Abram J, Klocker J, Innerhofer-Pompernigg N, Mittermayr M, Freund M C, Gravenstein N, Wenzel V
Univ.-Kinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, 6020, Innsbruck, Österreich.
Univ.-Klinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich.
Anaesthesist. 2016 Nov;65(11):866-871. doi: 10.1007/s00101-016-0226-8.
Injuries to blood vessels near the heart can quickly become life-threatening and include arterial injuries during central venous puncture, which can lead to hemorrhagic shock. We report 6 patients in whom injury to the subclavian artery and vein led to life-threatening complications. Central venous catheters are associated with a multitude of risks, such as venous thrombosis, air embolism, systemic or local infections, paresthesia, hemothorax, pneumothorax, and cervical hematoma, which are not always immediately discernible. The subclavian catheter is at a somewhat lower risk of catheter-associated sepsis and symptomatic venous thrombosis than approaches via the internal jugular and femoral veins. Indeed, access via the subclavian vein carries a substantial risk of pneumo- and hemothorax. Damage to the subclavian vein or artery can also occur during deliberate and inadvertent punctures and result in life-threatening complications. Therefore, careful consideration of the access route is required in relation to the patient and the clinical situation, to keep the incidence of complications as low as possible. For catheterization of the subclavian vein, puncture of the axillary vein in the infraclavicular fossa is a good alternative, because ultrasound imaging of the target vessel is easier than in the subclavian vein and the puncture can be performed much further from the lung.
心脏附近血管的损伤可迅速危及生命，包括中心静脉穿刺时的动脉损伤，这可能导致失血性休克。我们报告了6例锁骨下动静脉损伤导致危及生命并发症的患者。中心静脉导管存在多种风险，如静脉血栓形成、空气栓塞、全身或局部感染、感觉异常、血胸、气胸和颈部血肿，这些并不总是能立即被察觉。锁骨下导管发生导管相关败血症和有症状静脉血栓形成的风险比经颈内静脉和股静脉途径略低。事实上，经锁骨下静脉置管有发生气胸和血胸的重大风险。在有意和无意穿刺过程中也可能发生锁骨下静脉或动脉损伤，并导致危及生命的并发症。因此，需要根据患者情况和临床状况仔细考虑穿刺途径，以尽可能降低并发症的发生率。对于锁骨下静脉置管，在锁骨下窝穿刺腋静脉是一个很好的替代方法，因为对目标血管进行超声成像比对锁骨下静脉更容易，而且穿刺点可以离肺部更远。
