更低（49%对73%），均与股静脉置管存在差异（所有P<0.05）。锁骨下静脉组与股静脉组导管相关动脉损伤、PE和CRBSI情况相似（3%对2%、0%对1%、3%对3%；所有P>0.05）。锁骨下静脉置管中导管相关DVT发生率为2%，股静脉置管中为9%（P<0.001）。锁骨下静脉置管人群中气胸发生率为3%。总之，锁骨下静脉置管和股静脉置管均会引发显著并发症。与既往非紧急情况下的文献相比，锁骨下静脉导管相关气胸的发生更为常见，而股静脉CRBSI的发生比预期更为少见。这表明在初始创伤复苏期间，股静脉置管可能比锁骨下静脉置管更安全。
