Dutky P A, Stevens S L, Maull K I
Department of Surgery, University of Tennessee Medical Center, Knoxville 37920.
J Trauma. 1989 Jun;29(6):856-60. doi: 10.1097/00005373-198906000-00025.
Rapid fluid administration is the cornerstone of successful trauma resuscitation. Percutaneous insertion of catheter introducers has gained wide acceptance as a quick and reliable means of rapid intravascular volume expansion. Factors that affect rapid fluid resuscitation with these devices include catheter introducer kinking, the type and temperature of infusate, and diameter of co-apted administration tubing. Rates of flow through 8.5 French catheters from 0 to 80 degrees of catheter angulation were determined in vitro for various fluids (crystalloid, whole blood, diluted packed cells) and administration tubing of different sizes (regular IV tubing, blood tubing, and large-bore trauma tubing). The flow rate of crystalloid infusion through blood tubing was found to be approximately double that of regular IV tubing (316 cc/min vs. 160 cc/min), and trauma tubing had approximately three times the flow rate of blood tubing (805 cc/min). Warmed diluted packed cells could be infused almost twice as fast as cold whole blood (642 cc/min vs. 340 cc/min). Kinking of the catheter introducer, a heretofore poorly described phenomenon, halved the flow rate of fluids through large-bore trauma tubing (805 cc/min vs 350 cc/min) but had no effect when standard IV tubing was utilized. Piggybacking blood into an existing IV line instead of infusing it directly into the catheter can decrease blood flow 94% (340 cc/min vs. 20 cc/min). It is concluded that a large-bore catheter, by itself, does not guarantee high flow rates. Physician recognition of these concepts can result in improved resuscitation of hypovolemic patients.
快速液体输注是成功进行创伤复苏的基石。经皮插入导管导入器作为一种快速且可靠的快速血管内容量扩充方法已被广泛接受。影响使用这些装置进行快速液体复苏的因素包括导管导入器扭结、输注液的类型和温度以及适配的给药管路直径。在体外测定了不同液体（晶体液、全血、稀释红细胞悬液）和不同尺寸给药管路（普通静脉输液管、输血管路和大口径创伤管路）通过8.5法式导管在0至80度导管角度下的流速。发现晶体液通过输血管路的流速约为普通静脉输液管的两倍（316毫升/分钟对160毫升/分钟），而创伤管路的流速约为输血管路的三倍（805毫升/分钟）。温热的稀释红细胞悬液的输注速度几乎是冷全血的两倍（642毫升/分钟对340毫升/分钟）。导管导入器扭结这一此前描述较少的现象使大口径创伤管路中液体的流速减半（805毫升/分钟对350毫升/分钟），但使用标准静脉输液管时则无影响。将血液通过“背驮式”接入现有静脉输液管路而非直接注入导管可使血流减少94%（340毫升/分钟对20毫升/分钟）。得出的结论是，大口径导管本身并不能保证高流速。医生认识到这些概念可改善低血容量患者的复苏效果。
