Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, No. 201, Sec. 2, Shipai Road, Taipei 112, Taiwan, Republic of China.
College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China.
Br J Anaesth. 2017 Aug 1;119(2):192-199. doi: 10.1093/bja/aex133.
Central venous catheters (CVCs) are frequently used for monitoring haemodynamic status and rapidly delivering fluid therapy during the peri- and postoperative periods. Indwelling CVCs are typically used 7-14 days postoperatively for additional monitoring and treatment, but patients may develop asymptomatic catheter-related thrombosis, leading to life-threatening pulmonary embolism and death. Early detection helps to avoid such complications.
This prospective observational study investigated the risk factors associated with catheter-related right internal jugular vein thrombosis in patients undergoing chest surgery. The study enrolled 24 patients who were scheduled to receive chest surgeries during which catheters were needed. To detect thrombus formation, Doppler ultrasound examinations from the thyroid cartilage level to the supraclavicular region were used after CVC placement and on each of the following days until the catheter was removed.
No thrombosis was found in patients before surgery, but it appeared in 75% (18/24) after surgery. The risks of thrombosis increased with a longer duration of anaesthesia, greater amounts of bleeding, and use of postoperative ventilator support.
Earlier catheter removal may reduce the risk of catheter-related thrombosis and avoid possibly fatal complications after catheter-related thrombosis.
中心静脉导管（CVC）常用于监测围手术期血流动力学状态，并快速进行液体治疗。术后通常留置 CVC 7-14 天以进行额外监测和治疗，但患者可能会出现无症状的导管相关血栓形成，导致危及生命的肺栓塞和死亡。早期发现有助于避免此类并发症。
本前瞻性观察研究调查了接受胸部手术的患者与导管相关右颈内静脉血栓形成相关的危险因素。该研究纳入了 24 名计划接受胸部手术且需要置管的患者。在 CVC 放置后以及此后的每一天，直至导管移除，均从甲状软骨水平至锁骨上区域使用多普勒超声检查来检测血栓形成。
术前患者均未发现血栓，但术后有 75%（18/24）的患者出现血栓。血栓形成的风险随着麻醉时间延长、出血量增加以及术后呼吸机支持的使用而增加。
尽早移除导管可能会降低导管相关血栓形成的风险，并避免导管相关血栓形成后可能致命的并发症。
